Rethinking the role of Middle Meatal Spacers in Endoscopic Sinus Surgery : Absorbable Vs Non-absorbable Types - A Randomised Controlled Trial

Endoscopic sinus surgery aims to restore paranasal sinus ventilation and drainage. Middle meatal spacers – either absorbable or non absorbable serve as a useful adjunct in preventing postoperative complications such as synechiae formation and ostial stenosis in addition to meticulous surgical technique. This study aims to compare the efficacy and outcomes of using absorbable vs non-absorbable middle meatal spacer in endoscopic sinus surgery for patients with chronic rhinosinusitis. In this randomized controlled trial, 63 patients underwent functional endoscopic sinus surgery where the patient received an absorbable middle meatal spacer on one side and non-absorbable middle meatal spacer on the contralateral side, selected by simple randomisation. Preoperative assessment included diagnostic nasal endoscopy and CT-PNS. After pack removal, bleeding and pain was scored following which synechiae, granulation formation and nasal mucosal edema was assessed at 4 weeks and 12 weeks. Pain and bleeding after pack removal was more with non absorbable middle meatal spacers with a p-value of 0.0005. Synechiae and granulation were more common with absorbable spacers at both 4 and 12 weeks with a statistically significant p-value of 0.0005. There was no significant mucosal edema comparing both spacers at the end of 4 weeks and 12 weeks with p-values of 0.414 and 1.0 respectively. Though the absorbable spacer had lesser pain and bleeding on immediate pack removal, the non absorbable spacer had better long term outcomes. Thus, non absorbable spacer is preferred in clinical practice.