title: A randomized controlled trial of a middle meatal silastic stent for reducing adhesions and middle turbinate lateralization following endoscopic sinus surgery.
abstract: BACKGROUND
  Endoscopic sinus surgery (ESS) is indicated for patients with recalcitrant chronic rhinosinusitis symptoms. However, surgical revision can be required because of adhesion formation and middle turbinate lateralization. We investigate the efficacy of a middle meatal silastic stent in reducing these complications after ESS.
  
  
  METHODS
  Thirty-six patients were randomized to receive a silastic stent in the middle meatus unilaterally after ESS. The surgeon was blinded to the side receiving the stent until completion of the ESS. The contralateral side, with no stent, was the control side. Patients completed a 7-day, postoperative, visual analog scale symptom diary and were blinded to the stent side until its removal at the first postoperative visit. Patients were followed up after 2, 8, and 24 weeks. Endoscopic video of the sinus cavities were recorded at all visits and 2 blinded, independent ear/nose/throat (ENT) surgeons assessed the videos using a modified Lund-Kennedy scoring system.
  
  
  RESULTS
  Thirty-five of 36 patients completed 6-months' follow-up. Middle turbinate lateralization was observed in 13 sides without a stent vs 1 side with a stent. There was a significant reduction in adhesions at weeks 2 and 8 (p < 0.001) and crusting (p < 0.01) in the stent side compared to control. Video scores at 6 months after surgery for stent and control sides remained unchanged from the 8-week visit. There was no difference between sides for symptom scores, edema, or nasal discharge.
  
  
  CONCLUSIONS
  Middle meatal silastic stents are well tolerated by patients and effective in reducing middle turbinate lateralization, adhesions, and crusting postoperatively in ESS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Chun L
authors.initials: CL
authors.lastname: Chan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Behrad
authors.initials: B
authors.lastname: Elmiyeh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Charmaine
authors.initials: C
authors.lastname: Woods
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Shahid
authors.initials: S
authors.lastname: Ullah
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Indunil
authors.initials: I
authors.lastname: Gunawardena
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: A Simon
authors.initials: AS
authors.lastname: Carney
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia.
authors.forename: Eng H
authors.initials: EH
authors.lastname: Ooi
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004129:Dimethylpolysiloxanes; D005260:Female; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000473:pathology*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D012086:Reoperation / Q000379:methods; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D015607:Stents; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D014420:Turbinates / Q000473:pathology*
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon
keywords: endoscopic; intranasal surgery; middle turbinates; rhinosinusitis; surgical procedure; tissue adhesions