***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: After functional endoscopic sinus surgery ( FESS ) , nasal packing may be necessary and a packing material which has benefits in both cost and efficacy would be required . This study aim ed to determine the efficacy of Gelfoam packing on hemostasis and wound healing after FESS .  Patients who underwent bilateral FESS due to chronic bilateral rhinosinusitis were enrolled . R and omly , one side was selected for Gelfoam packing and the other side for no packing . Subjective symptoms and objective findings such as synechia , granulation , pus discharge , edema , stenosis , and crust were evaluated . A total of 21 patients ( 17 men and 4 women ; mean age 39.7 years ranging from 12 to 75 years ) were included . There were no statistical significant differences between two groups regarding both subjective symptoms and objective findings during 4 months after surgery . Three patients had postoperative bleeding in the no packing side . Gelfoam packing may be recommendable in terms of efficacy and cost-benefit after FESS Objective : To determine if a hyaluronic acid/carboxymethylcellulose ( HA/CMC ) sinus dressing reduces the rate of postoperative scarring . Methods : In a r and omized , matched-controlled , single-blinded study , following the completion of surgery , an HA/CMC dressing was r and omly assigned to one side with the opposite unpacked side serving as a control . Results : Fifty-three patients underwent surgery for chronic rhinosinusitis ( CRS ; 39 patients ) or CRS with nasal polyposis ( 14 patients ) . At the 8-week follow-up , there was no difference in synechiae on the HA/CMC side compared to the control ( p = 0.09 ) . HA/CMC-treated sinuses , however , demonstrated fewer synechiae in the first 2 weeks postoperatively compared to the control ( p = 0.01 ) , and were associated with significantly less nasal congestion at the 4-week ( p = 0.02 ) and 8-week follow-up visits ( 0.03 ) . Conclusion : There was no long-term difference in the rate of synechiae in the HA/CMC-treated sinus compared to the control . However , less severe nasal congestion and synechiae in the initial postoperative period may reduce the need for aggressive sinus debridement Aim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose ( CMC ) foam dressing in functional endoscopic sinus surgery ( FESS ) in adult patients . In the present prospect i ve study , 60 patients with bilateral chronic rhinosinusitis were included . All patients underwent bilateral FESS . Thirty patients had both nasal cavities packed with dissolvable CMC foam ( CMCF ) and another 30 patients had their nasal cavities packed with routine nasal packing ( RNP ) in latex glove fingers . The haemostatic effect of the CMCF was assessed during the recovery period , and pain levels were recorded by the patients on a visual analogue scale 24 h after surgery . The prevalence of postoperative middle meatal synechia formation was assessed 1 , 2 , 4 and 8 weeks after the operation . Four ( 13.3 % ) of the patients packed with CMCF had primary postoperative bleeding during the recovery period and required additional dressing . Bleeding appeared in two ( 6.7 % ) patients packed with RNP . The mean level of pain was 0.962 ( range 0–4 ) for patients packed with CMCF but was 5.5 ( range 3–9 ) for patients packed with RNP . Four ( 6.7 % ) of 26 CMCF patients and 10 ( 35.7 % ) of 28 RNP patients developed a synechia in the middle meatus . We found that dissolvable CMC foam dressing is associated with very low levels of localised pain and with low levels of postoperative bleeding and synechia formation OBJECTIVES The aim of the study was to evaluate the effects and morbidities of Meropack , an absorbable hyaluronic acid packing material , placed in the middle meatus after endoscopic sinus surgery in children with chronic sinusitis . METHODS Sixty consecutive children with similar degrees of bilateral chronic sinusitis were enrolled in the study . Meropack was r and omly inserted into one side of the middle meatus , while the opposite sinus was not packed after functional endoscopic sinus surgery . Patients were investigated 3 , 8 , and 12 weeks after surgery . The effects and morbidities of nasal dressings in the middle meatus were evaluated with respect to six distinct parameters : blood loss during surgery , postoperative hemorrhage , synechiae , granulation tissue , infection , and patency of the maxillary sinus ostia . RESULTS Mean blood loss of packed and unpacked sinuses did not significantly differ ( p > 0.05 ) . Twenty-nine ( 15 packed , 14 unpacked ) of the 120 sinuses underwent resection of the lateral wall of concha bullosa . Four of 14 unpacked sinuses had postoperative hemorrhaging , while the 15 packed sinuses did not ( p < 0.05 ) . The mean synechiae scores at the first follow-up visit for the Meropack filled and unpacked sinuses differed significantly ( p < 0.05 ) . For the 8- and 12-week follow-up visits , severity of adhesions , granulation tissue formation , infection rate , and patency of the maxillary sinus ostia did not differ significantly between the Meropack filled sinuses and the unpacked sinuses ( p > 0.05 for all ) . CONCLUSION Meropack dressings effectively prevented postoperative hemorrhage , but did not significantly reduced synechiae after endoscopic sinus surgery . Therefore , we recommend that Meropack packing is not necessary for routine use following pediatric functional endoscopic sinus surgery ( FESS ) . However , it should be reserved for children who are predisposed to develop postoperative hemorrhages or adhesions , such as resection of the concha bullosa , traumatic surgery with the creation of large raw surfaces on the middle turbinate , and revision surgery with preexisting adhesions OBJECTIVE : Mitomycin C ( MMC ) is an antineoplastic agent that has been shown to decrease scar tissue after ophthalmologic surgery . Our goal was to determine whether the application of MMC at the conclusion of sinus surgery decreases the incidence of postoperative adhesion