Double-Blinded, Randomized, Controlled Trial of Medicated versus Nonmedicated Merocel Sponges for Functional Endoscopic Sinus Surgery

Objective: This study aimed to compare differences between medicated and nonmedicated Merocel middle meatal spacers (MMSs) on sinonasal mucosal healing (histopathologic and endoscopic difference), patient discomfort, and pain on removal of the MMS following functional endoscopic sinus surgery. Methods: Forty-eight patients with chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive a medication-soaked Merocel MMS (either one of budesonide, gentamicin, or manuka honey) in one nostril and a nonmedicated Merocel MMS in the contralateral side. Patients were seen on postoperative day 7 and were asked to complete a visual analogue score to report the level of discomfort from nasal packing on each side. Under endoscopic visualization, biopsies of mucosa were taken from both middle meati and assessed by a blinded pathologist to determine the level of mucosal inflammation on a scale of 0 to 4. Results: The budesonide-soaked Merocel MMS showed a trend toward reduced mucosal inflammation when compared to the control Merocel MMS, but the results were not statistically significant. There was no statistically significant difference in the degree of discomfort and pain on the removal of the packings between the medication-soaked Merocel MMS and the nonmedicated Merocel MMS, although there was a trend toward less pain for the manuka honey-soaked Merocel MMS. Conclusions: Although our study failed to show any significant benefit from the addition of medication to the Merocel MMS, further studies with different compounds are recommended to determine whether a medicated MMS could indeed be a superior alternative to the standard MMS.