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Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis

Published online by Cambridge University Press:  06 February 2017

E Fong ,
M Garcia ,
C M Woods  and
E Ooi
E Fong*
Affiliation:
Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Bedford Park, Australia Ears, Nose and Throat Department, Princess Alexandra Hospital, Woolloongabba, Australia
M Garcia
Affiliation:
Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Bedford Park, Australia
C M Woods
Affiliation:
Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Bedford Park, Australia
E Ooi
Affiliation:
Otolaryngology – Head and Neck Surgery, Flinders Medical Centre and Flinders University, Bedford Park, Australia
*
Address for correspondence: Dr Eric Fong, ENT Department, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia Fax: +61 8 8204 7524 E-mail: eric.fong@my.jcu.edu.au
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Abstract

Background:

Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.

Methods:

Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.

Results:

Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.

Conclusion:

Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

Keywords

RhinitisSurgeryQuality Of LifeDrug TherapyHyaluronic Acid
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 131 , Supplement S1 , January 2017 , pp. S2 - S11
Copyright
Copyright © JLO (1984) Limited 2017 

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Footnotes

Presented at the Australian Society of Otolaryngology – Head and Neck Surgery 65th Annual Scientific Meeting, 7–9 March 2015, Sydney, Australia.

References

1 Australian Institute of Health and Welfare. Chronic Respiratory Diseases in Australia: Their Prevalence, Consequences and Prevention. Canberra: Australian Institute of Health and Welfare, 2005 Google Scholar
2 Pleis, JR, Lucas, JW, Ward, BW. Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital Health Stat 10 2009;(242):1–157 Google Scholar
3 Van Cauwenberge, P, Van Hoecke, H, Bachert, C. Pathogenesis of chronic rhinosinusitis. Curr Allergy Asthma Rep 2006;6:487–94CrossRefGoogle ScholarPubMed
4 Fokkens, WJ, Lund, VJ, Mullol, J, Bachert, C, Alobid, I, Baroody, F et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 2012;(23):3 p preceding table of contents, 1–298 Google Scholar
5 Musy, PY, Kountakis, SE. Anatomic findings in patients undergoing revision endoscopic sinus surgery. Am J Otolaryngol 2004;25:418–22CrossRefGoogle ScholarPubMed
6 Henriquez, OA, Schlosser, RJ, Mace, JC, Smith, TL, Soler, ZM. Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis. Laryngoscope 2013;123:2615–19Google Scholar
7 Bassiouni, A, Chen, PG, Naidoo, Y, Wormald, PJ. Clinical significance of middle turbinate lateralization after endoscopic sinus surgery. Laryngoscope 2015;125:36–41 Google Scholar
8 Jorissen, M. Postoperative care following endoscopic sinus surgery. Rhinology 2004;42:114–20Google ScholarPubMed
9 Rudmik, L, Soler, ZM, Orlandi, RR, Stewart, MG, Bhattacharyya, N, Kennedy, DW et al. Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 2011;1:417–30CrossRefGoogle ScholarPubMed
10 Brody, HJ. Use of hyaluronidase in the treatment of granulomatous hyaluronic acid reactions or unwanted hyaluronic acid misplacement. Dermatol Surg 2005;31(8 Pt 1):893–7Google Scholar
11 Fraser, JR, Laurent, TC, Laurent, UB. Hyaluronan: its nature, distribution, functions and turnover. J Intern Med 1997;242:27–33 Google Scholar
