EFFICACY OF PLATELET-RICH PLASMA NASAL PACKING IN ENDOSCOPIC SINUS SURGERY: A PROSPECTIVE RANDOMISED CONTROLLED SPLIT-NOSE STUDY

Abstract

Background: Mucosal re-epithelialisation after functional endoscopic sinus surgery (FESS) determines long-term surgical success, yet conventional nasal packing does little to promote it. Platelet-rich plasma (PRP) is an autologous concentrate of growth factors with established pro-healing, angiogenic and anti-inflammatory activity. Objective: To evaluate the efficacy of PRP-impregnated nasal packing on post-operative mucosal healing, bleeding, crusting, infection and synechiae formation after FESS for chronic rhinosinusitis (CRS). Methods: A prospective randomised controlled split-nose trial was conducted on 63 patients aged 18–60 years with medically refractory CRS and a Lund–Mackay score above 8. In each patient, one nasal cavity was packed with a PRP impregnated pack and the contralateral cavity with a saline-impregnated pack, allocated by an alternate-sequence method, so that every patient served as his or her own control. Packs were removed at 48 hours by a single blinded endoscopist. Sides were graded using the Lund–Kennedy endoscopic score at weeks 1, 2, 4 and 8, and SNOT-22 was recorded before surgery and at week 8. Paired comparisons used the Wilcoxon signed-rank and McNemar exact tests. Results: Lund–Kennedy scores were significantly lower on the PRP side at every visit. At week 8 the PRP side scored 0.76 ± 0.71 versus 1.35 ± 0.74 on the saline side (mean difference 0.59, 95% CI 0.38–0.79; p < 0.001; Cohen's d = 0.81). At 48-hour pack removal the PRP side showed less bleeding (1.29 ± 0.73 vs 1.86 ± 0.69; p < 0.001), less crusting (23, 36.5% vs 46, 73.0%; p < 0.001) and less pain (1.16 ± 0.65 vs 1.76 ± 0.64; p < 0.001). Crusting was significantly reduced on the PRP side from week 2 onwards, and synechiae at week 8 occurred in 3 sides (4.8%) on the PRP side versus 11 (17.5%) on the saline side (p = 0.039). Infection rates did not differ. SNOT-22 improved from 54.5 ± 9.5 to 22.7 ± 5.2 (mean reduction 31.9 points; p < 0.001). Conclusion: PRP-impregnated nasal packing is a safe, inexpensive, autologous adjunct that accelerates mucosal healing and significantly reduces bleeding, crusting, pain and synechiae formation after endoscopic sinus surgery, without increasing infective risk.