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Xiong W, Zhu Q, Hu X, Yuan Y, Zhao Y, Jing X, Guo Q. Association of Childhood IgA Vasculitis With Allergic Rhinitis and Chronic Rhinosinusitis. Kidney Int Rep 2024; 9:2759-2766. [PMID: 39291203 PMCID: PMC11403040 DOI: 10.1016/j.ekir.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/11/2024] [Accepted: 07/02/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Immunoglobulin A vasculitis (IgAV) is related to chronic inflammation; however, little is known about the associations between IgAV and allergic rhinitis (AR) or chronic rhinosinusitis (CRS). We evaluated the relationships among IgAV, AR, and CRS in children. Methods The clinical data of children with IgAV who were hospitalized from January to December 2019 were analyzed retrospectively. Four groups were created, the simple AR, simple CRS, AR + CRS, and non-AR or non-CRS groups, to explore the relationships among IgAV, AR, and CRS. Results We included 504 children with IgAV; and 357 (70.8%) were combined with AR or CRS, including 51 with simple AR, 70 with simple CRS, and 236 with AR + CRS. The incidences of renal involvement and recurrent rash were significantly higher in the simple AR group than in the non-AR or non-CRS group (P < 0.001). The incidences of renal involvement and recurrent rash were significantly higher in the AR + CRS group than in the non-AR or non-CRS group (P < 0.001). The incidences of renal involvement between the simple CRS group and non-AR or non-CRS group did not differ significantly, but that of recurrent rash was significantly higher than that in the other groups (P < 0.001). Age, abdominal pain, recurrent rash, simple AR, and AR combined with CRS were risk factors for renal involvement (all odds ratio [OR] > 1, P < 0.05). Conclusion Chronic rhinitis may be related to the pathogenesis of IgAV, and AR or CRS may be the triggering factors of IgAV. AR may be a risk factor for renal involvement and recurrent rash in patients with IgAV.
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Affiliation(s)
- Weilin Xiong
- Pediatric Hospital of the First affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
- Department of Pediatrics, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Qingjun Zhu
- Department of Scientific Research, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Xiaolei Hu
- Department of Pediatrics, Yinchuan First People's Hospital, Yinchuan, China
| | - Yehong Yuan
- Pediatric Hospital of the First affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
- Department of Pediatrics, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yongwang Zhao
- Pediatric Hospital of the First affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
- Department of Pediatrics, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Xiaoping Jing
- Department of Traditional Chinese Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingyin Guo
- Pediatric Hospital of the First affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
- Department of Pediatrics, Henan University of Traditional Chinese Medicine, Zhengzhou, China
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2
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Narasimhan G, Deshmukh PT, Gaurkar SS, Khan FQ. A Comprehensive Review Exploring Allergic Rhinitis With Nasal Polyps: Mechanisms, Management, and Emerging Therapies. Cureus 2024; 16:e59191. [PMID: 38807811 PMCID: PMC11130740 DOI: 10.7759/cureus.59191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/28/2024] [Indexed: 05/30/2024] Open
Abstract
Allergic rhinitis (AR) and nasal polyps (NP) are common inflammatory disorders of the upper airways that often coexist and significantly impact patients' quality of life. This comprehensive review explores the intricate relationship between AR and NP, elucidating the underlying mechanisms, clinical manifestations, and management strategies. Immunological mechanisms, genetic predispositions, and environmental factors contribute to the development and progression of both conditions. Pharmacological therapies, including intranasal corticosteroids and biologic agents, are cornerstone treatments for managing AR with NP. At the same time, surgical interventions such as functional endoscopic sinus surgery (FESS) may be necessary in refractory cases. Emerging therapies, including immunomodulatory agents and precision medicine approaches, hold promise in improving treatment outcomes. A multidisciplinary approach, personalized treatment plans, and patient education are essential for optimizing clinical practice. Future research should focus on identifying novel therapeutic targets, conducting large-scale clinical trials, exploring precision medicine approaches, and investigating the role of the microbiome. Addressing these research priorities and implementing evidence-based treatment strategies can improve outcomes for patients with AR and NP.
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Affiliation(s)
- Gowtham Narasimhan
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad T Deshmukh
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sagar S Gaurkar
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Farhat Q Khan
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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3
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Ismail KA, Mukherjee M, Kareta MS, Lopez SMC. Enabling methanol fixation of pediatric nasal wash during respiratory illness for single cell sequencing in comparison with fresh samples. Pediatr Res 2024; 95:835-842. [PMID: 37758866 DOI: 10.1038/s41390-023-02780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) including pneumonia, bronchitis, and bronchiolitis is the sixth leading cause of mortality around the world and leading cause of death in children under 5 years. Systemic immune response to viral infection is well characterized. However, there is little data regarding the immune response at the upper respiratory tract mucosa. The upper respiratory mucosa is the site of viral entry, initial replication and the first barrier against respiratory infections. Lower respiratory tract samples can be challenging to obtain and require more invasive procedures. However, nasal wash (NW) samples from the upper respiratory tract can be obtained with minimal discomfort to the patient. METHOD In a pilot study, we developed a protocol using NW samples obtained from hospitalized children with LRTI that enables single cell RNA sequencing (scRNA-seq) after the NW sample is methanol-fixed. RESULTS We found no significant changes in scRNA-seq qualitative and quantitative parameters between methanol-fixed and fresh NW samples. CONCLUSIONS We present a novel protocol to enable scRNA-seq in NW samples from children admitted with LRTI. With the inherent challenges associated with clinical samples, the protocol described allows for processing flexibility as well as multicenter collaboration. IMPACT There are no significant differences in scRNA-seq qualitative and quantitative parameters between methanol fixed and fresh Pediatric Nasal wash samples. The study demonstrates the effectiveness of methanol fixation process on preserving respiratory samples for single cell sequencing. This enables Pediatric Nasal wash specimen for single cell RNA sequencing in pediatric patients with respiratory tract infection and allows processing flexibility and multicenter collaboration.
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Affiliation(s)
- Khaled A Ismail
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD, USA
| | - Malini Mukherjee
- Functional Genomics and Bioinformatics Core, Sioux Falls, SD, USA
| | - Michael S Kareta
- Functional Genomics and Bioinformatics Core, Sioux Falls, SD, USA
- Genetics & Genomics Group, Sanford Research, Sioux Falls, SD, USA
- Department of Pediatrics, Sanford School of Medicine-University of South Dakota, Sioux Falls, SD, USA
| | - Santiago M C Lopez
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD, USA.
- Department of Pediatrics, Sanford School of Medicine-University of South Dakota, Sioux Falls, SD, USA.
- Children's Health Specialty Clinic, Sanford Children's Hospital, Sioux Falls, SD, USA.
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Pourmehran O, Zarei K, Pourchez J, Vreugde S, Psaltis A, Wormald PJ. Advancements in acoustic drug delivery for paranasal sinuses: A comprehensive review. Int J Pharm 2023; 644:123277. [PMID: 37516215 DOI: 10.1016/j.ijpharm.2023.123277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Chronic rhinosinusitis (CRS) impacts patients' quality of life and healthcare costs. Traditional methods of drug delivery, such as nasal sprays and irrigation, have limited effectiveness. Acoustic Drug Delivery (ADD) using a nebulizer offers targeted delivery of drug to the sinuses, which may improve the treatment of CRS. This review examines the influence of aerosol particle characteristics, aero-acoustic parameters, inlet flow conditions, and acoustic waves on sinus drug delivery. Key findings reveal that smaller particles improve the ADD efficiency, whereas larger sizes or increased density impair it. The oscillation amplitude of the air plug in the ostium is crucial for the ADD efficiency. Introducing acoustic waves at the NC-sinus system's resonance frequency improves aerosol deposition within sinuses. Future research should address advanced models, optimizing particle characteristics, investigating novel acoustic waveforms, incorporating patient-specific anatomy, and evaluating long-term safety and efficacy. Tackling these challenges, ADD could offer more effective and targeted treatments for sinus-related conditions such as CRS.
