Evidence map›Paper›PMID 41136575›Full record

SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

Surgical extent in chronic rhinosinusitis stratified by the LOEM system: systematic review and meta-analysis.

Miriam González-García, Lucía Prieto-Sánchez-de-Puerta, Meritxell Clari-Comes, Daniel Martín-Jiménez, Julissa Vizcarra-Melgar, Concepción Gago-Torres, Carmen Palma-Martínez, Jaime González-García, Alfonso Del Cuvillo-Bernal, Isam Alobid and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Miriam González-GarcíaRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain. miriamgonga@hotmail.com.ORCID http://orcid.org/0009-0000-2151-0139
Lucía Prieto-Sánchez-de-PuertaRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.
Meritxell Clari-ComesDepartment of Otolaryngology-Head and Neck Surgery, Hospital Universitario Álava, Álava, 01009, Spain.
Daniel Martín-JiménezRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain. dmartin0701@gmail.com.
Julissa Vizcarra-MelgarDepartment of Otolaryngology-Head and Neck Surgery, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain.
Concepción Gago-TorresRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.
Carmen Palma-MartínezRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.
Jaime González-GarcíaRhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.
Alfonso Del Cuvillo-BernalRhinology and Asthma Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain.
Isam AlobidDepartment of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain.
Manuel Bernal-SprekelsenDepartment of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain.
Soledad López-EnríquezDepartamento de Bioquímica Médica y Biología Molecular e Inmunología, Universidad de Sevilla, Seville, Spain.
Ramón Moreno-Luna *Rhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.
Serafín Sánchez-Gómez *Rhinology Unit, Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Virgen Macarena, Av. Dr. Fedriani 3, Seville, 41009, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeEndoscopic sinus surgery (ESS) is widely used for chronic rhinosinusitis (CRS), but the optimal surgical extent remains unclear. The Lamella Ostium Extent Mucosa (LOEM) system provides a standardized framework to stratify surgical procedures and improve comparability. This study aimed to compare outcomes of limited versus extensive ESS and to explore results according to LOEM categories.

methodsA systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched through April 2025. Eligible studies included adults with CRS undergoing ESS comparing limited and extensive surgical approaches. Outcomes included quality of life (SNOT-22), symptom severity (VAS), recurrence, and revision surgery. Procedures were reclassified according to the LOEM system by consensus.

resultsThirteen studies involving 2,024 patients were included. Extended procedures (LOEM 2-4) were associated with fewer revisions, lower recurrence rates, and greater SNOT-22 improvement compared with limited surgery (LOEM 1). The most extensive approach (LOEM 4) showed the highest symptom improvement.

conclusionMore extensive ESS was associated with superior outcomes in CRS, including lower revision and recurrence rates and greater symptom relief. While the primary objective was to compare limited and extensive approaches, retrospective application of the LOEM classification provided a structured framework that not only confirmed these trends but also enabled more granular comparisons across surgical subtypes, from conservative functional surgery (LOEM 1-2) to radical and regenerative techniques (LOEM 3-4).

Indexed as

EndoscopyRhinitisSinusitisChronic DiseaseHumansQuality of LifeRecurrenceRhinosinusitisChronic rhinosinusitisNasal surgical proceduresParanasal Sinuses/SurgerySinusitisTreatment outcome

Identifiers

PMID41136575

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.