Nasal washes in chronic rhinosinusitis, review article

Nasal washes in chronic rhinosinusitis, review article

Main Article Content

Alicia Benítez
Sandra Toso
Carlos Mena
Enrique Pérez

Abstract

Chronic rhinosinusitis (CRS) is a chronic condition of inflammation in the mucosa of the paranasal sinuses that is associated with a significantly impaired quality of life, which motivates the constant study of therapies for its control and cost reduction. The cutting edge of clinical management for CRS is topical therapy. The advantages of topical medical therapy include direct administration of the drug into the diseased tissue, the possibility of administering higher local concentrations of the drug and minimizing systemic absorption which is not without adverse effects, thus becoming an important strategy in the management of CRS. The objective of this literature review is to formally review and identify topical medical therapy strategies and promote an evidence-based approach to their use. A literature review was conducted based on a keyword search. The computerized databases of PubMed, ElSevier and ResearchGate were accessed. We included articles highlighting the results of the use of topical therapies in CRS and that the type of study was a clinical trial. This review identified and evaluated the literature on topical therapy strategies for CRS: saline irrigation, topical antibiotics, topical steroids, and topical antifungals. Topical therapy has become an important tool in the treatment arsenal for CRS. Based on a review of the literature, nasal irrigation with saline and topical steroid sprays are the most evidence supportive. Nonstandard topical nasosinusal steroid therapies may be an option for managing CRS. 

References

Albu, S., 2012. Novel drug-delivery systems for patients with chronic rhinosinusitis. Drug Des. Devel. Ther. 6, 125–132. https://doi.org/10.2147/DDDT.S25199

Biswas, K., Cavubati, R., Gunaratna, S., Hoggard, M., Waldvogel-Thurlow, S., Hong, J., Chang, K., Wagner Mackenzie, B., Taylor, M., Douglas, R., 2019. Comparison of Subtyping Approaches and the Underlying Drivers of Microbial Signatures for Chronic Rhinosinusitis. mSphere 4. https://doi.org/10.1128/mSphere.00679-18

Bonfils, P., Escabasse, V., Coste, A., Gilain, L., Louvrier, C., Serrano, E., de Bonnecaze, G., Mortuaire, G., Chevalier, D., Laccourreye, O., Mainardi, J.-L., 2015. Efficacy of tobramycin aerosol in nasal polyposis. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 132, 119–123. https://doi.org/10.1016/j.anorl.2015.03.008

Culig, J., Leppée, M., Vceva, A., Djanic, D., 2010. Efficiency of hypertonic and isotonic seawater solutions in chronic rhinosinusitis.

Med. Glas. Off. Publ. Med. Assoc. Zenica-Doboj Cant. Bosnia Herzeg. 7, 116–123.

Desrosiers, M.Y., Salas-Prato, M., 2001. Treatment of chronic rhinosinusitis refractory to other treatments with topical antibiotic therapy delivered by means of a large-particle nebulizer: results of a controlled trial. Otolaryngol.--Head Neck Surg. Off. J. Am. Acad. Otolaryngol.-Head Neck Surg. 125, 265–269. https://doi.org/10.1067/mhn.2001.117410

Ebbens, F.A., Scadding, G.K., Badia, L., Hellings, P.W., Jorissen, M., Mullol, J., Cardesin, A., Bachert, C., van Zele, T.P.J., Dijkgraaf, M.G.W., Lund, V., Fokkens, W.J., 2006. Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis. J. Allergy Clin. Immunol. 118, 1149–1156. https://doi.org/10.1016/j.jaci.2006.07.058

Gerlinger, I., Fittler, A., Fónai, F., Patzkó, A., Mayer, A., Botz, L., 2009. Postoperative application of amphotericin B nasal spray in chronic rhinosinusitis with nasal polyposis, with a review of the antifungal therapy. Eur. Arch. Oto-Rhino-Laryngol. Off. J. Eur. Fed.

Oto-Rhino-Laryngol. Soc. EUFOS Affil. Ger. Soc. Oto-Rhino-Laryngol. - Head Neck Surg. 266, 847–855. https://doi.org/10.1007/s00405-008-0836-0

Giotakis, A.I., Karow, E.M., Scheithauer, M.O., Weber, R., Riechelmann, H., 2016. Saline irrigations following sinus surgery - a controlled, single blinded, randomized trial. Rhinology 54, 302–310. https://doi.org/10.4193/Rhino16.026

Harvey, R.J., Schlosser, R.J., 2009. Local Drug Delivery. Otolaryngol. Clin. North Am. 42, 829–845. https://doi.org/10.1016/j.otc.2009.07.005

Hashemian, Farshad, Hashemian, Farnaz, Molaali, N., Rouini, M., Roohi, E., Torabian, S., 2016. Clinical effects of topical antifungal therapy in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial of intranasal fluconazole. EXCLI J. 15, 95–102. https://doi.org/10.17179/excli2015-678

Hauptman, G., Ryan, M.W., 2007. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol.--Head Neck Surg. Off. J. Am. Acad. Otolaryngol.-Head Neck Surg. 137, 815–821. https://doi.org/10.1016/j.otohns.2007.07.034

Head, K., Sharp, S., Chong, L.-Y., Hopkins, C., Philpott, C., 2018. Topical and systemic antifungal therapy for chronic rhinosinusitis. Cochrane Database Syst. Rev. 9, CD012453. https://doi.org/10.1002/14651858.CD012453.pub2