12 Chen, WY, Abatangelo, G. Functions of hyaluronan in wound repair. Wound Repair Regen 1999;7:79–89 Google Scholar
13 Goa, KL, Benfield, P. Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs 1994;47:536–66CrossRefGoogle ScholarPubMed
14 King, SR, Hickerson, WL, Proctor, KG. Beneficial actions of exogenous hyaluronic acid on wound healing. Surgery 1991;109:76–84 Google ScholarPubMed
15 Voigt, J, Driver, VR. Hyaluronic acid derivatives and their healing effect on burns, epithelial surgical wounds, and chronic wounds: a systematic review and meta-analysis of randomized controlled trials. Wound Repair Regen 2012;20:317–31Google Scholar
16 Souza-Fernandes, AB, Pelosi, P, Rocco, PR. Bench-to-bedside review: the role of glycosaminoglycans in respiratory disease. Crit Care 2006;10:237 CrossRefGoogle ScholarPubMed
17 Soldati, D, Rahm, F, Pasche, P. Mucosal wound healing after nasal surgery. A controlled clinical trial on the efficacy of hyaluronic acid containing cream. Drugs Exp Clin Res 1999;25:253–61Google Scholar
18 Casale, M, Sabatino, L, Frari, V, Mazzola, F, Dell'Aquila, R, Baptista, P et al. The potential role of hyaluronan in minimizing symptoms and preventing exacerbations of chronic rhinosinusitis. Am J Rhinol Allergy 2014;28:345–8Google Scholar
19 Chen, Q, Sun, G, Wang, Y, Zhong, W, Shu, XZ. The evaluation of two new hyaluronan hydrogels as nasal dressing in the rabbit maxillary sinus. Am J Rhinol Allergy 2012;26:152–6CrossRefGoogle ScholarPubMed
20 Orlandi, RR, Shu, XZ, McGill, L, Petersen, E, Prestwich, GD. Structural variations in a single hyaluronan derivative significantly alter wound-healing effects in the rabbit maxillary sinus. Laryngoscope 2007;117:1288–95Google Scholar
21 Proctor, M, Proctor, K, Shu, XZ, McGill, LD, Prestwich, GD, Orlandi, RR. Composition of hyaluronan affects wound healing in the rabbit maxillary sinus. Am J Rhinol 2006;20:206–11CrossRefGoogle ScholarPubMed
22 Yildirim, A, Turgut, B, Bebek, AI, Gumus, C, Kocaturk, S, Kunt, T. Early effect of exogenous Na hyaluronate on mucociliary clearance. Am J Rhinol 2005;19:244–7Google Scholar
23 Zhao, X, Grewal, A, Briel, M, Lee, JM. A systematic review of nonabsorbable, absorbable, and steroid-impregnated spacers following endoscopic sinus surgery. Int Forum Allergy Rhinol 2013;3:896–904 Google Scholar
24 Wu, W, Cannon, PS, Yan, W, Tu, Y, Selva, D, Qu, J. Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis. Eye 2011;25:746–53Google Scholar
25 Smith, TL, Hwang, PH, Murr, AH, Lavigne, F, Koreck, A. Interrater reliability of endoscopic parameters following sinus surgery. Laryngoscope 2012;122:230–6CrossRefGoogle ScholarPubMed
26 Smith, TL, Mendolia-Loffredo, S, Loehrl, TA, Sparapani, R, Laud, PW, Nattinger, AB. Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2005;115:2199–205Google Scholar
27 Chang, EH. New insights into the pathogenesis of cystic fibrosis sinusitis. Int Forum Allergy Rhinol 2014;4:132–7Google Scholar
28 Anfuso, A, Ramadan, H, Terrell, A, Demirdag, Y, Walton, C, Skoner, DP et al. Sinus and adenoid inflammation in children with chronic rhinosinusitis and asthma. Ann Allergy Asthma Immunol 2015;114:103–10Google Scholar
29 Joanna Briggs Institute. Reviewers' Manual. Adelaide: Joanna Briggs Institute, 2014 Google Scholar
30 Review Manager (RevMan) [computer program]. Version 5.2. Copenhagen: Nordic Cochrane Centre, Cochrane Collaboration, 2012 Google Scholar
31 Miller, RS, Steward, DL, Tami, TA, Sillars, MJ, Seiden, AM, Shete, M et al. The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 2003;128:862–9Google ScholarPubMed