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Affiliation(s)
- Oveis Pourmehran
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
| | - Kavan Zarei
- Faculty of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Jeremie Pourchez
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Alkis Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
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Trincianti C, Tosca MA, Ciprandi G. Updates in the diagnosis and practical management of allergic rhinitis. Expert Rev Clin Pharmacol 2023; 16:669-676. [PMID: 37314373 DOI: 10.1080/17512433.2023.2225770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/12/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a widespread disease that can be associated with other conditions, including conjunctivitis, rhinosinusitis, asthma, food allergy, and atopic dermatitis. Diagnosis is based on the history and documentation of sensitization, such as the production of allergen-specific IgE, preferably using molecular diagnostics. Treatments are based on patient education, non-pharmacological and pharmacological remedies, allergen-specific immunotherapy (AIT), and surgery. Symptomatic treatments mainly concern intranasal/oral antihistamines and/or nasal corticosteroids. AREAS COVERED This review discusses current and emerging management strategies for AR, covering pharmacological and non-pharmacological remedies, AIT, and biologics in selected cases with associated severe asthma. However, AIT presently remains the unique causal treatment for AR. EXPERT OPINION The management of allergic rhinitis could include new strategies. In this regard, particular interest should be considered in the fixed association between intranasal antihistamines and corticosteroids, probiotics and other natural substances, and new formulations (tablets) of AIT.
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6
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Verma RR, Verma R. Sinonasal Irrigation After Endoscopic Sinus surgery - Past to Present and Future. Indian J Otolaryngol Head Neck Surg 2023:1-8. [PMID: 37362105 PMCID: PMC10148615 DOI: 10.1007/s12070-023-03525-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/21/2023] [Indexed: 06/28/2023] Open
Abstract
Functional endoscopic sinus surgery (FESS) is the gold standard treatment for medically refractive chronic rhinosinusitis, aimed at removing diseased tissue and improving natural sinus drainage and aeration. Irrigation of the sinuses has been known to improve sinus mucosal health and is an essential adjunct to surgery. There are a number of methods, devices, and solutions available which are used for nasal irrigation. Neti Pot, squeeze bottle, syringe, rubber bulb and commercially available nasal sprays are some of the simpler used devices used for douching. Electric devices like flosser, Hydropulse and the Navage nasal irrigation systems are available but it's not clear if they provide any advantage over the other methods. We use and propose a gravitational pressure-pulsed device which provides adequate volume and force without the need for external pressure. Salt with sodium bicarbonate is the most used solution base. Hypertonic saline has been described to be more efficacious compared to isotonic saline. Additives such as sodium hypochlorite, antibiotics, corticosteroids, manuka honey and xylitol have proven to be beneficial. Large volume positive pressure irrigations have proven to be beneficial. Optimal position for irrigation varies for low or high-volume irrigation systems. Patient education regarding precautions and disinfection of the device is a must.
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Affiliation(s)
- Ravneet Ravinder Verma
- Department of ENT Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Ravinder Verma
- Verma Hospital and Research Centre, Gujral Nagar, Jalandhar, 144001 India
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7
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Bernstein JA, White AA, Han JK, Lang DM, Elkayam D, Baroody FM. Review of evidence supporting the use of nasal corticosteroid irrigation for chronic rhinosinusitis. Ann Allergy Asthma Immunol 2023; 130:46-57. [PMID: 36116748 DOI: 10.1016/j.anai.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze published reports on the efficacy and safety of CSI in CRS and evaluate the clinical implications of current gaps in evidence. Corticosteroid irrigation (CSI) is commonly used for management of chronic rhinosinusitis (CRS) with nasal polyps; however, such use is not approved by the US Food and Drug Administration (FDA). DATA SOURCES Publications were obtained through PubMed searches through January 2022. STUDY SELECTION Searches were conducted using 2 terms: "chronic rhinosinusitis" or "nasal polyps" as the first term and "corticosteroid irrigation," "steroid nasal lavage," or "sinus rinse" as the second term. We reviewed relevant, peer-reviewed literature (19 original research [9 controlled, 10 uncontrolled trials], 7 reviews, and 1 meta-analysis) reporting safety and efficacy of CSI in patients with CRS. RESULTS Studies were difficult to compare because they used a variety of solution volumes (60 mL to 125 mL per nostril), corticosteroid agents (budesonide, betamethasone, mometasone, or fluticasone), corticosteroid doses, preparation protocols (by compounding pharmacy or by patient), and administration (frequency, time of day, body positioning). It is difficult to determine which parameters might substantially influence clinical effects because studies were generally small, showed marginal benefits, and rarely assessed safety. To date, no studies evaluating CSI have shown statistically significant differences in a type-I error-controlled primary end point over any comparator, possibly owing to small sample sizes. CONCLUSION Designing more robust clinical trials may help determine whether CSI is a valid treatment option. Until more evidence supporting CSI use exists, health care professionals should strongly consider choosing FDA-approved therapies for the treatment of CRS.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Immunology-Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew A White
- Division of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, California
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Elkayam
- Bellingham Asthma, Allergy and Immunology Clinic, Bellingham, Washington
| | - Fuad M Baroody
- Department of Surgery (Otolaryngology-Head and Neck Surgery) and Pediatrics, University of Chicago Medicine and the Comer Children's Hospital, Chicago, Illinois
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8
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Asghar A, Imran HM, Bano N, Maalik S, Mushtaq S, Hussain A, Varjani S, Aleya L, Iqbal HMN, Bilal M. SARS-COV-2/COVID-19: scenario, epidemiology, adaptive mutations, and environmental factors. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:69117-69136. [PMID: 35947257 PMCID: PMC9363873 DOI: 10.1007/s11356-022-22333-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
The coronavirus pandemic of 2019 has already exerted an enormous impact. For over a year, the worldwide pandemic has ravaged the whole globe, with approximately 250 million verified human infection cases and a mortality rate surpassing 4 million. While the genetic makeup of the related pathogen (SARS-CoV-2) was identified, many unknown facets remain a mystery, comprising the virus's origin and evolutionary trend. There were many rumors that SARS-CoV-2 was human-borne and its evolution was predicted many years ago, but scientific investigation proved them wrong and concluded that bats might be the origin of SARS-CoV-2 and pangolins act as intermediary species to transmit the virus from bats to humans. Airborne droplets were found to be the leading cause of human-to-human transmission of this virus, but later studies showed that contaminated surfaces and other environmental factors are also involved in its transmission. The evolution of different SARS-CoV-2 variants worsens the condition and has become a challenge to overcome this pandemic. The emergence of COVID-19 is still a mystery, and scientists are unable to explain the exact origin of SARS-CoV-2. This review sheds light on the possible origin of SARS-CoV-2, its transmission, and the key factors that worsen the situation.
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Affiliation(s)
- Asma Asghar
- Department of Biochemistry, University of Agriculture Faisalabad, Faisalabad, 38000, Pakistan
| | - Hafiz Muhammad Imran
- Department of Biochemistry, Government College University Faisalabad, Faisalabad, 38000, Pakistan
| | - Naheed Bano
- Department of Fisheries & Aquaculture, MNS-University of Agriculture, Multan, Pakistan
| | - Sadia Maalik
- Department of Zoology, Government College Women University, Sialkot, Pakistan
| | - Sajida Mushtaq
- Department of Zoology, Government College Women University, Sialkot, Pakistan
| | - Asim Hussain
- Department of Biochemistry, University of Agriculture Faisalabad, Faisalabad, 38000, Pakistan
| | - Sunita Varjani
- Gujarat Pollution Control Board, Gandhinagar, 382 010, Gujarat, India
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Hafiz M N Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, 64849, Monterrey, Mexico
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huai'an, 223003, China.
