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Hyaluronic Acid for Sinonasal Surgery: A Systematic Review and Meta-Analysis
Esther Yanxin Gao1,2,3, Benjamin Kye Jyn Tan2,3,4, Joie Yi Yun Teo3
1Department of Otolaryngology-Head and Neck Surgery, Sengkang General Hospital, Singapore, Singapore.
International Forum of Allergy & Rhinology
|February 7, 2025
Summary
Hyaluronic acid dressings show promise in sinonasal surgery, significantly reducing adhesions and edema while improving healing. This meta-analysis supports its use to optimize outcomes after functional endoscopic sinus surgery (FESS).
Area of Science:
- Otolaryngology
- Surgical Innovation
- Biomaterials in Medicine
Background:
- Hyaluronic acid (HA) is explored for sinonasal surgery due to wound healing and anti-inflammatory properties.
- Clinical evidence for HA's efficacy in sinonasal surgery, particularly functional endoscopic sinus surgery (FESS), is currently inconclusive.
- This meta-analysis evaluates HA's impact on objective and subjective outcomes post-sinonasal surgery.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) assessing hyaluronic acid's effectiveness in sinonasal surgery.
- To determine if hyaluronic acid improves outcomes compared to standard post-operative care.
- To assess the safety profile of hyaluronic acid in the context of sinonasal procedures.
Main Methods:
- A comprehensive search of PubMed, Embase, and Scopus identified relevant RCTs.
- Two reviewers assessed study eligibility and risk of bias using the Cochrane Risk of Bias 2 tool.
- Random-effects models were employed for meta-analysis of dichotomous and continuous outcomes, with publication bias assessed via funnel plots and trim-and-fill.
Main Results:
- Fifteen RCTs involving 789 participants were included; 13 focused on FESS.
- Hyaluronic acid significantly reduced synechiae formation (RR 0.65) and post-operative edema (RR 0.70).
- Improved epithelialization (RR 0.48) was observed with hyaluronic acid use; no adverse events were reported.
Conclusions:
- Hyaluronic acid dressings are safe and effective adjuncts for sinonasal surgery.
- HA demonstrates benefits in reducing synechiae, edema, and enhancing epithelialization post-FESS.
- Consideration of hyaluronic acid is recommended to optimize post-operative recovery in sinonasal procedures.
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