The Effect of Chitosan-Based Dressings on Postoperative Outcomes in Patients Undergoing Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis

Background Endoscopic sinus surgery (ESS) remains the gold standard for chronic rhinosinusitis, but complications such as adhesions, ostial stenosis, and poor mucosal healing occur. Chitosan-based nasal packs and gels have been proposed as adjuncts for their hemostatic and anti-adhesive properties. Objective To assess chitosan-based therapies after ESS. Methods Randomized trials comparing chitosan-based products with no treatment, standard care, or active comparators were included; active comparators included standard dressings or biomaterials, whereas no-treatment comparisons reflected split-nose designs. Outcomes were ostial area preservation and wound-healing parameters at final follow-up. Random-effects models pooled weighted mean differences (WMDs) for ostial outcomes and risk ratios (RRs) for binary outcomes. Results Ten randomized controlled trials were included (5 reporting ostial outcomes, up to 9 reporting binary outcomes). Six studies compared chitosan-based products with no treatment and 4 with active comparators. At final follow-up, chitosan-based products improved ostial area preservation versus no treatment (WMD = 18.3%, 95% confidence interval: 11.6-25.1%; P < .0001), with greater effects in the frontal (WMD = 23.9%) and sphenoid (WMD = 23.4%) than maxillary sinus (WMD = 9.1%; subgroup P = .027). Pooled analyses showed chitosan-based products reduced adhesions (RR = 0.36, P = .006) and crusting (RR = 0.67, P = .009). However, after stratification by comparator type, neither adhesions nor crusting remained significant in the no-treatment subgroup, whereas crusting remained significant only versus active comparators (RR = 0.64, P = .007). Chitosan-based products reduced infection versus no treatment (RR = 0.39, P = .002), but not versus active comparators. Conclusions Chitosan-based preparations may preserve frontal and sphenoidal but not maxillary ostial size and reduce infection when compared with no treatment. Reduced crusting was observed only with active comparators. Small subgroup sizes and limited head-to-head evidence do not support claims of superiority; given the cost of chitosan-based dressings, more RCTs are needed.