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9
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Roberts AEL, Xanthe C, Hopkins AL, Bodger O, Lewis P, Mahenthiralingam E, Duckers J, Jenkins RE. A pilot study investigating the effects of a manuka honey sinus rinse compared to a standard sinus rinse on sino-nasal outcome test scores in cystic fibrosis patients. Pilot Feasibility Stud 2022; 8:216. [PMID: 36153609 PMCID: PMC9508718 DOI: 10.1186/s40814-022-01175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background People with cystic fibrosis (CF) are prone to bacterial respiratory infections; these are often antibiotic resistant, are difficult to treat, and impact on the quality of life and lung function. The upper respiratory tract can act as a reservoir for these pathogens, and as part of clinical care, sinus rinses are used to alleviate symptoms in the upper airway. We have developed a sinus rinse containing manuka honey, to identify whether it can help improve symptoms or reduce the bacterial load. Methods We will undertake a randomised controlled trial where 30 adults with CF will be recruited and randomised to either the control or intervention group. Both groups will follow a sinus rinse protocol for 30 days (± 7 days); the control group will use the standard of care rinse, and the intervention group will use a manuka honey rinse. Both groups will provide samples at day 0 and day 30. The primary outcome measure will be a change in the 22-item Sino-Nasal Outcome Test (SNOT-22) score. Secondary outcomes will include changes to quality of life (questionnaire), bacterial load/community composition, and sputum viscosity. Discussion This trial will look at the use of a manuka honey-infused sinus rinse solution on patients diagnosed with cystic fibrosis (CF) suffering with sinusitis; it will allow us to determine the efficacy of the manuka honey sinus rinse compared to standard rinse and will allow us to determine if molecular bacterial diversity analysis will provide in-depth information beyond the usual conventional microbiological. It will allow us to determine the feasibility of recruiting participants to this type of trial, allow us to check participant compliance with the protocol, and inform future studies. Trial registration Approval was obtained from the Research Ethics Committee Wales REC7 reference 18/WA/0319. Results of this study will be published at international conferences and in peer-reviewed journals; they will also be presented to the relevant stakeholders and research networks. Trial registration number: ClinicalTrials.gov Identifier NCT04589897 (retrospectively registered)
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Chitsuthipakorn W, Kanjanawasee D, Hoang MP, Seresirikachorn K, Snidvongs K. Benefits of nasal saline treatment in acute rhinosinusitis: Systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12:1006-1017. [PMID: 34971301 DOI: 10.1002/alr.22957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/30/2021] [Accepted: 12/24/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS), the evidence in adult patients is inconclusive. Our objective was to assess the add-on benefits of saline treatment in adults with ARS. METHODS Literature searches were performed (updated May 9, 2021). Randomized, controlled trials studying the effects of nasal saline treatment in adults with ARS were included. Data were pooled for meta-analysis. Outcomes were composite symptoms score (CSS), disease-specific quality-of-life (DS-QoL) score, individual symptom score, endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. RESULTS Eleven studies (718 patients) were included in our investigation. Nasal discharge was the only symptom improved (standardized mean difference [SMD], -0.36; 95% confidence interval [CI], -0.66 to -0.05]. Saline as an add-on treatment brought no benefit to CSS and DS-QoL score at both time-points (3-10 days and at the end of the study). Other outcomes also showed no benefits with use of saline, including endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. Subgroup analyses showed improvement in viral ARS patients for CSS (SMD, -0.60; 95% CI, -1.12 to -0.08) and DS-QoL score (mean difference, -15.90; 95% CI, -31.78 to -0.02), and also in patients using high-volume saline (SMD, -0.42; 95% CI, -0.78 to -0.06). CONCLUSION Nasal saline as an add-on treatment improved rhinorrhea. There was no improvement in CSS and DS-QoL, except among the subgroup of viral ARS patients using high-volume saline. There were no differences in adverse events between the saline and non-saline treatments.
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Affiliation(s)
- Wirach Chitsuthipakorn
- Center of Excellence in Otolaryngology, Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Dichapong Kanjanawasee
- Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Research Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Minh P Hoang
- Department of Otolaryngology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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11
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Yang Y, Sun Y, Xiang F, Zhang M, Fu L, Zhang Q. Efficacy and safety of traditional Chinese medicine nasal irrigation on chronic rhinosinusitis recovery after endoscopic sinus surgery: A protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0272371. [PMID: 35913939 PMCID: PMC9342793 DOI: 10.1371/journal.pone.0272371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Continuous comprehensive treatment is still needed after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) to promote the recovery of sinus mucosal morphology and function. Traditional Chinese medicine (TCM) nasal irrigation is a promising external treatment of TCM, but at present, the application of TCM nasal irrigation after ESS for CRS has not been recommended by the guidelines. Therefore, this article aims to develop a systematic overview and meta-analysis protocol to assess the effectiveness and safety of Chinese herbal nasal rinse for CRS recovery after ESS.
Methods
Seven databases shall be retrieved from their inception until December 2021. Eligible randomized controlled trials will be covered in the study. The outcome indicators of the survey will consist of efficacy, visual analogue scale score, Lund-Kennedy score for nasal endoscopy, Lund-Mackay score for sinus computed tomography and other secondary outcome indicators. The selection of literature, extraction of data, and methodological quality evaluation of literature shall be conducted by two researchers separately. If there is any dispute, it can be discussed and solved by a third researcher. Review Manager 5.3 software will be applied to data analysis.
Results
The article will make a detailed research programme to explore the efficacy and safety of TCM nasal irrigation on CRS recovery after ESS.
Conclusion
This protocol is suitable for evaluating the effectiveness and safety of TCM nasal rinse for CRS recovery after ESS, and can provide corresponding evidence-based medical evidence.
Systematic review registration
Open Science Framework Registration DOI: 10.17605/OSF.IO/ZV73Q.
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Affiliation(s)
- Yepeng Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Yaning Sun
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Feng Xiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Min Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Li Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P.R. China
- World Health Organization Collaborating Centre, CHN-56, Chengdu, Sichuan Province, P.R. China
- * E-mail:
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12
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Audag N, Cnockaert P, Reychler G, Poncin W. Consensus on Nasal Irrigation in Infants: A Delphi Study. Ann Otol Rhinol Laryngol 2022; 132:674-683. [PMID: 35833594 DOI: 10.1177/00034894221112514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nasal irrigation is regularly used in infants to relieve upper airway symptoms. However, because there is no consensus on good practice, nasal irrigation in infants is described and applied heterogeneously among clinicians and between clinical trials. OBJECTIVE The aim of this study was to establish consensus regarding the use of nasal irrigation in infants. METHODS A panel of Belgian physiotherapists and physicians experienced in performing nasal irrigation in infants were surveyed using the Delphi technique. Three survey rounds were used. Participants rated their level of (dis)agreement to each statement in each round using a 6-point Likert scale. Consensus was defined for statements which collected at least 75% of responses in agreement or disagreement. The questionnaire of Round 1 was built on nasal irrigation practice habits previously collected from parents, childcare workers, and healthcare professionals. Questionnaires from rounds 2 and 3 were amended based on experts written feedback. RESULTS Thirty experts (12 physicians and 18 physiotherapists) completed all 3 questionnaires. Consensus was achieved for 47 of 75 statements (63%) distributed over the following domains: "contraindications," "indications and frequency of use," "irrigation means," "solution preparation," "solution volume," "realization of the technique," and "assessment of the efficacy of nasal irrigation." CONCLUSION This study provides the first well-constructed consensus on good practice on nasal irrigation in infants. Consensus on several statements across different domains were established but require validation in future trials. This study also proposes direction for future research focusing on statements that did not reach consensus.
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Affiliation(s)
- Nicolas Audag
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute Ecole Vinci-Secteur Santé-Département de kinésithérapie, Brussels, Belgium
| | - Pierre Cnockaert
- Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute Ecole Vinci-Secteur Santé-Département de kinésithérapie, Brussels, Belgium
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute Ecole Vinci-Secteur Santé-Département de kinésithérapie, Brussels, Belgium
| | - William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute Ecole Vinci-Secteur Santé-Département de kinésithérapie, Brussels, Belgium
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13
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Audag N, Dubus JC, Combret Y. [Respiratory physiotherapy in pediatric practice]. Rev Mal Respir 2022; 39:547-560. [PMID: 35738979 DOI: 10.1016/j.rmr.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 01/11/2023]
Abstract
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
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Affiliation(s)
- N Audag
- Institut de recherche expérimentale et clinique, pôle de pneumologie, ORL & dermatologie, groupe recherche en kinésithérapie respiratoire, université Catholique de Louvain, Bruxelles, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, Bruxelles 1200, Belgique.
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-Enfants, Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - Y Combret
- Secteur de kinésithérapie, Groupe Hospitalier du Havre, 76600 Le Havre, France
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14
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The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions. Mar Drugs 2022; 20:md20050330. [PMID: 35621981 PMCID: PMC9147352 DOI: 10.3390/md20050330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.
