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A blinded randomized controlled trial evaluating the efficacy of chitosan gel on ostial stenosis following endoscopic sinus surgery
Author(s) -
Ngoc Ha Thanh,
Valentine Rowan,
Moratti Stephen,
Robinson Simon,
Hanton Lyall,
Wormald PeterJohn
Publication year - 2013
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.21136
Subject(s) - medicine , ostium , stenosis , randomized controlled trial , maxillary sinus , surgery , endoscopic sinus surgery , sinus (botany) , nuclear medicine , radiology , botany , biology , genus
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. Conclusion 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.