32 Franklin, JH, Wright, ED. Randomized, controlled, study of absorbable nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis. Am J Rhinol 2007;21:214–17Google Scholar
33 Berlucchi, M, Castelnuovo, P, Vincenzi, A, Morra, B, Pasquini, E. Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study. Eur Arch Otorhinolaryngol 2009;266:839–45Google Scholar
34 Shi, R, Zhou, J, Wang, B, Wu, Q, Shen, Y, Wang, P et al. The clinical outcomes of new hyaluronan nasal dressing: a prospective, randomized, controlled study. Am J Rhinol Allergy 2013;27:71–6Google Scholar
35 Wormald, PJ, Boustred, RN, Le, T, Hawke, L, Sacks, R. A prospective single-blind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery. Am J Rhinol 2006;20:7–10 Google Scholar
36 Kimmelman, CP, Edelstein, DR, Cheng, HJ. Sepragel sinus (hylan B) as a postsurgical dressing for endoscopic sinus surgery. Otolaryngol Head Neck Surg 2001;125:603–8Google Scholar
37 Woodworth, BA, Chandra, RK, Hoy, MJ, Lee, FS, Schlosser, RJ, Gillespie, MB. Randomized controlled trial of hyaluronic acid/carboxymethylcellulose dressing after endoscopic sinus surgery. ORL J Otorhinolaryngol Relat Spec 2010;72:101–5Google Scholar
38 Catalano, PJ, Roffman, EJ. Evaluation of middle meatal stenting after minimally invasive sinus techniques (MIST). Otolaryngol Head Neck Surg 2003;128:875–81Google Scholar
39 Cantone, E, Castagna, G, Sicignano, S, Ferranti, I, Rega, F, Di Rubbo, V et al. Impact of intranasal sodium hyaluronate on the short-term quality of life of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2014;4:484–7Google Scholar
40 Macchi, A, Terranova, P, Digilio, E, Castelnuovo, P. Hyaluronan plus saline nasal washes in the treatment of rhino-sinusal symptoms in patients undergoing functional endoscopic sinus surgery for rhino-sinusal remodeling. Int J Immunopathol Pharmacol 2013;26:137–45Google Scholar
41 Kim, JH, Lee, JH, Yoon, JH, Chang, JH, Bae, JH, Kim, KS. Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose after endoscopic sinus surgery. Am J Rhinol 2007;21:95–9CrossRefGoogle ScholarPubMed
42 Gelardi, M, Guglielmi, AV, De Candia, N, Maffezzoni, E, Berardi, P, Quaranta, N. Effect of sodium hyaluronate on mucociliary clearance after functional endoscopic sinus surgery. Eur Ann Allergy Clin Immunol 2013;45:103–8Google ScholarPubMed
43 Gouteva, I, Shah-Hosseini, K, Meiser, P. Clinical efficacy of a spray containing hyaluronic acid and dexpanthenol after surgery in the nasal cavity (septoplasty, simple ethmoid sinus surgery, and turbinate surgery). J Allergy (Cairo) 2014;2014:635490 Google Scholar
44 Lee, JY, Lee, SW. Preventing lateral synechia formation after endoscopic sinus surgery with a silastic sheet. Arch Otolaryngol Head Neck Surg 2007;133:776–9Google Scholar
45 Shrime, MG, Tabaee, A, Hsu, AK, Rickert, S, Close, LG. Synechia formation after endoscopic sinus surgery and middle turbinate medialization with and without FloSeal. Am J Rhinol 2007;21:174–9CrossRefGoogle ScholarPubMed
46 Turner, L, Shamseer, L, Altman, DG, Weeks, L, Peters, J, Kober, T et al. Consolidated standards of reporting trials (CONSORT) and the completeness of reporting of randomised controlled trials (RCTs) published in medical journals. Cochrane Database Syst Rev 2012;(11):MR000030CrossRefGoogle ScholarPubMed
47 Wang, TC, Tai, CJ, Tsou, YA, Tsai, LT, Li, YF, Tsai, MH. Absorbable and nonabsorbable packing after functional endoscopic sinus surgery: systematic review and meta-analysis of outcomes. Eur Arch Otorhinolaryngol 2015;272:1825–31Google Scholar