Hyaluronic Acid for Sinonasal Surgery: A Systematic Review and Meta-Analysis

Hyaluronic acid has gained widespread attention for its potential role in sinonasal surgery, especially functional endoscopic sinus surgery (FESS), due to its wound healing and anti-inflammatory properties. However, clinical evidence on its efficacy remains inconclusive. This meta-analysis aims to clarify the efficacy of hyaluronic acid in improving both objective and subjective outcomes after sinonasal surgery.

Two blinded reviewers searched PubMed, Embase, and Scopus databases, then selected randomized controlled trials (RCTs) on hyaluronic acid use in sinonasal surgery compared to routine post-operative care. The risk of bias was graded using the Cochrane Risk of Bias 2 (RoB 2) tool. Data was analyzed using random-effects models to pool risk ratios for dichotomous outcomes and the ratio of means (RoM) for continuous outcomes. Publication bias was assessed via funnel plots and the trim-and-fill method.

From 244 records, 15 RCTs-13 on FESS and two on septoplasty and inferior turbinoplasty-were selected, with 789 participants. Meta-analysis for the 13 studies on FESS was performed. Hyaluronic acid significantly reduced synechiae formation (relative risk [RR] 0.65, 95% confidence interval [CI] 0.44-0.94), improved epithelialization (RR 0.48, 95% CI 0.27-0.86), and decreased post-operative edema (RR 0.70, 95% CI 0.50-0.97) compared to routine post-FESS care. All included studies had a low to moderate risk of bias, and there was no substantial publication bias. There were no adverse events reported.

Hyaluronic acid dressings are safe and may reduce synechiae, edema, and improve epithelialization after sinonasal surgery. Hyaluronic acid may be considered as an adjunct after FESS to optimize post-operative outcomes.