A prospective single-blind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery

Background: The aim of this study was to determine whether there was any benefit or detrimental consequences of placing a hyaluronic acid pack (Merogel) into the middle meatus after endoscopic sinus surgery (ESS). Methods: A randomized controlled blinded study was performed in 42 patients with chronic sinusitis undergoing ESS. The patients were randomized to receive Merogel on one side and no packing on the other side. Patients were assessed at 2, 4, and 6-8 weeks after surgery and the presence of synechia, edema, and infection was noted with the observer blinded to the side that had received the Merogel. Results: At 2 weeks the side packed with Merogel had 35% synechiae, 83% edema, and 30% mucopurulent discharge and on the control side the figures were similar with 22.5% synechiae, 83% edema, and 28% mucopurulent discharge. In both groups these figures improved over the observation period but percentages in the groups remained similar. At no time point was the difference between the packed and unpacked sides statistically significant for any of the measures when assessed with Fisher's exact test. Conclusion: Merogel nasal packing has no significant beneficial or detrimental effect in terms of synechia, edema, or infection when placed in the middle meatus after ESS.