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15
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Park DY, Choi JH, Kim DK, Jung YG, Mun SJ, Min HJ, Park SK, Shin JM, Yang HC, Hong SN, Mo JH. Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults. Clin Exp Otorhinolaryngol 2022; 15:5-23. [PMID: 35158420 PMCID: PMC8901942 DOI: 10.21053/ceo.2021.00654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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16
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Nasal irrigation practice habits in infants: A Belgian survey: Nasal irrigation practice habits in infants. Arch Pediatr 2022; 29:200-206. [PMID: 35094908 DOI: 10.1016/j.arcped.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nasal irrigation is widely used in infants to relieve nasal obstruction. However, the nasal irrigation technique has not been standardized, and nasal irrigation practice habits (NIPH) in infants have not been investigated. Our objective was to provide an overview of NIPH in infants among parents, childcare workers, and healthcare professionals living in Belgium. METHODS Parents, childcare workers, physiotherapists, nurses, pharmacists, and physicians were invited to fill in an electronic survey questioning their NIPH in infants. The survey was disseminated through social networks, practitioners' associations, and creches. RESULTS The questionnaire was fully completed by 359 participants. A ready-made solution was used by 93% of participants, of whom 92% used physiological saline. The prophylactic use of nasal irrigation was considered appropriate or very appropriate by 65% of all participants. The irrigation frequency was particularly heterogeneous among participants. The optimal solution propulsion speed and solution volume to be used depended on the group of participants being interviewed. At least 37% of parents and 20% of physicians did not take a stand on the optimal irrigation volume to use in each age category. On average, 83% of participants described performing nasal irrigation by lying the infant on one side and delivering the solution through the top nostril. Finally, 74% of respondents declared that no risk was associated with this technique. CONCLUSION Although some common NIPH viewpoints among the surveyed participants were identified, several disagreements were reported, reflecting the absence of a standardized method of nasal irrigation.
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17
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Chitsuthipakorn W, Thanaphiphatsatja A, Doungbuppha P, Lawpoolsri S, Seresirikachorn K, Snidvongs K. Effects of large volume, isotonic nasal saline irrigation for acute rhinosinusitis: a randomized controlled study. Int Forum Allergy Rhinol 2021; 11:1424-1435. [PMID: 33960674 DOI: 10.1002/alr.22807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The purpose of this study was to compare the effects of nasal saline irrigation (large volume, positive pressure isotonic saline) in addition to standard treatment in patients with acute rhinosinusitis (ARS). METHODS This parallel, randomized controlled trial was conducted at a tertiary hospital. The adult patients with ARS (age ≥18 years) were randomly assigned to two groups. The irrigation group received 0.9% saline irrigation twice daily, using a 250-ml squeeze bottle, in addition to standard treatment. The no-irrigation group received standard treatment only. Patients were evaluated at baseline, 1 week, and 2 weeks. The quality of life, rhinologic subscore, symptom score, endoscopy score, and cure rate were compared. RESULTS Sixty-one patients (30: irrigation, 31: no-irrigation) were enrolled. There were 17 males and 44 females. The mean age was 41.06 years. Although both groups showed improvements, the improvement of each outcome was not different between the groups. Subgroup analysis by ARS subtype showed benefits of irrigation in the common cold subgroup; the improvements that were greater than control included: rhinologic subscore, intergroup mean difference -4.15 [95% confidence interval (CI), -7.49, -0.80] at 1 week and -5.23 [95% CI, -9.69, -0.78] at 2 weeks; combined symptom score -5.35 [95% CI, -10.55, -0.14] at 1 week and -8.02 [95%CI, -14.36, -1.70] at 2 weeks. CONCLUSION The add-on isotonic nasal saline irrigation using a large volume, positive pressure device did not add benefits equally for all ARS patients. The benefits of irrigation on quality of life and nasal symptoms were only observed in the common cold patient subgroup.
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Affiliation(s)
- Wirach Chitsuthipakorn
- Center of Excellence in Otolaryngology, Head and Neck Surgery, Rajavithi Hospital, Bangkok, Thailand.,College of Medicine, Rangsit University, Bangkok, Thailand
| | | | | | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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18
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Martínez-Serrano A, Martínez-Campos P, Seijoso-González L, Ruiz-Rojo H. Revisión narrativa de la técnica de los lavados nasales en pediatría. ENFERMERIA CLINICA 2021; 31:189-194. [DOI: 10.1016/j.enfcli.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
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19
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Piromchai P, Phannikul C, Thanaviratananich S. Syringe with Nasal Applicator versus Syringe Alone for Nasal Irrigation in Acute Rhinosinusitis: A Matched-Pair Randomized Controlled Trial. Biomed Hub 2021; 6:25-29. [PMID: 33791314 DOI: 10.1159/000512664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Nasal saline irrigation is a common procedure to relieve nasal symptoms in upper respiratory tract diseases. There is no consensus on the recommended nasal saline delivery devices. The objectives of this study were to evaluate efficacy, satisfaction, adherence, and adverse effects in patients with acute upper respiratory tract diseases using a syringe with a nasal applicator for nasal irrigation. Methods Patients with acute nasopharyngitis, acute rhinitis, or acute rhinosinusitis were randomly allocated to use either (1) a syringe with a nasal applicator or (2) a syringe alone to irrigate one nostril. After the patients had completed irrigation with the allocated device in one nostril, they were instructed to perform nasal irrigation using the other device in the other nostril. All patients were instructed to use a syringe with a nasal applicator at home. The efficacy, satisfaction scores, adherence, and adverse effects were recorded. Results Sixty-four patients were enrolled. The mean age of the patients was 33.95 years (18-59 years). The mean duration of symptoms was 4.80 days. None of the enrolled patients regularly performed nasal irrigation. Forty-two had acute nasopharyngitis, 10 had acute rhinitis, and 12 had acute rhinosinusitis. At baseline, the mean overall efficacy score for the syringe with a nasal applicator was 8.17 ± 1.43, and that for the syringe alone was 5.95 ± 2.02 (MD 2.23, p < 0.001, 95% CI 1.75-2.70). At 1 week, the syringe with the nasal applicator had significantly higher scores in 3 of 4 domains, including symptom relief, ease of use, and patients' willingness to recommend the device to others, compared to baseline (p < 0.05). None of the enrolled patients had epistaxis, retained/dislodged the applicator during irrigation, or experienced an allergic reaction to the applicator after 1 week of nasal irrigation. Conclusion Use of a syringe with an applicator for nasal irrigation yielded high scores in overall efficacy.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chayakorn Phannikul
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 408] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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21
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Tapiala J, Hyvärinen A, Toppila-Salmi S, Suihko E, Penttilä E. Nasal saline irrigation: prescribing habits and attitudes of physicians and pharmacists. Scand J Prim Health Care 2021; 39:35-43. [PMID: 33569979 PMCID: PMC7971247 DOI: 10.1080/02813432.2021.1880123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
OBJECTIVES To explore the opinions, the usage and the patient education given on nasal saline irrigation by physicians and pharmaceutical personnel working in Finland. DESIGN An internet-based survey with predetermined, multiple-choice answers. SETTING Primary care centres, occupational health centres and private care centres in Eastern Finland as well as pharmacies in Finland. MAIN OUTCOME MEASURES Healthcare professionals views, practice and general knowledge of nasal irrigation for sinonasal symptoms and conditions. RESULTS We received 595 completed surveys (110 physicians, 485 pharmacists). The majority of the respondents recommended nasal saline irrigation for their patients either as a symptomatic treatment (98.0%) or to treat a specific condition (97.5%) such as acute rhinosinusitis, chronic rhinosinusitis and allergic rhinitis. Nasal saline irrigation was also often recommended as a prophylaxis for airway-infections (71.9%) and to enhance the health of the nasal mucosa (58.2%). In general, the possible adverse effects were recognised poorly by both professions. There was a clear difference between the two professions, as physicians were more conservative in recommending nasal saline irrigation and recognised possible adverse effects, such as epistaxis, pain, and dryness of the nose, better (75% vs. 59%, p = 0.002). CONCLUSIONS Nasal saline irrigation seems to be a popular treatment recommended by many health care professionals in Finland. Physicians and pharmaceutical personnel had variable opinions on the indications, utility and risks of nasal saline irrigation. There are also clear differences between physicians and pharmaceutical personnel's practices. There is a need to better educate professionals about nasal saline irrigation and to further study whether nasal saline irrigation is efficient and safe option for the different common sinonasal conditions.KEY POINTSLittle information is available on how physicians and pharmacists recommend nasal saline irrigation as a symptomatic treatment.Physicians and pharmacists seem to have variable opinions about the indications, utility and safety of nasal saline irrigation.The patient education given is in general very heterogenous.Both professions require more education to ensure that the usage remains as safe as possible for the patient.
