Steroid-eluting sinus stents for improving symptoms in chronic rhinosinusitis patients undergoing functional endoscopic sinus surgery

Background

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nasal and paranasal sinus mucosa. Although the cause of CRS remains unclear, multiple factors are likely to contribute to its development. CRS is treated with medical therapy (topical or oral steroids) and surgery. While medical treatments offer relief for most patients with CRS, functional endoscopic sinus surgery (FESS) is commonly performed. However, the surgical outcome of FESS can be compromised by postoperative inflammation, polyposis (formation of polyps) and adhesions of the nasal mucous lining, which often require subsequent interventions. Postoperative treatments are therefore required to achieve optimal long-term results. Steroid-eluting sinus stents are devices that are inserted into the nose, sinuses or both, and gradually release a steroid after FESS. They are used to prevent stenosis (narrowing) of the sinus openings and provide anti-inflammatory benefits during the postoperative healing period. However, it is unknown whether steroid-eluting sinus stents offer any beneficial effect in improving nasal symptoms of patients with CRS.

Study characteristics

We searched for all randomised controlled trials (RCTs) that studied the effects of steroid-eluting sinus stents compared to non-steroid-eluting sinus stents, nasal packing or no treatment in adult patients with CRS who underwent FESS. From the 159 records we retrieved using our search strategy, we identified 21 trials that could potentially be included as they used sinus stents for patients undergoing FESS. However, we had to exclude these trials from the review because they met some but not all of the inclusion criteria. We therefore identified no trials that could be included in the review.

Key results

No trials met our inclusion criteria.

Quality of evidence

We are unable to conclude whether or not steroid-eluting sinus stents offer more beneficial effects, over those of surgery alone, than non-steroid-eluting sinus stents, nasal packing or no treatment in patients with CRS undergoing FESS. High-quality RCTs are needed to answer this question. This review is current to May 2015.

Authors' conclusions: 

We are unable to provide evidence to establish whether steroid-eluting sinus stents have potential advantages and disadvantages for patients with CRS undergoing FESS. Future, high-quality RCTs are needed to assess whether or not steroid-eluting sinus stents confer any beneficial effects, over those of surgery alone, when compared to non-steroid sinus stents.

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Background: 

Functional endoscopic sinus surgery (FESS) has become a well-established approach for treating patients with chronic rhinosinusitis (CRS) refractory to medical management. However, the surgical outcome may be compromised by postoperative inflammation, polyposis and adhesions, which often require subsequent intervention. Bioabsorbable, steroid-eluting sinus stents are inserted into the nose, sinuses or both following surgery to prevent stenosis of the sinus openings during the postoperative healing period. The slow release of corticosteroid aims to decrease mucosal oedema and expedite wound healing. Whether a steroid-eluting stent offers any beneficial effects in terms of improving sinonasal symptoms has not been systematically reviewed.

Objectives: 

To assess the safety and efficacy of steroid-eluting sinus stent placement in CRS patients after FESS.

Search strategy: 

The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 4); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 May 2015.

Selection criteria: 

We included all randomised controlled trials (RCTs) comparing steroid-eluting sinus stents with non-steroid-eluting sinus stents, nasal packing or no treatment in adult CRS patients undergoing FESS.

Data collection and analysis: 

We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results: 

We identified no RCTs that met our inclusion criteria. Among the 159 records retrieved using our search strategy, 21 trials had the potential to be included given that they had tested sinus stents, spacers and packing materials for patients with CRS undergoing FESS. However, we excluded these trials from the review because they met some but not all of the inclusion criteria.

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