title: Effect of steroid-releasing sinus implants on postoperative medical and surgical interventions: an efficacy meta-analysis.
abstract: BACKGROUND
  Endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent interventions. A bioabsorbable, steroid-releasing sinus implant has been studied in 2 prospective, randomized clinical trials for its ability to preserve sinus patency and reduce medical and surgical interventions after ESS in patients with CRS. The objective of this study was to perform a meta-analysis of the efficacy results from the 2 trials.
  
  
  METHODS
  The 2 prospective, randomized, double-blinded, multicenter trials enrolled a total of 143 patients utilizing an intrapatient control design. Postoperative day 30 videos were obtained for each patient, randomly ordered, and presented to an independent panel of 3 otolaryngologists for grading of efficacy endpoints. The need for postoperative interventions, formation of polyposis, and adhesions were assessed. Results from the 2 studies were then pooled.
  
  
  RESULTS
  Implants were successfully placed in all 286 ethmoid sinuses. According to the grading done by the panel, drug-releasing implants reduced postoperative interventions by 35% (p = 0.0008), lysis of adhesions by 51% (p = 0.0016), and oral steroid need by 40% (p = 0.0023), compared to controls. The relative reduction in frank polyposis was 46% (p < 0.0001).
  
  
  CONCLUSIONS
  Early postoperative healing is a predictor of longer-term success after sinus surgery. Evaluation of postoperative outcomes by a blinded independent panel demonstrates that steroid-releasing implants that provide a sustained release of corticosteroid improve surgical outcomes by reducing frank polyp formation, sinus adhesions, and middle turbinate lateralization. Steroid-releasing implants reduce the need for surgical intervention, and the need for oral steroid treatment.
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA 23507, USA. hanjk@evms.edu
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Han
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Marple
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Murr
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Lanier
authors.forename: James W
authors.initials: JW
authors.lastname: Stambaugh
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Mugglin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002908:Chronic Disease; D004343:Drug Implants / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009298:Nasal Polyps / Q000188:drug therapy / Q000517:prevention & control; D059747:Nasal Surgical Procedures; D010256:Paranasal Sinuses / Q000187:drug effects / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012220:Rhinitis / Q000188:drug therapy* / Q000601:surgery*; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D004343:Drug Implants