Effect of hypochlorous acid nasal spray as an adjuvant therapy after functional endoscopic sinus surgery

Abstract

Objectives

To evaluate the efficacy of hypochlorous acid (HOCl) nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS).

Material and methods

Patients with chronic rhinosinusitis who had received FESS for treatment were recruited and assigned to one of two groups at random at one month post-surgery. In the HOCl group, patients received 0.02% HOCl nasal spray three times a day for two months. In the control group, normal saline (NS) nasal irrigation was given. Before FESS and before and after nasal spray or irrigation, patients completed the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22). In addition, patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures obtained from their middle meatus.

Results

Seventy-eight patients completed the study. Among them, 41 received HOCl nasal spray, and 37 received NS irrigation. Endoscopic score significantly decreased after 2-month HOCl nasal spray (p = 0.036). TWSNOT-22 score also decreased, although insignificantly (p = 0.285). In contrast, TWSNOT-22 score significantly decreased after NS nasal irrigation (p = 0.017), but endoscopic score did not significantly decrease (p = 0.142).

Conclusions

Our results showed that HOCl nasal spray had a similar effect to that of NS nasal irrigation in post-FESS care. It can be an alternative of NS nasal irrigation for its convenient application.

Introduction

Topical therapy is a popular treatment modality for various sinonasal diseases including upper respiratory tract infection, rhinitis, rhinosinusitis, and postoperative or post-radiation care [1], [2], [3], [4], [5]. Topical therapy may have several effects including mechanical removal of mucus and crusts, increase in mucus clearance, enhanced ciliary beat activity, disruption and removal of antigens, and biofilm and inflammatory mediators [6]. It can also transport medication into the sinus [7]. However, there is little consensus on the methods of topical therapy, including the rinsing volume, pressure, frequency, devices, and head position [6]. Among different methods, nasal saline irrigation is currently recommended for postoperative treatment in patients with chronic rhinosinusitis without nasal polyps [8].

Hypochlorous acid (HOCl) is a weak acid which is produced when chlorine dissolves in water, and has been demonstrated to have bactericidal effects [9]. HOCl solution has been used as a nasal irrigant to treat chronic rhinosinusitis (CRS) [10], [11]. Recently, HOCl solution has become commercially available as a nasal spray in Taiwan. In this study, we evaluated the efficacy of HOCl nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS).

Section snippets

Study design and population

The flow chart and design of the experiment are shown in Fig. 1. CRS Patients who failed medical treatment and subsequently underwent FESS were collected between February 2017 and January 2020. The diagnosis of CRS was made according to the EPOS criteria based on patient history, nasal endoscopy, and CT of the sinuses [6]. We excluded patients who had taken antibiotics within a week before FESS, and those with a history of immunodeficiency or sinus surgery. Patients with a pathological

Patients

A total of 78 patients were included in the final analysis, with 41 in the HOCl group and 37 in the saline group (Fig. 1). Among the 78 patients, 24 were comorbid with allergic rhinitis and 4 had allergic rhinitis and asthma. Fifty-six were grouped having type-2 CRS and the others were non-type 2 endotype. Forty-five had CRSsNPs and 33 had CRSwNPs. In the HOCl group, the mean age was 47.9 years (range: 21 to 80), with 25 males and 16 females. In the saline group, the mean age was 43.8 years

Discussion

A low concentration of HOCl solution has been reported to have strong anti-bacterial, antiviral, and anti-fungal effects [9]. Cho et al. treated 26 pediatric CRS patients without a history of nasal surgery using low-concentration hypochlorous nasal irrigation or saline nasal irrigation for 4 weeks [10]. Patients received nasal irrigation with 30 mL of HOCl or normal saline for 10 s twice a day while sitting or standing. They found that nasal irrigation with a low concentration of HOCl solution

Conclusions

The HOCl nasal spray used in this study is commercially available and convenient to use. Patients do not need to make HOCL solution themselves using a device. It had a similar effect on post-FESS care compared with saline nasal irrigation. It might be an alternative to nasal saline irrigation for post-FESS care in the era of COVID-19. Further investigation should be conducted to determine the long-term effects of low-concentration HOCl solution on sinonasal mucosa.

Ethical statement

This study was approved by the Ethics Committee of Taichung Veterans General Hospital. Written consent was obtained from each patient.

Declaration of competing interest

The authors declare that they have no financial conflict of interest.

Acknowledgments

The authors are grateful to the Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan, for assistance with the statistical analysis.

Funding

This study was supported by a grant (TCVGH-1067006C) from Taichung Veterans General Hospital, Taiwan, R.O.C.

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