Injectable Chitosan Hydrogel Particles as Nasal Packing Materials After Endoscopic Sinus Surgery for Treatment of Chronic Sinusitis

Abstract

After endoscopic sinus surgery (ESS), nasal packing is often used to stop bleeding and promote wound healing. Because maintaining a moist environment is important to enhance wound healing, hydrogel-based wound dressings are effective to promote wound healing. Chitosan is used in the medical field because of its high hemostatic and wound healing properties. We developed a pH-neutral and non-toxic chitosan hydrogel, which was difficult to achieve using conventional methods. In this study, we show in animal experiments that the chitosan hydrogel (hydrogel particles) had higher wound healing properties than a commercially available solid wound dressing (dry state) composed of the same polymer. Additionally, we applied the injectable chitosan hydrogel particles as nasal packing materials to patients with bilateral chronic sinusitis undergoing ESS in a pilot clinical study. Concerning symptom scores, though the results narrowly missed statistical differences (p < 0.05), the average scores of our chitosan hydrogel were superior to those of a commercially available wound dressing (especially p = 0.09 for nasal bleeding). These findings suggest that the injectable chitosan hydrogel could be a viable option as a packing material following ESS.