Role of nasal packing in surgical outcome for chronic rhinosinusitis with polyposis

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OBJECTIVES/HYPOTHESIS: To analyze the differences between biodegradable and nondegradable nasal dressings with regard to their effects on wound healing in the short and medium term and on surgical outcomes in the long term, after endoscopic sinus surgery (ESS). STUDY DESIGN: A prospective, randomized, partly blinded, controlled trial. METHODS: A total of 56 patients undergoing bilateral ESS for chronic rhinosinusitis with polyposis were enrolled and randomized to receive biodegradable (Nasopore; Stryker, Hamilton, ON, Canada) on one side and nondegradable packing (Merocel; Medtronic Xomed, Minneapolis, MN) on the opposite side. Postoperative morbidities (pain, bleeding, facial edema, nasal blockage) related to dressings were assessed on postoperative day 6. Wound healing (edema, crusting, secretions, synechia, granulation tissue formation, and percentage re-epithelialization) were evaluated at 2 weeks, 1 month, 3 months, and 6 months using modified Lund-Kennedy scores. Long-term assessment at 12 months was done using validated Lund-Kennedy scores. RESULTS: Morbidities related to nondegradable packing were significantly higher than with degradable packing (Wilcoxon signed rank test, P<.01). Pain, bleeding, nasal blockage, and facial edema were significantly less with absorbable packing. No statistically significant difference was found between sinonasal cavities packed with biodegradable or nondegradable materials with regard to healing scores and percentage of re-epithelialization at 2 weeks, 1 month, 3 months, 6 months, and surgical outcomes at 1 year (P>.05). However, healing at 6 months was correlated with the preoperative Lund-Mackay radiology and surgery scores (Spearman's rho correlation test, P<.05 and P<.01, respectively). CONCLUSIONS: No significant healing or surgical outcome differences were found between biodegradable and nondegradable packing. However pain, bleeding, nasal blockage, and facial edema were lower with biodegradable packing. LEVEL OF EVIDENCE: 1b.