formation . METHODS : At the completion of endoscopic sinus surgery in 55 patients , a cotton pledget saturated with 1 mL of 0.4 mg/mL MMC was placed for 4 minutes in the right or left middle meatus and a similar saline-soaked pledget was placed on the opposite side . Patients were examined postoperatively by a masked observer for the presence of synechiae and mucosal changes . RESULTS : Postoperative adhesions were observed in 16 patients ( 29 % ) with a mean follow-up of 4.1 months . These adhesions were bilateral in 6 patients ( 10.9 % ) and unilateral in 10 patients ( 18 % ) . Unilateral adhesions were observed on only 2 sides ( 3.6 % ) treated with MMC and 8 controls ( 14.5 % ) ( P = 0.058 ) . No adverse effects were observed . CONCLUSIONS : MMC was found to be safe to use during sinus surgery , and it may reduce the incidence of postoperative adhesions at the dosage used in this study . SIGNIFICANCE : Because of the observed trend toward decreased synechiae formation with MMC application , further trials using higher concentrations and application times are warranted 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 r and omized controlled blinded study was performed in 42 patients with chronic sinusitis undergoing ESS . The patients were r and omized 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 Nasal packings can aid in control of postoperative bleeding and healing following functional endoscopic sinus surgery ( FESS ) , but traditional non-resorbable stents have several inherent drawbacks . We performed a r and omized , controlled , multicenter clinical trial to assess efficacy of resorbable nasal packing in patients undergoing FESS for chronic rhinosinusitis . A total of 66 patients for 88 nasal cavities were r and omized to receive either hyaluronan resorbable packing ( MeroGel ® ) or st and ard non-resorbable nasal dressing after FESS . All underwent preoperative rhinoscopy , CT of sinuses , and , after surgery , were reassessed by rhinoscopy at 2 , 4 , and 12 weeks in blinded fashion . A total of 44 nasal cavities ( MeroGel ® -group ) received resorbable packing , whereas the remaining 44 were packed with non-resorbable nasal dressing . At follow-up endoscopic visit , the presence of nasal synechia was evaluated as primary outcome . Moreover , the tolerability and surgical h and ling properties of MeroGel ® and its comfort were assessed by surgeons and patients . Preoperative severity of rhinosinusitis was similar in both groups . No significant adverse events were observed in all patients . Follow-up endoscopy showed a lower proportion of nasal adhesions in MeroGel ® -group at both 4 ( P = 0.041 ) and 12 weeks ( P < 0.001 ) . Moreover , an improvement of other endoscopic nasal findings such as re-epithelialization , presence of granulation tissue , and appearance of nasal mucosa of nasal cavities after FESS was observed in the MeroGel ® -group . Tolerability and surgical h and ling properties of MeroGel ® were positively rated by clinicians and the overall patient judged comfort of MeroGel ® was favorable . In conclusion , MeroGel ® can be considered a valid alternative to st and ard non-resorbable nasal dressings . It is safe , well-accepted , well-tolerated , and has significant advantage of being resorbable . Moreover , it may favor improved healing in patients undergoing FESS and reduce formation of adhesions Background Functional endoscopic sinus surgery ( FESS ) has become the treatment of choice for patients with medically resistant chronic rhinosinusitis .  Nasal packing is usually placed after the surgery to support wound healing and prevent adhesions . The purpose of this study was to investigate the effect of carboxy-methylated cellulose ( CMC ) nasal packing on wound healing after FESS compared with no nasal packing . Methods Twenty-six patients underwent bilateral FESS .  The patients were r and omized to receive CMC mesh or gel packing on one side and no packing on the opposite side . The patients were followed at 2 , 4 , and 12 weeks after surgery . Endoscopically visible CMC , crusting , mucosal integrity , synechia formation , granulation tissue formation , and adverse side effects were assessed and documented . Results No adverse side effects were observed . No significant differences were found between the CMC-packed side and the unpacked side with respect to the outcome measure of wound healing . No difference was found between two different forms of CMC in terms of wound healing . Two weeks after surgery , endoscopically visible CMC was detected in four patients of the CMC mesh group , whereas none of the patients in the CMC gel group had endoscopically visible CMC ( p = 0.040 ) . Conclusion As we were unable to establish an effect , we must question the efficacy of this packing material and the necessity of its use after FESS based on the technique of the Graz University Medical School . The mesh form of CMC could be potentially useful as a vehicle for extended drug delivery owing to its longer retention time in the nose OBJECTIVE : To assess the safety and efficacy of Sepragel sinus , a hylan B gel ( cross-linked hyaluronic acid molecule ) , when used as a postoperative dressing after endoscopic sinus surgery as a facilitator of healing and a preventative for scarring and stenosis . STUDY DESIGN : Ten patients undergoing bilateral endoscopic ethmoidectomy in an outpatient specialty hospital operating room underwent complete filling of a r and omly selected right or left ethmoidectomy cavity  with Sepragel sinus . Outcome measures were synechiae , middle meatal stenosis , mucosal status , mucosal regeneration , transparency of Sepragel sinus , and subjective pain and congestion . RESULTS : Sepragel sinus significantly improved all 
    Output:
    
Conclusions This systematic review and meta analysis suggests that use of middle meatal packing does not significantly reduce the risk of synechiae formation after ESS .
Additional prospect i ve r and omized studies on this topic will further eluci date the utility of middle meatal packing