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Affiliation(s)
- Jesse Tapiala
- Department of Otorhinolaryngology – Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
- CONTACT Jesse Tapiala Department of Otorhinolaryngology, Kuopio University Hospital, P.O. Box 1777, Kuopio, FI-70211, Finland
| | - Antti Hyvärinen
- Department of Otorhinolaryngology – Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Suihko
- Joensuun Uusi Apteekki and University of Eastern, Joensuu, Finland
| | - Elina Penttilä
- Department of Otorhinolaryngology – Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Tai J, Lee K, Kim TH. Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis. Pharmaceutics 2021; 13:246. [PMID: 33578812 PMCID: PMC7916625 DOI: 10.3390/pharmaceutics13020246] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic rhinosinusitis is an upper respiratory disease during which topical drug treatment via the nasal cavity is the most actively utilized therapeutic strategy. In addition to steroids, antibiotics, and antifungal agents, which are widely used in clinical practice, research on novel topical agents to improve the bacterial biofilm or mucociliary clearance remains ongoing. Moreover, owing to the complex structure of the nasal cavity, the effects of nasal drug delivery vary depending on factors related to delivery fluid dynamics, including device, volume, and compounds. In this article, we review methods and compounds that have been applied to chronic rhinosinusitis management and introduce recent advances and future perspectives in nasal drug delivery for upper respiratory diseases.
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Affiliation(s)
| | | | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.T.); (K.L.)
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Kifer D, Bugada D, Villar-Garcia J, Gudelj I, Menni C, Sudre C, Vučković F, Ugrina I, Lorini LF, Posso M, Bettinelli S, Ughi N, Maloberti A, Epis O, Giannattasio C, Rossetti C, Kalogjera L, Peršec J, Ollivere L, Ollivere BJ, Yan H, Cai T, Aithal GP, Steves CJ, Kantele A, Kajova M, Vapalahti O, Sajantila A, Wojtowicz R, Wierzba W, Krol Z, Zaczynski A, Zycinska K, Postula M, Lukšić I, Čivljak R, Markotić A, Brachmann J, Markl A, Mahnkopf C, Murray B, Ourselin S, Valdes AM, Horcajada JP, Castells X, Pascual J, Allegri M, Primorac D, Spector TD, Barrios C, Lauc G. Effects of Environmental Factors on Severity and Mortality of COVID-19. Front Med (Lausanne) 2021; 7:607786. [PMID: 33553204 PMCID: PMC7855590 DOI: 10.3389/fmed.2020.607786] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented. Methods: We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application. Findings: Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973-0.988, p < 0.001) and per increase in ambient temperature of 1°C to be 0.854 (0.773-0.944, p = 0.007). Statistically significant decreases of comparable magnitude in median hospital stay, probability of transfer to the intensive care unit, and need for mechanical ventilation were also observed in most, but not all hospitals. The analysis of individually reported symptoms of 37,187 individuals in the UK also showed the decrease in symptom duration and disease severity with time. Interpretation: Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.
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Affiliation(s)
- Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Dario Bugada
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Judit Villar-Garcia
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Carole Sudre
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | | | - Ivo Ugrina
- Faculty of Science, University of Split, Split, Croatia
| | - Luca F. Lorini
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Margarita Posso
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Silvia Bettinelli
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Nicola Ughi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Maloberti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Oscar Epis
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristina Giannattasio
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Rossetti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livije Kalogjera
- Department of Otolaryngology-Head and Neck Surgery, Zagreb School of Medicine, University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
| | - Jasminka Peršec
- Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Zagreb, Croatia
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Luke Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Benjamin J. Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Huadong Yan
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Ting Cai
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Guruprasad P. Aithal
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Anu Kantele
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mikael Kajova
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, Helsingin ja Uudenmaan Sairaanhoitopiiri Diagnostic Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rafal Wojtowicz
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Zbigniew Krol
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Artur Zaczynski
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Katarina Zycinska
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Warsaw, Poland
| | - Ivica Lukšić
- University of Zagreb School of Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital for Infectious Diseases “Fran Mihaljević”, Catholic University of Croatia, Zagreb, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Johannes Brachmann
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | | | | | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ana M. Valdes
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Juan P. Horcajada
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Xavier Castells
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Julio Pascual
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Massimo Allegri
- Pain Therapy Service Policlinico of Monza Hospital, Monza, Italy
| | - Dragan Primorac
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
- St. Catharine Hospital, Zagreb, Croatia
- Eberly College of Science, Penn State University, University Park, PA, United States
- University of Osijek School of Medicine, Osijek, Croatia
- Faculty of Dental Medicine and Health, University of Rijeka School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Clara Barrios
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
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Baruah B. Could Simultaneous Nasal and Oral Irrigation Be a Nontherapeutic Tool against SARS-CoV-2? ACS Chem Neurosci 2021; 12:2-4. [PMID: 33338375 DOI: 10.1021/acschemneuro.0c00740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
For the last 8 months, COronaVIrus Disease 2019 (COVID-19) has been hovering over the planet as a pandemic, and there is no sign of this virus going away anytime soon. In the meantime, life must go on, businesses must remain open, manufacturing must flow smoothly to fulfill consumers' daily demands, and education cannot be halted. Simultaneously, the frontline workers like doctors, nurses, support staff, and other essential workers are working tirelessly in their respective fields in the absence of a widely available effective vaccine. The question is: What should every citizen who needs to venture out to fulfill their daily business do in addition to wearing a mask, handwashing, and physical distancing? Could we add simultaneous nasal and oral irrigation as a nontherapeutic practice to our personal care list as an additional preventative layer?
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Affiliation(s)
- Bharat Baruah
- Department of Chemistry and Biochemistry, Kennesaw State University, Kennesaw, Georgia 30144-5591, United States
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25
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Stathis C, Victoria N, Loomis K, Nguyen SA, Eggers M, Septimus E, Safdar N. Review of the use of nasal and oral antiseptics during a global pandemic. Future Microbiol 2021; 16:119-130. [PMID: 33464122 PMCID: PMC7842245 DOI: 10.2217/fmb-2020-0286] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
A review of nasal sprays and gargles with antiviral properties suggests that a number of commonly used antiseptics including povidone-iodine, Listerine®, iota-carrageenan and chlorhexidine should be studied in clinical trials to mitigate both the progression and transmission of SARS-CoV-2. Several of these antiseptics have demonstrated the ability to cut the viral load of SARS-CoV-2 by 3-4 log10 in 15-30 s in vitro. In addition, hypertonic saline targets viral replication by increasing hypochlorous acid inside the cell. A number of clinical trials are in process to study these interventions both for prevention of transmission, prophylaxis after exposure, and to diminish progression by reduction of viral load in the early stages of infection.
