The efficacy of a novel chitosan gel on hemostasis after endoscopic sinus surgery in a sheep model of chronic rhinosinusitis

Am J Rhinol Allergy. 2009 Jan-Feb;23(1):71-5. doi: 10.2500/ajra.2009.23.3266.


Background: Postoperative bleeding remains a major problem after endoscopic sinus surgery (ESS). Patients who continue to bleed after ESS are at risk of airway compromise from inhalation of blood clots or from aspiration of blood-stained vomitus. The aim of this study was to determine the in vivo efficacy of a novel gel on hemostasis after ESS in a sheep model of chronic rhinosinusitis.

Methods: Twenty-one sheep infested with Oestrus ovus underwent ESS with standardized mucosal injuries created at the anterior ethmoid region using a microdebrider. Immediately after injury a baseline bleeding time was taken using the Boezaart Surgical Field Grading Scale. Computer randomization was performed to either receive chitosan/dextran (CD) gel or no treatment (control). Boezaart bleeding scores were calculated for each side every 2 minutes. Each postoperative day videoendoscopy was performed to document crusting/CD gel dissolution.

Results: The CD gel side was significantly more hemostatic at 2, 4, and 6 minutes after injury. Average time to hemostasis was significantly better for the intervention side versus control side, 4.09 (+/-1.61) versus 6.57 (+/-2.20), respectively (p = 0.049). Complete hemostasis occurred by 6 minutes for all CD gel sides; however, control side bleeding was noted on three sides at 8 minutes and on one side at 10 minutes. There was no significant difference in crusts scores at days 1, 3, 7, and 14.

Conclusion: In the sheep model of ESS, CD gel significantly improved hemostasis compared with the control at 2, 4, and 6 minutes after mucosal injury.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Intranasal
  • Animals
  • Chitosan / administration & dosage*
  • Disease Models, Animal
  • Endoscopy / methods*
  • Ethmoid Sinusitis / surgery*
  • Gels
  • Hemostasis, Endoscopic / methods*
  • Hemostatics / administration & dosage
  • Otorhinolaryngologic Surgical Procedures / methods*
  • Postoperative Hemorrhage / therapy*
  • Rhinitis / surgery*
  • Sheep
  • Video Recording


  • Gels
  • Hemostatics
  • Chitosan