Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

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.

Yardstick for the medical management of chronic rhinosinusitis

“…83,84 One larger prospective open-label study investigated normal IS vs a mineral-rich IS solution in CRSwNP postcomplete ethmoidectomy and found that adding minerals to the IS solution improved endoscopic and QOL scores in older patients, patients with an initial poor QOL or higher symptom scores, and in smokers. 85 Finally, a recent study compared NI with buffered HS to physiological seawater in patients with CRSwNP post-FESS but further characterized them as eosinophilic (ECRSwNP) and noneosinophilic (NECRSwNP) phenotypes. 86 They found that as a group, there were substantial subjective and objective improvements with NI irrespective of the solution used; however, when patients were stratified based on ECRSwNP and NECRSwNP, the latter group treated with buffered HS experienced a greater improvement in mucosal edema and crusting immediately postoperatively and substantial objective improvement in Lund-Kennedy endoscopic scores and saccharine clearance times.…”

Safety and Impact of Nasal Lavages During Viral Infections Such as SARS-CoV-2

“…Isotonic solutions with slightly alkaline pH optimize trophic and functional recovery of the respiratory epithelium. 2 In chronic rhinosinusitis, saline solutions improve mucociliary clearance 3 without altering commensal bacteria. 4 These actions may aid recovery of the nasal epithelium after viral injury and reduce associated symptoms of rhinitis.…”

“…8 Nasal lavages are commonly used treatments in the upper respiratory tract infections and can decrease duration of illness in common cold. 3,23,24 Given the potential benefits summarized above, nasal saline irrigation may enhance recovery in patients known to be infected with COVID-19. Patients are currently being recruited to a randomized controlled trial to evaluate the benefits to COVID-19 patients, although no results are yet available.…”

“… 8 Nasal lavages are commonly used treatments in the upper respiratory tract infections and can decrease duration of illness in common cold. 3 , 23 , 24 …”

Seawater nasal wash to reduce symptom duration and viral load in COVID-19 and upper respiratory tract infections: a randomized controlled multicenter trial

“…Nasal irrigation is commonly prescribed for the prevention and treatment of URTI symptoms and other sinonasal conditions [ 5 – 10 ]. It provides mechanical cleaning of nasal content [ 11 ], with rare adverse events [ 12 , 13 ]. It enhances mucociliary clearance thereby reducing the contact time of airborne elements with mucus [ 11 , 14 – 16 ].…”