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Affiliation(s)
| | | | | | - Shaun A Nguyen
- Department of Otolaryngology, Head & Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Maren Eggers
- Prof Dr G Enders MVZ Laboratory & Institute of Virology, Infectious Diseases, Stuttgart, BW 70193, Germany
| | - Edward Septimus
- Department of Population Medicine, Harvard Medical School & the Harvard Pilgrim Healthcare Institute, Boston, MA 02215, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA & The William S Middleton Memorial Veterans Hospital, Madison, WI 53726, USA
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26
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Piromchai P, Puvatanond C, Kirtsreesakul V, Chaiyasate S, Suwanwech T. A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients. Laryngoscope Investig Otolaryngol 2020; 5:1003-1010. [PMID: 33364388 PMCID: PMC7752074 DOI: 10.1002/lio2.497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. METHODS We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. RESULTS Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. CONCLUSIONS Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Charoiboon Puvatanond
- Department of Otorhinolaryngology, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of MedicinePrince of Songkla UniversitySongkhlaThailand
| | - Saisawat Chaiyasate
- Department of Otolaryngology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Triphoom Suwanwech
- Department of Otorhinolaryngology, Faculty of Medicine, Siriraj HospitalMahidol UniversityBangkokThailand
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27
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Esposito S, Jones MH, Feleszko W, Martell JAO, Falup-Pecurariu O, Geppe N, Martinón-Torres F, Shen KL, Roth M, Principi N. Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement. Microorganisms 2020; 8:E1810. [PMID: 33213053 PMCID: PMC7698530 DOI: 10.3390/microorganisms8111810] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, 43126 Parma, Italy
| | - Marcus Herbert Jones
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre (RS) 90619-900, Brazil;
| | - Wojciech Feleszko
- Department of Pediatric Pneumonology and Allergy, The Medical University of Warsaw, 00-927 Warsaw, Poland;
| | - José A. Ortega Martell
- Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo 42082, Mexico;
| | - Oana Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Children’s Clinic Hospital, 500036 Brasov, Romania;
| | - Natalia Geppe
- Department of Paediatrics, Sechenov First Moscow State Medical University, 115093 Moscow, Russia;
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Kun-Ling Shen
- China National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
| | - Michael Roth
- Pulmonary Cell Research and Pneumology, Department of Biomedicine and Internal Medicine, University Hospital Basel, 4002 Basel, Switzerland;
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28
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de Gabory L, Kérimian M, Sagardoy T, Verdaguer A, Gauchez H. Paediatric nasal irrigation: The "fencing" method. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:107-113. [PMID: 32891588 DOI: 10.1016/j.anorl.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nasal irrigation is a grade A recommendation treatment, which is essential in many pathological conditions. Very heterogeneous practices are observed in paediatrics as a result of poor instruction in this technique. We propose to describe the nasal irrigation technique developed by a team of respiratory physiotherapists in Lille for the management of cystic fibrosis and bronchiolitis. This technique is intended for children over the age of 6 months, as it requires an oral breathing reflex and cough reflex that are not systematically acquired before this age. Nasal irrigation is performed on a 30° upward inclined plane on a calm and cooperative child, away from meals. The child is maintained gently, without pressure, in the fencing position with the head turned away from the practitioner. Using a continuous flow spray, the practitioner grasps the top of the upper nostril and irrigates the nostril for an average of 3 s (6mL per nostril). These steps are then repeated until satisfactory patency is achieved in both nostrils. This technique constitutes a practical tool to help healthcare professionals and parents perform nasal irrigation in young children over the age of 6 months.
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Affiliation(s)
- L de Gabory
- Service d'ORL et de chirurgie cervico-faciale, Centre F.-X. Michelet, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Université Bordeaux, 33000 Bordeaux, France.
| | - M Kérimian
- Service d'ORL et de chirurgie cervico-faciale, Centre F.-X. Michelet, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Université Bordeaux, 33000 Bordeaux, France
| | - T Sagardoy
- Service d'ORL et de chirurgie cervico-faciale, Centre F.-X. Michelet, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Université Bordeaux, 33000 Bordeaux, France
| | - A Verdaguer
- Pôle de Santé de la Grâce de Dieu, 14000 Caen, France
| | - H Gauchez
- Centre de kinésithérapie respiratoire et fonctionnelle du Nord (CKRF), 59700 Marcq-en-Baroeul, France
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29
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Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study. Am J Otolaryngol 2020; 41:102502. [PMID: 32460989 DOI: 10.1016/j.amjoto.2020.102502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sodium hyaluronate has been proposed as a treatment for improving the symptoms of chronic rhinosinusitis. The present study evaluated the effect of the intranasal administration of hyaluronic acid in a group of patients affected by chronic rhinosinusitis without nasal polyps (CRSsNP). MATERIALS AND METHODS Thirty subjects aged 18-65 years affected by CRSsNP were enrolled. The subjects were randomly administered hyaluronic acid or isotonic saline solution by nasal nebulizer twice per day for 30 days. They were evaluated before (T0) and after the treatment (T1) with Sino-Nasal Outcome Test-22, visual analogue scale for rhinorrhea, nasal obstruction, facial pain and hyposmia/hypogeusia, nasal endoscopy, active anterior rhinomanometry, peak nasal inspiratory flow and nasal cytology. RESULTS Comparing the study and the control group, at T1 no significant differences were observed in both objective and subjective parameters. Being included in the study group rather than in the control group did not have a significant effect on the variation of the considered parameters between T0 and T1. Considering the effects of the micronized douches independently from the type of solution used (either hyaluronic acid or isotonic saline solution), although no difference emerged between study and control group for any of the objective parameters, there was an improvement of Sino-Nasal Outcome Test-22 scores (p = .0005), visual analogue scale for nasal obstruction (p = .0006) and for hyposmia/hypogeusia (p = .04). CONCLUSIONS The treatment with micronized nasal douches can improve the sino-nasal symptoms of CRSsNP, in particular nasal obstruction and olfactory ability. No advantage of the use of hyaluronic acid over isotonic saline solution emerged.
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30
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Uppuluri CT, Ravi PR, Dalvi AV, Shaikh SS, Kale SR. Piribedil loaded thermo-responsive nasal in situ gelling system for enhanced delivery to the brain: formulation optimization, physical characterization, and in vitro and in vivo evaluation. Drug Deliv Transl Res 2020; 11:909-926. [PMID: 32514705 DOI: 10.1007/s13346-020-00800-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methyl cellulose (MC) based nasal in situ gels were developed to enhance the brain delivery of piribedil (PBD), an anti-Parkinson's drug. Different grades of MC and several solutes (NaCl, KCl, Na.Citrate, STPP, PEG-6000, sucrose, etc.) were screened to formulate thermo-responsive nasal in situ gelling systems. Formulations were evaluated for their sol-gel transition temperature and time, rheological behaviour, in vitro drug release, mucociliary clearance (MCC), ex vivo nasal toxicity, and in vivo brain availability studies in Wistar rats. Intranasal (i.n.) administration was carried out using a cannula-microtip setup to deliver PBD at the olfactory region of the nose. The concentration and viscosity grade of MC and also the concentration and type of solute used were found to affect the rheological behaviour of the formulations. Among the solutes tested, NaCl was found to be effective for formulating MC in situ gels. The developed in situ gels significantly delayed the MCC of PBD from the site of administration when compared with conventional suspension (p < 0.05). Further, formulations with higher gel strength showed lower in vitro drug release rate and longer intranasal residence (delayed MCC) (p < 0.05). The absolute brain availability (brain AUC0-t) of PBD increased to 35.92% with i.n. delivery when compared to 4.71% with oral administration. Overall, it can be concluded that intranasal delivery of PBD is advantageous when compared to the currently practiced oral therapy. Graphical abstract.
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Affiliation(s)
- Chandra Teja Uppuluri
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Jawaharnagar (Village), Kapra (M), Hyderabad, Telangana, 500078, India
| | - Punna Rao Ravi
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Jawaharnagar (Village), Kapra (M), Hyderabad, Telangana, 500078, India.
| | - Avantika V Dalvi
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Jawaharnagar (Village), Kapra (M), Hyderabad, Telangana, 500078, India
| | - Shafik Shakil Shaikh
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Jawaharnagar (Village), Kapra (M), Hyderabad, Telangana, 500078, India
| | - Suvarna R Kale
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Jawaharnagar (Village), Kapra (M), Hyderabad, Telangana, 500078, India
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31
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Kumpitsch C, Koskinen K, Schöpf V, Moissl-Eichinger C. The microbiome of the upper respiratory tract in health and disease. BMC Biol 2019; 17:87. [PMID: 31699101 PMCID: PMC6836414 DOI: 10.1186/s12915-019-0703-z] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 02/08/2023] Open
Abstract
The human upper respiratory tract (URT) offers a variety of niches for microbial colonization. Local microbial communities are shaped by the different characteristics of the specific location within the URT, but also by the interaction with both external and intrinsic factors, such as ageing, diseases, immune responses, olfactory function, and lifestyle habits such as smoking. We summarize here the current knowledge about the URT microbiome in health and disease, discuss methodological issues, and consider the potential of the nasal microbiome to be used for medical diagnostics and as a target for therapy.
