A blinded randomized controlled trial evaluating the efficacy of chitosan gel on ostial stenosis following endoscopic sinus surgery. Issue 7 (16th January 2013)

• Record Type: Journal Article
• Authors: Ngoc Ha, Thanh; Valentine, Rowan; Moratti, Stephen; Robinson, Simon; Hanton, Lyall; Wormald, Peter‐John
• Is Part Of: International forum of allergy & rhinology. Volume 3:Issue 7(2013:Jul.)
• Page Start: 573
• Page End: 580
• Publication Date: 2013-01-16
• Subjects: 617.51005
• DOI: 10.1002/alr.21136
• Languages: English
• ISSNs: 2042-6976

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="alr21136-sec-0010" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="alr21136-sec-0020" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="alr21136-sec-0030" sec-type="section"> <title>Results</title> <p>Intraoperative ostial areas were comparable for CD gel and control sides (38 mm<sup>2</sup> vs 39 mm<sup>2</sup>, 131 mm<sup>2</sup> vs 120 mm<sup>2</sup>, and 203 mm<sup>2</sup> vs 193 mm<sup>2</sup>, in frontal, sphenoid, and maxillary ostia, respectively; <italic>p</italic> > 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, <italic>p</italic> < 0.001; 85% vs 47% sphenoid, <italic>p</italic> < 0.001; and 74% vs 54% maxillary ostia, <italic>p</italic> = 0.002). The difference between raw ostial areas reached statistical significance in sphenoid (<italic>p</italic> < 0.001) and maxillary (<italic>p</italic> = 0.01), but not in frontal ostia (<italic>p</italic> > 0.05) at 12 weeks.</p> </sec> <sec id="alr21136-sec-0040" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>