{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T17:57:11Z","timestamp":1781459831593,"version":"3.54.1"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Rhinol&amp;#65533;Allergy"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess chitosan-based therapies after ESS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2009=\u200918.3%, 95% confidence interval: 11.6-25.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001), with greater effects in the frontal (WMD\u2009=\u200923.9%) and sphenoid (WMD\u2009=\u200923.4%) than maxillary sinus (WMD\u2009=\u20099.1%; subgroup\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.027). Pooled analyses showed chitosan-based products reduced adhesions (RR\u2009=\u20090.36,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.006) and crusting (RR\u2009=\u20090.67,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.009). 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\u2009=\u20090.64,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.007). Chitosan-based products reduced infection versus no treatment (RR\u2009=\u20090.39,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002), but not versus active comparators.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19458924261457275","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T09:17:44Z","timestamp":1781169464000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Chitosan-Based Dressings on Postoperative Outcomes in Patients Undergoing Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7428-966X","authenticated-orcid":false,"given":"Ahmed K.","family":"Almukhlifi","sequence":"first","affiliation":[{"name":"Taibah University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah O.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Qassim Health Cluster"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara S.","family":"Alansari","sequence":"additional","affiliation":[{"name":"King Saud University for Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1525-5268","authenticated-orcid":false,"given":"Osama B.","family":"Alharbi","sequence":"additional","affiliation":[{"name":"College of Medicine,Ibn Sina National College, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4528-1478","authenticated-orcid":false,"given":"Reema A.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Taibah University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed H.","family":"Alkhaldi","sequence":"additional","affiliation":[{"name":"Jouf University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Alkhorayef","sequence":"additional","affiliation":[{"name":"College of Medicine,Ibn Sina National College, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayef S.","family":"Alkhazi","sequence":"additional","affiliation":[{"name":"Ohud Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0115458"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20072"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200302000-00015"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10126-005-0097-5"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2010.24.3422"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21136"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23054"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1338209"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.21053\/ceo.2015.00591"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1945892420983645"},{"issue":"12","key":"e_1_3_2_12_2","first-page":"1181","article-title":"The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery","volume":"7","author":"Ha T","year":"2017","unstructured":"Ha T, Valentine R, Moratti S, Hanton L, Robinson S, Wormald PJ. The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery. Int Forum Allergy Rhinol. 2017;7(12):1181\u20131187.","journal-title":"Int Forum Allergy Rhinol"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.21053\/ceo.2015.00976"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22961"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23205"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2024.1196499"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/19458924251321142"}],"container-title":["American Journal of Rhinology &amp; Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19458924261457275","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19458924261457275","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19458924261457275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T17:09:27Z","timestamp":1781456967000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19458924261457275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":16,"alternative-id":["10.1177\/19458924261457275"],"URL":"https:\/\/doi.org\/10.1177\/19458924261457275","relation":{},"ISSN":["1945-8924","1945-8932"],"issn-type":[{"value":"1945-8924","type":"print"},{"value":"1945-8932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"19458924261457275"}}