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Affiliation(s)
- Christina Kumpitsch
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Kaisa Koskinen
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Veronika Schöpf
- Institute of Psychology, University of Graz, Universitaetsplatz 2, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
- Present address: Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
- BioTechMed-Graz, Mozartgasse 12/II, 8010 Graz, Austria
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32
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Salati H, Bartley J, White DE. Nasal saline irrigation - A review of current anatomical, clinical and computational modelling approaches. Respir Physiol Neurobiol 2019; 273:103320. [PMID: 31689534 DOI: 10.1016/j.resp.2019.103320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/14/2019] [Accepted: 10/11/2019] [Indexed: 11/28/2022]
Abstract
Nasal saline irrigation is frequently utilised in allergic rhinitis and rhinosinusitis management, and after nasal and sinus surgery. Anatomical modelling, clinical and computational studies guide treatment optimisation. This review offers a comprehensive summary of the modelling methodologies used in previous nasal irrigation studies by undertaking a systematic analysis of anatomical, clinical and computational investigations that assessed nasal saline irrigation using Medline, EMBASE, and Cochrane Review databases. Both procedural and assessment methods were reviewed. It was found that all twenty-four publications reviewed did not discuss the influence of the nasal cycle on internasal geometry and nasal resistance. Cadaver studies misrepresent in vivo nasal geometry. Irrigation pressure and shear forces, which could influence mucociliary transport and postoperative cleaning, were not evaluated. Previous studies focus on irrigation coverage and have not considered the nasal cycle which influences unilateral nasal resistance and thus pressure/ flow relationships and may also increase nasal air-locking. New computational fluid dynamic models could better inform nasal irrigation clinical practice.
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Affiliation(s)
- Hana Salati
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jim Bartley
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - David E White
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
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Jiao J, Yang J, Li J, Li Y, Zhang L. Hypertonic saline and seawater solutions damage sinonasal epithelial cell air-liquid interface cultures. Int Forum Allergy Rhinol 2019; 10:59-68. [PMID: 31610615 DOI: 10.1002/alr.22459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nasal irrigation (NI) is commonly used to treat several sinonasal diseases, including chronic rhinosinusitis with nasal polyps (CRSwNP); however, the effects of NI on the sinonasal epithelium are not fully known. The aim of this study was to investigate the effects of commonly used NI solutions on epithelial mucociliary and barrier functionality in primary cultured human nasal epithelial cells (HNECs). METHODS HNECs from control subjects and patients with CRSwNP were established as air-liquid interface (ALI) cultures. Differentiated cultures were treated with different NI solutions, including isotonic 0.9% and hypertonic 3.0% saline, isotonic and hypertonic seawater, and Ringer lactate solution. The changes in ciliary beat frequency (CBF), numbers of ciliated and goblet cells, and cytotoxicity were measured. Epithelial barrier functionality was assessed by measuring the transepithelial electric resistance (TER), paracellular flux, and expression of tight junction protein zonula occludens-1 (ZO-1) and occludin. RESULTS Isotonic saline, isotonic seawater, and Ringer lactate solutions did not affect epithelial mucociliary and barrier function in either control or CRSwNP-derived ALI cultures; however, hypertonic saline induced a significant disruption of these cell functions in both cultures. Hypertonic seawater caused a transient decrease of CBF and TER in CRSwNP-derived ALI cultures, in contrast to inducing an obvious mucociliary and barrier dysfunction and cytotoxicity in control ALI cultures. CONCLUSION Although isotonic NI solutions appear to not affect epithelial mucociliary and barrier function in control and CRSwNP-derived ALI cultures, hypertonic saline and seawater solutions damaged sinonasal epithelial cells in ALI cultures. The safety and efficacy of these solutions requires further investigation.
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Affiliation(s)
- Jian Jiao
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jun Yang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Jingyun Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Ying Li
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
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Wynne M, Atkinson C, Schlosser RJ, Mulligan JK. Contribution of Epithelial Cell Dysfunction to the Pathogenesis of Chronic Rhinosinusitis with Nasal Polyps. Am J Rhinol Allergy 2019; 33:782-790. [PMID: 31382760 DOI: 10.1177/1945892419868588] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background In the past, the airway epithelium was thought to be primarily an inert physical barrier. We now know that the upper airway epithelium plays a critical role in both innate and adaptive immunity, and that epithelial dysfunction is strongly associated with inflammatory airway disease. The pathogenesis of chronic rhinosinusitis is poorly understood, but growing evidence supports a key role for the airway epithelium in the pathophysiology of the disease. Objective The purpose of this study is to explore our current understanding of how dysfunction in human sinonasal epithelial cells (HSNECs) contributes to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) and to examine how current and developing therapies affect epithelial cell functions. Methods A literature review of papers published in English pertaining to epithelial cell dysfunction in patients with CRSwNP was performed using the PubMed database. The search utilized combinations of the following key words: sinusitis, polyps, epithelium, pathophysiology, barrier function, dendritic cells, eosinophils, T cells, complement, mucociliary clearance, vitamin D, cytokines, chemokines, taste receptors, steroids, saline, and therapy. Results HSNEC mucociliary clearance, barrier function, secretion of cytokines, influence on dendritic cells, influence on T-cells, regulation of eosinophils, vitamin D metabolism, complement production, and taste receptor function are altered in patients with CRSwNP and contribute to the pathogenesis of the disease. Current therapies utilized to manage CRSwNP counteract the effects of HSNEC dysfunction and relieve key symptoms of the disease. Conclusion HSNECs are key players in both innate and adaptive immunity, and altered epithelial functions are closely intertwined with the pathogenesis of CRSwNP. Our review supports further investigation of altered HSNEC function in patients with CRSwNP and supports development of novel epithelial-targeted therapies for its management.
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Affiliation(s)
- Michael Wynne
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery, Medical University of South Carolina, Lee Patterson Allen Transplant Immunobiology Laboratory, Charleston, South Carolina
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer K Mulligan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Gantz O, Danielian A, Yu A, Ference EH, Kuan EC, Wrobel B. Sinus irrigation penetration after balloon sinuplasty vs functional endoscopic sinus surgery in a cadaveric model. Int Forum Allergy Rhinol 2019; 9:953-957. [PMID: 31336043 DOI: 10.1002/alr.22386] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nasal irrigation is a cornerstone of treatment for chronic rhinosinusitis. The purpose of this study was to quantify irrigation penetration to the sinuses following balloon sinuplasty and functional endoscopic sinus surgery (FESS). METHODS Balloon sinuplasty followed by FESS was performed on 4 cadaver heads. Using a high-volume, high-flow bottle, each head was irrigated with fluorescein-dyed water prior to and following each procedure, and recorded by rigid endoscopy through trephinations. Three blinded, fellowship-trained rhinologists reviewed videos and scored the extent of staining (using an accepted scale of 0 to 3) for each site. RESULTS The mean score prior to any procedure was maxillary sinus 1.67, frontal sinus 1.29, and nasal cavity 1.71. After balloon sinuplasty the mean was maxillary 2.25, frontal 2.04, and nasal cavity 2.17. After FESS the mean was maxillary 2.75, frontal 2.08, and nasal cavity 2.63. There was a statistically significant increase for both maxillary (p = 0.005) and frontal sinuses (p = 0.006) following balloon sinuplasty. There was a statistically significant increase following FESS compared to balloon for the maxillary sinus (p = 0.003), but not the frontal sinus (p = 0.96). Interrater reliability was good, with Cronbach's alpha of 0.85. CONCLUSION Irrigation improved in all sinuses following balloon sinuplasty and FESS. There was further improvement to the maxillary sinus after FESS; however, there was no difference in irrigation to the frontal sinuses following FESS compared to balloon sinuplasty. Extended frontal sinus approaches such as the Modified Lothrop procedure should be considered if more extensive access for irrigation is required.
