{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:28:41Z","timestamp":1770960521370,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2015,10,28]],"date-time":"2015-10-28T00:00:00Z","timestamp":1445990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Evidence\u2010based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency\/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Double\u2010blinded prospective (level 1) comparison and equivalency analysis of three plant\u2010based absorbable hemostatic agents (carboxymethylcellulose [CMC] gel, mucopolysaccharide hemospheres (MPH), and potato starch wafer) in patients undergoing bilateral ESS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with medically refractory CRS who underwent bilateral ESS were recruited and prospectively followed. At the conclusion of ESS, one of three different hemostatic agents was applied to each nasal passage. Subjective patient data was obtained using rated symptoms compared between the two sides (nasal obstruction, bleeding, pain, and nasal discharge) at baseline and on postoperative days 1, 7, and 14. Objective data was obtained by blinded endoscopic scoring to rate mucosal edema, inflammation, granulation, crusting, infection, and synechiae formation on postoperative weeks 1, 3, and 6.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010eight patients who underwent ESS for CRS were included. There is no statistical difference in subjective scores for any of the variables measured, although (MPH) nearly reached statistical significance at postoperative day 7 for increased pain (<jats:italic>P<\/jats:italic> = 0.06) and obstruction (<jats:italic>P<\/jats:italic> = 0.22). Objective measures showed equivalency between all products, except the CMC gel approached significance at week 3 for increased crusting (<jats:italic>P<\/jats:italic> = 0.10), granulation (<jats:italic>P<\/jats:italic> = 0.24), and debridement (<jats:italic>P<\/jats:italic> = 0.07). At 6 weeks, increased debridement (<jats:italic>P<\/jats:italic> = 0.14) also approached significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Careful and deliberate consideration should be taken when choosing products to assist our surgical endeavors. Subjectively, patients treated with MPH showed near\u2010significant increases in pain and obstruction. In objective measures, CMC gel nearly reaches significance for more postoperative debridement, with increased crusting and inflammation. Product choice could consider these factors, although it remains at the discretion of the surgeon. This model of comparison allows careful product comparison and should be applied to other hemostatics, as well as other materials in use in otolaryngology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>1b. <jats:italic>Laryngoscope<\/jats:italic>, 126:S5\u2013S13, 2016<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.25678","type":"journal-article","created":{"date-parts":[[2015,10,28]],"date-time":"2015-10-28T12:40:15Z","timestamp":1446036015000},"source":"Crossref","is-referenced-by-count":11,"title":["Product comparison model in otolaryngology: Equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery"],"prefix":"10.1002","volume":"126","author":[{"given":"Jastin L.","family":"Antisdel","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University St. Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University St. Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Comer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Kentucky Lexington Kentucky"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Otolaryngology\u2013Head and Neck Surgery Duke University Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Gurrola","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Virginia Charlottesville Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyad","family":"Khabbaz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pittsburgh Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara","family":"Christopher","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Saint Louis University St. Louis Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stilianos","family":"Kountakis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Georgia Regents University Augusta Georgia U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,10,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3752"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-5998(95)70152-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599810391852"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20777"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e3283346f36"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.2986"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20101"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000230399.24306.50"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240501900304"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/194589240301700405"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31816c7bc9"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2010.24.3422"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2011.25.3619"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21344"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.06.078"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-008-0881-8"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.10.012"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200409000-00007"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000184581.67185.6e"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.3011"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2012.26.3813"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin11.215"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2008.22.3171"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21005"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3267"},{"key":"e_1_2_7_28_1","first-page":"112","article-title":"Prospective, double\u2010blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery","volume":"38","author":"Shoman N","year":"2009","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24543"},{"key":"e_1_2_7_30_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4193\/Rhino13.020","article-title":"Patient comfort following FESS and Nasopore packing, a double blind, prospective, randomized trial","volume":"52","author":"Kastl KG","year":"2014","journal-title":"Rhinology"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31816ba576"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3266"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-013-1767-0"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21136"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20905"},{"issue":"1","key":"e_1_2_7_36_1","first-page":"S14","article-title":"Double\u2010blinded, randomized, controlled trial of medicated versus nonmedicated merocel sponges for functional endoscopic sinus surgery","volume":"40","author":"Chang EH","year":"2011","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2013.27.3942"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2013.27.3924"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20067"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2014.28.4053"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2010.24.3523"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010014\u20103107\u20102"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.25678","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.25678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T12:03:28Z","timestamp":1695989008000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.25678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,28]]},"references-count":41,"journal-issue":{"issue":"S2","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1002\/lary.25678"],"URL":"https:\/\/doi.org\/10.1002\/lary.25678","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,28]]}}}