Jiang, R.-S., Hsu, S.-H., Liang, K.-L., 2015. Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery. Am. J. Rhinol. Allergy 29, 435–440. https://doi.org/10.2500/ajra.2015.29.4246

Jiang, R.-S., Twu, C.-W., Liang, K.-L., 2018. Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo-controlled, double-blind study. Int. Forum Allergy Rhinol. 8, 41–48. https://doi.org/10.1002/alr.22033

Liang, K.-L., Su, M.-C., Shiao, J.-Y., Tseng, H.-C., Hsin, C.-H., Lin, J.-F., Jiang, R.-S., 2008. Amphotericin B irrigation for the treatment of chronic rhinosinusitis without nasal polyps: a randomized, placebo-controlled, double-blind study. Am. J. Rhinol. 22, 52–58. https://doi.org/10.2500/ajr.2008.22.3115

Low, T.-H.H., Woods, C.M., Ullah, S., Carney, A.S., 2014. A double-blind randomized controlled trial of normal saline, lactated Ringer’s, and hypertonic saline nasal irrigation solution after endoscopic sinus surgery. Am. J. Rhinol. Allergy 28, 225–231. https://doi.org/10.2500/ajra.2014.28.4031

Macdonald, K.I., Wright, E.D., Sowerby, L.J., Rotenberg, B.W., Chin, C.J., Rudmik, L., Sommer, D.D., Nayan, S., DesRosiers, M., Tewfik, M.A., Valdes, C.J., Massoud, E., Thomas, D., Kilty, S.J., Vescan, A., Mechor, B., Lavigne, F., Fandino, M., Javer, A.R., Witterick, I.J., 2015. Squeeze bottle versus saline spray after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial. Am. J. Rhinol. Allergy 29, e13-17. https://doi.org/10.2500/ajra.2015.29.4125

Nikakhlagh, S., Abshirini, H., Lotfi, M., Mohammadi, S.M., Saki, N., 2016. A comparison between the effects of nasal lavage with hypertonic, isotonic and hypotonic saline solutions for the treatment of chronic sinusitis. J. Glob. Pharma Technol. 8, 68–73.

Pinto, J.M., Elwany, S., Baroody, F.M., Naclerio, R.M., 2006. Effects of saline sprays on symptoms after endoscopic sinus surgery. Am. J. Rhinol. 20, 191–196.

Salib, R.J., Talpallikar, S., Uppal, S., Nair, S.B., 2013. A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products SterimarTM and Sinus RinseTM following functional endoscopic sinus surgery. Clin. Otolaryngol. Off. J. ENT-UK Off. J. Neth. Soc. Oto-Rhino-Laryngol. Cervico-Facial Surg. 38, 297–305. https://doi.org/10.1111/coa.12132

Shikani, A.H., Kourelis, K., Alqudah, M.A., Shikani, H.J., Cope, E., Kirk, N., Bergstedt, D., Basaraba, R.J., Leid, J.G., 2013. Multimodality topical therapy for refractory chronic rhinosinusitis: our experience in thirteen patients with and twelve patients without nasal polyps. Clin. Otolaryngol. Off. J. ENT-UK Off. J. Neth. Soc. Oto-Rhino-Laryngol. Cervico-Facial Surg. 38, 254–258. https://doi.org/10.1111/coa.12096

Sykes, D.A., Wilson, R., Chan, K.L., Mackay, I.S., Cole, P.J., 1986. Relative importance of antibiotic and improved clearance in topical treatment of chronic mucopurulent rhinosinusitis. A controlled study. Lancet Lond. Engl. 2, 359–360. https://doi.org/10.1016/s0140-6736(86)90051-6

Vaughn, A., Shaver, C., Clark, D., 2019. Association Between Culture and Culture-Independent Microtyping in Recalcitrant Chronic Rhinosinusitis. Ear. Nose. Throat J. 98, 94–97. https://doi.org/10.1177/0145561318823371

Videler, W.J.M., van Drunen, C.M., Reitsma, J.B., Fokkens, W.J., 2008. Nebulized bacitracin/colimycin: a treatment option in recalcitrant chronic rhinosinusitis with Staphylococcus aureus? A double-blind, randomized, placebo-controlled, cross-over pilot study. Rhinology 46, 92–98.

Vilhena, D.D., Duarte, D., Lopes, G., 2016. Calidad de vida en la rinosinusitis crónica con poliposis nasal. Rev. ORL 7, 17–22. https://doi.org/10.14201/orl.13527

Weschta, M., Rimek, D., Formanek, M., Polzehl, D., Podbielski, A., Riechelmann, H., 2004. Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. J. Allergy Clin. Immunol. 113, 1122–1128. https://doi.org/10.1016/j.jaci.2004.03.038

Woodhouse, B.M., Cleveland, K.W., 2011. Nebulized antibiotics for the treatment of refractory bacterial chronic rhinosinusitis. Ann. Pharmacother. 45, 798–802. https://doi.org/10.1345/aph.1P723

Wormald, P.-J., Cain, T., Oates, L., Hawke, L., Wong, I., 2004. A comparative study of three methods of nasal irrigation. The Laryngoscope 114, 2224–2227. https://doi.org/10.1097/01.mlg.0000149463.95950.c5