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Middle Meatal Spacers for Synechiae Prevention Following Endoscopic Sinus Surgery: An Updated Systematic Review and
Raisa Chowdhury1, Hamad Almhanedi2, Salman Hussain3
1Faculty of Medicine and Health Sciences McGill University Montreal Quebec Canada.
Objective:
To determine whether middle meatal spacers reduce postoperative synechiae following endoscopic sinus surgery (ESS) and to compare the effectiveness of absorbable versus nonabsorbable spacer materials.
Methods:
A PRISMA 2020-guided systematic review and meta-analysis was performed. PubMed/MEDLINE, Embase, and Web of Science were searched (January 2012-March 2025) for randomized controlled trials in adults undergoing ESS comparing middle meatal spacers versus no-spacer controls. The primary outcome was synechiae within 3 months. Random-effects meta-analysis generated pooled relative risks (RR) with 95% confidence intervals (CI); prespecified subgroup and sensitivity analyses assessed robustness.
Results:
Nine randomized controlled trials comprising 703 patients met inclusion criteria, with eight studies providing dichotomous synechiae data for meta-analysis. Middle meatal spacers significantly reduced postoperative synechiae compared with no spacer (RR 0.43; 95% CI 0.26-0.71; p = 0.001), with moderate heterogeneity (I 2 = 52.3%). Absorbable spacers demonstrated a statistically significant protective effect (RR 0.48; 95% CI 0.25-0.93; p = 0.03), whereas nonabsorbable spacers showed a nonsignificant protective trend under random-effects modeling. No significant difference was observed between absorbable and nonabsorbable spacer subgroups. Trials evaluating steroid-eluting spacers did not demonstrate clear superiority over nonsteroid absorbable spacers for synechiae prevention.
Conclusion:
Middle meatal spacers reduce postoperative synechiae after ESS, with the most consistent evidence supporting absorbable materials. Given wide variation in baseline synechiae risk, selective rather than routine use is supported.
