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BACKGROUND: Hyaluronic acid has gained widespread attention for its potential role in sinonasal surgery, especially functional endoscopic sinus surgery (FESS), due to its wound healing and anti-inflammatory properties. However, clinical evidence on its efficacy remains inconclusive. This meta-analysis aims to clarify the efficacy of hyaluronic acid in improving both objective and subjective outcomes after sinonasal surgery. METHODS: Two blinded reviewers searched PubMed, Embase, and Scopus databases, then selected randomized controlled trials (RCTs) on hyaluronic acid use in sinonasal surgery compared to routine post-operative care. The risk of bias was graded using the Cochrane Risk of Bias 2 (RoB 2) tool. Data was analyzed using random-effects models to pool risk ratios for dichotomous outcomes and the ratio of means (RoM) for continuous outcomes. Publication bias was assessed via funnel plots and the trim-and-fill method. RESULTS: From 244 records, 15 RCTs-13 on FESS and two on septoplasty and inferior turbinoplasty-were selected, with 789 participants. Meta-analysis for the 13 studies on FESS was performed. Hyaluronic acid significantly reduced synechiae formation (relative risk [RR] 0.65, 95% confidence interval [CI] 0.44-0.94), improved epithelialization (RR 0.48, 95% CI 0.27-0.86), and decreased post-operative edema (RR 0.70, 95% CI 0.50-0.97) compared to routine post-FESS care. All included studies had a low to moderate risk of bias, and there was no substantial publication bias. There were no adverse events reported. CONCLUSIONS: Hyaluronic acid dressings are safe and may reduce synechiae, edema, and improve epithelialization after sinonasal surgery. Hyaluronic acid may be considered as an adjunct after FESS to optimize post-operative outcomes.