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

IF 6.8 2区医学 Q1 OTORHINOLARYNGOLOGY International Forum of Allergy & Rhinology Pub Date : 2025-02-07 DOI:10.1002/alr.23537

Esther Yanxin Gao, Benjamin Kye Jyn Tan, Joie Yi Yun Teo, George Shiyao He, Claire Jing-Wen Tan, Brian Sheng Yep Yeo, Andy Jian Kai Chua

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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透明质酸用于鼻窦手术：系统回顾和荟萃分析。

背景：透明质酸由于其伤口愈合和抗炎的特性，在鼻窦手术，特别是功能性内窥镜鼻窦手术（FESS）中的潜在作用而受到广泛关注。然而，关于其疗效的临床证据仍不确定。本荟萃分析旨在阐明透明质酸在改善鼻窦手术后客观和主观预后方面的功效。方法：两名盲法审评者检索PubMed、Embase和Scopus数据库，然后选择透明质酸在鼻窦手术中的应用与常规术后护理的随机对照试验（rct）。使用Cochrane risk of bias 2 （RoB 2）工具对偏倚风险进行分级。使用随机效应模型对数据进行分析，汇总二分类结局的风险比和连续结局的均值比（RoM）。通过漏斗图和修剪填充法评估发表偏倚。结果：从244个记录中，选择了15个rct，其中13个是FESS， 2个是中隔成形术和下鼻甲成形术，共有789名参与者。对13项FESS研究进行meta分析。与fess术后常规护理相比，透明质酸显著减少粘丝形成（相对危险度[RR] 0.65, 95%可信区间[CI] 0.44-0.94），改善上皮化（RR 0.48, 95% CI 0.27-0.86），减少术后水肿（RR 0.70, 95% CI 0.50-0.97）。所有纳入的研究都有低到中等偏倚风险，没有明显的发表偏倚。无不良事件报告。结论：透明质酸敷料是安全的，可以减少鼻窦手术后的粘连、水肿和改善上皮化。透明质酸可以作为FESS术后的辅助治疗来优化术后结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Forum of Allergy & Rhinology OTORHINOLARYNGOLOGY-

CiteScore

11.70

自引率

10.90%

发文量

185

审稿时长

6-12 weeks

期刊介绍： International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.