title: A blinded randomized controlled trial evaluating the efficacy of chitosan gel on ostial stenosis following endoscopic sinus surgery.
abstract: BACKGROUND
  Stenosis of sinus ostia following endoscopic sinus surgery (ESS) is the most common reason for revision surgery. Chitosan-dextran (CD) gel has been shown to be an effective hemostatic agent; however, its effects on ostial stenosis are unknown. This study aims to quantify the effect of CD gel on circumferential scarring following ESS.
  
  
  METHODS
  A prospective, blinded, randomized, controlled trial was conducted in 26 patients undergoing ESS. Measurements of neo-ostia were taken using a standard-sized measuring probe. CD gel was applied unilaterally, while contralateral sides received no gel. Ostial diameters were measured by a blinded observer at 2, 8, and 12 weeks postoperation. Sinus ostial areas calculated as a proportion of the original were compared for each ostium at each time point.
  
  
  RESULTS
  Intraoperative ostial areas were comparable for CD gel and control sides (38 mm(2) vs 39 mm(2) , 131 mm(2) vs 120 mm(2) , and 203 mm(2) vs 193 mm(2) , in frontal, sphenoid, and maxillary ostia, respectively; p > 0.05). CD gel significantly improved sinus ostial patency. The largest difference was seen when ostial areas at 12 weeks were compared with their corresponding baseline areas (66% vs 31% frontal, p < 0.001; 85% vs 47% sphenoid, p < 0.001; and 74% vs 54% maxillary ostia, p = 0.002). The difference between raw ostial areas reached statistical significance in sphenoid (p < 0.001) and maxillary (p = 0.01), but not in frontal ostia (p > 0.05) at 12 weeks.
  
  
  CONCLUSIONS
  CD gel produced significantly less stenosis of all neo-ostia following ESS and may reduce the necessity for revision surgery in patients with chronic rhinosinusitis.
authors: Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
authors: Thanh
authors: T
authors: Ngoc Ha
authors: Rowan
authors: R
authors: Valentine
authors: Stephen
authors: S
authors: Moratti
authors: Simon
authors: S
authors: Robinson
authors: Lyall
authors: L
authors: Hanton
authors: Peter-John
authors: PJ
authors: Wormald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D048271:Chitosan / Q000008:administration & dosage*; D003251:Constriction, Pathologic / Q000188:drug therapy*; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D005782:Gels; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003911:Dextrans; D005782:Gels; D048271:Chitosan
keywords: chitosan; chronic rhinosinusitis; dextran; endoscopic sinus surgery; hemostasis; ostial stenosis; wound healing