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Affiliation(s)
- Oliver Gantz
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Arman Danielian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Alison Yu
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Elisabeth H Ference
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine Medical Center, Orange, CA
| | - Bozena Wrobel
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Abstract
BACKGROUND The spectrum of rhinological diseases is wide, as is that of their drug-based treatment. Only 1272 compounds coded R01 (nasal preparations) are listed in the ATC group (Anatomical Therapeutic Chemical Classification). Conservative therapy of rhinological diseases additionally includes systemic (often oral) application of corticosteroids, antibiotics and immunomodulators. OBJECTIVE The aim of this paper is to outline possible complications of medication (subdivided into classes of ingredients) commonly used to treat rhinological diseases in hospitals. Useful therapeutic and preventive measures will be presented. MATERIALS AND METHODS Based on the expert information in the current pharmacological drug index (ATC) for the R01 group as well as literature research in the PubMed, Cochrane Library and MEDLINE databases, medication used for the treatment of rhinological diseases was analysed in terms of side effects and their frequency. RESULTS Common side effects of intranasally applied medication are local irritations, burning, dryness and epistaxis. Orally or intravenously applied rhinological medication can affect the organs and lead to side effects such as cardiac dysrhythmia or alterations of the blood count. It is recommended that the therapeutic be selected on an individual basis and that the patient be thoroughly informed about possible side effects. CONCLUSION Particularly when treating children or pregnant or breastfeeding women, the indications of all nasal preparations should be checked carefully. The huge variety of rhinologicals enables an optimal individual selection on the basis of consideration of known side effects.
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Piromchai P, Puvatanond C, Kirtsreesakul V, Chaiyasate S, Thanaviratananich S. Effectiveness of nasal irrigation devices: a Thai multicentre survey. PeerJ 2019; 7:e7000. [PMID: 31179187 PMCID: PMC6542345 DOI: 10.7717/peerj.7000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/20/2019] [Indexed: 01/21/2023] Open
Abstract
Background Nasal irrigation is widely used as an adjunctive treatment for nasal diseases. There is little evidence regarding the efficacy of the devices used in this procedure. The objective of this survey was to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients and physicians. Methods We conducted a multicentre survey study between November 2017 and October 2018. Physician and patient questionnaires were developed based on the available literature and expert opinion. The physician questionnaire was submitted to the Otolaryngology residents and staff of each centre and their network. The physicians were also asked to distribute the patient questionnaire to their patients. Results Information regarding 331 devices used by the patients was collected. The mean age of the patients was 45.46 ± 17.19 years (from 5 to 81). Roughly half were male, and half were female (48.6%: 51.4%). Among the high-pressure devices, we found that the high-pressure large-volume nasal irrigation devices yielded significantly higher symptom scores in seven of 12 domains (p < 0.05). Among the large-volume devices, we found that the large-volume high-pressure nasal irrigation devices received significantly higher symptom scores in 4 of 12 domains (p < 0.05). However, a higher proportion of patients using the large-volume high-pressure devices had retained fluid in the sinuses compared to those using large-volume low-pressure devices (p < 0.001). Conclusions This survey supports the regular use of nasal irrigation, particularly with large-volume high-pressure devices, as an effective treatment for nasal disease. It may be effective at clearing nasal secretion, improve nasal congestion, decrease post-nasal drip, improve sinus pain or headache, improve taste and smell, and improve sleep quality. It could be used by patients with good compliance and minimal side effects.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Charoiboon Puvatanond
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Saisawat Chaiyasate
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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de Benedictis FM, Carloni I, Comberiati P, Shields MD, Bush A, Chang AB. Wet Cough and Nasal Symptoms in Children: Can We Do Better? Front Pediatr 2019; 7:459. [PMID: 31956642 PMCID: PMC6949513 DOI: 10.3389/fped.2019.00459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.
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Affiliation(s)
| | - Ines Carloni
- Department of Child and Mother Health, Salesi Children's Hospital, Ancona, Italy
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael D Shields
- Centre for Experimental Medicine, Royal Belfast Hospital for Sick Children, Queen's University of Belfast, Belfast, United Kingdom
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial School of Medicine, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
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de Gabory L, Escabasse V, Boudard P, de Bonnecaze G, Rumeau C, Jankowski R, Debry C, Morinière S, Merino B, Mortuaire G, Malard O, Bordenave L. Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy. Eur Arch Otorhinolaryngol 2018; 276:447-457. [PMID: 30536161 PMCID: PMC6394433 DOI: 10.1007/s00405-018-5232-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/28/2018] [Indexed: 12/01/2022]
Abstract
Purposes The purpose of this study was to compare the efficacy of a mineral-rich solution vs normal saline solution (0.9% NaCl) following endoscopic complete bilateral ethmoidectomy. Methods This was a prospective, multicenter, randomized, controlled, open-label trial in subjects suffering from steroid-resistant sinonasal polyposis. Adults performed 4 nasal irrigations of mineral or saline solutions daily for 28 days. Evaluations included subject-reported RHINO quality of life (QoL) and NOSE scores, tolerability, and satisfaction, the Lund–Kennedy endoscopic score and assessments of crusting, secretions and mucociliary clearance (rhinoscintigraphy). Results A total of 189 subjects were randomized. Clinically relevant improvements (> 20 points) in RhinoQOL and NOSE scores were measured in both groups without any significant inter-group difference. Among the subjects with impaired RhinoQOL at pre-inclusion, the change in Impact-RhinoQOL score was significantly superior in mineral-rich vs saline solution at day 21 (p = 0.028) and day 28 (p = 0.027). The Lund–Kennedy score continuously improved in both groups earlier with the mineral-rich solution. Crusts were significantly fewer in number and less severe/obstructive in patients receiving mineral-rich vs saline solution at day 7 (p = 0.026) and day 14 (p = 0.016). Furthermore, secretions disappeared significantly more quickly and were less thick/purulent with mineral-rich solution at day 14 (p = 0.002) and day 21 (p = 0.043). Less epistaxis was reported in the mineral vs saline solution (p = 0.008 at day 21). Conclusions Our findings indicate that the composition of a nasal irrigation solution influences endoscopic scores and QoL after sinus surgery for patients over 60, those with an initially poor QoL and higher symptom score, and smokers.
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Affiliation(s)
- Ludovic de Gabory
- ENT Department, CHU Bordeaux, 33000, Bordeaux, France. .,CHU Bordeaux, CIC 14-01 IT, 33000, Bordeaux, France. .,Univ. Bordeaux, 33000, Bordeaux, France. .,ENT Department, University Hospital of Bordeaux, Hôpital Pellegrin, Centre F-X Michelet, Place A. Raba-Léon, 33076, Bordeaux Cedex, France.
| | | | - Philippe Boudard
- ENT Department, Saint-Augustin Private Hospital, Bordeaux, France
| | | | - Cécile Rumeau
- ENT Department, University Hospital of Nancy, Nancy, France
| | | | - Christian Debry
- ENT Department, University Hospital of Strasbourg, Strasbourg, France
| | | | - Bertrand Merino
- Nuclear Medicine Department, Saint-Augustin Private Hospital, Bordeaux, France
| | | | - Olivier Malard
- ENT Department, University Hospital of Nantes, Nantes, France
| | - Laurence Bordenave
- CHU Bordeaux, CIC 14-01 IT, 33000, Bordeaux, France.,Univ. Bordeaux, 33000, Bordeaux, France.,Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France
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The effects of nasal irrigation with various solutions after endoscopic sinus surgery: systematic review and meta-analysis. The Journal of Laryngology & Otology 2018; 132:673-679. [DOI: 10.1017/s0022215118000919] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundNasal irrigation is commonly performed in patients with chronic rhinosinusitis after functional endoscopic sinus surgery. This study systematically assessed the clinical efficacy of nasal irrigation from the medical literature.MethodsThe PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched using a comprehensive strategy, limited to English-language articles, published from October 1971 to March 2017, and comprising human subjects.ResultsA total of 824 trials were identified, 5 of which, involving 331 participants, were included in this systematic review. After selection, only three trials were eligible for inclusion in a meta-analysis. Nasal irrigation using normal saline and various solutions was found to be effective in reducing symptom scores and endoscopic scores for chronic rhinosinusitis patients after functional endoscopic sinus surgery. Comparison of outcome measures, such as eosinophil count reduction, revealed that various solutions are more effective than normal saline alone; however, no statistical significance was found in terms of reduced symptom or endoscopic scores.ConclusionBased on the current limited evidence, nasal irrigation is an effective therapy for chronic rhinosinusitis patients after functional endoscopic sinus surgery. However, when comparing various solutions with normal saline, no significant difference was found in symptom scores or endoscopic scores.
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