title: Systematic review and metaanalysis of middle meatal packing after endoscopic sinus surgery.
abstract: OBJECTIVE
  The objective of this systematic review was to evaluate synechiae formation in patients who underwent packing in the middle meatus at the completion of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis.
  
  
  METHODS
  PubMed and Ovid.
  
  
  METHODS
  Prospective randomized controlled studies of ESS with the placement of middle meatal packing were reviewed and included for analysis. Metaanalysis of the pooled data was performed.
  
  
  RESULTS
  Eighteen prospective, randomized, controlled trials met inclusion criteria, resulting in a total of 925 subjects. Although there was a trend toward decreased risk of synechiae formation in the patients who underwent placement of middle meatal packing postoperatively (RR = 0.544), this did not achieve statistical significance on metaanalysis (p = 0.052).
  
  
  CONCLUSIONS
  This systematic review and metaanalysis suggests that use of middle meatal packing does not significantly reduce the risk of synechiae formation after ESS. There was, however, significant heterogeneity of the data analyzed, and the difference between groups was just short of statistical significance in our metaanalysis. Additional prospective randomized studies on this topic will further elucidate the utility of middle meatal packing.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh, Pennsylvania, USA.
authors.forename: Candace E
authors.initials: CE
authors.lastname: Hobson
authors.forename: Garret W
authors.initials: GW
authors.lastname: Choby
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.forename: Stella
authors.initials: S
authors.lastname: Lee
mesh_terms: D000818:Animals; D001458:Bandages; D004724:Endoscopy; D006801:Humans; D010256:Paranasal Sinuses / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*