Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study

Savietto, Enrico; Marioni, Gino; Maculan, Pietro; Pettorelli, Andrea; Scarpa, Bruno; Simoni, Edi; Astolfi, Laura; Marchese‐Ragona, Rosario; Ottaviano, Giancarlo

doi:10.1016/j.amjoto.2020.102502

Cited by 16 publications

(25 citation statements)

References 27 publications

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“…Taking into account that more than 50% of our population was found to be positive to at least one of the tested allergens, we would have expected to find a higher expression of eosinophils at nasal cytology. However, it has been reported that a long exposure to dust (in our population, the mean amount of working years in a bakery was 14) can produce a status of minimal persistent inflammation, which is characterized, at nasal cytology, by a high presence of neutrophils and a very low ciliated cell expression [ 28 , 39 , 40 ]. In this regard, 45.5% of the bakers did not present ciliated cells at nasal cytology.…”

Section: Discussionmentioning

confidence: 99%

“…Nasal cytology was examined through anterior rhinoscopy using a Rhino-Probe (Arlington Scientific Inc., Springville, UT, USA) nasal curette, and all the specimens were examined under the light microscope by the same operator (G.O.). The cytological variables considered were the total number of ciliated cells, with and without hyperchromatic supranuclear stria (HSS), and the total number of inflammatory cells (neutrophil granulocytes and eosinophil granulocytes) counted for each specimen in five separate high-power fields (HPF, original magnification ×100) [ 26 , 27 , 28 ].…”

Section: Methodsmentioning

confidence: 99%

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Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

Crivellaro

Ottaviano

Maculan

et al. 2020

IJERPH

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A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

Crivellaro

Ottaviano

Maculan

et al. 2020

IJERPH

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“…They concluded that 4% cromolyn sodium nasal solution is not beneficial in the treatment of patients with NARES syndrome. Nasal irrigations have been suggested in the treatment of chronic rhinitis [77][78][79], and the use of nasal saline spray/ irrigation should also be considered in the treatment of NARES patients. Notwithstanding, to date, no specific studies have been performed on these patients.…”

Section: Therapy Of Naresmentioning

confidence: 99%

Clinical Evidence of Type 2 Inflammation in Non-allergic Rhinitis with Eosinophilia Syndrome: a Systematic Review

Corso

Seccia

Ottaviano

et al. 2022

Curr Allergy Asthma Rep

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Purpose of Review Non-allergic rhinitis (NAR) includes different subtypes, among which NAR with eosinophilia syndrome (NARES) is the most important because of severity of symptoms and the high risk of comorbidities. Its pathophysiology is still object of debate, but a crucial role of chronic eosinophilic inflammation has been recognized. The aim of this review is to critically analyze the current evidence regarding the hypothesis that NARES may be considered a type 2 inflammatory disorder. Recent FindingsThe definition and diagnostic criteria for NARES are not universally shared and adopted, thus generating difficulties in reproducing the results. At present, there is extreme heterogeneity in sampling methods and disagreement in the cut-off of local eosinophilic count to determine a diagnosis of NARES. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was applied to identify English-language experimental and clinical articles regarding NARES. The search was performed in April 2021. Twenty-six articles were included. Summary Our data suggest a particular heterogeneity regarding sampling and specific cut-offs adopted for diagnosis of NARES and consensus should be reached. We suggest that eosinophil count should be reported as an absolute value for at least 10 observed rich fields in order to increase the level of standardization. Consensus among authors on this topic should be reached with particular attention to the cut-off for diagnosis. In the future, this limitation may be overcome by the identification of repeatable biomarkers to refine diagnosis and prognosis of NARES. Furthermore, our data strongly suggest that NARES have numerous similarities with clinical features of the most common type 2 diseases such as eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP): late onset, association with type 2 comorbidities, selective eosinophilic tissue infiltration, remarkable response to oral and intranasal corticosteroids, and progression in a type 2 CRSwNP.

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“…Among these, a graded recommendation was developed for sodium hyaluronate, xylitol, and honey, as these are used and studied more frequently. Seven RCTs were conducted on nasal irrigation with sodium hyaluronate additives [90][91][92][93][94][95][96]. Of these, five studies were conducted in the postoperative period, and two studies were performed on patients with CRSwNP and CRS without nasal polyps (CRSsNP), respectively.…”

Section: Supporting Textmentioning

confidence: 99%

Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

Park

Choi

Kim

et al. 2022

Clin Exp Otorhinolaryngol

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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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Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: A prospective, randomized, double-blind, controlled study

Cited by 16 publications

References 27 publications

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

Clinical Evidence of Type 2 Inflammation in Non-allergic Rhinitis with Eosinophilia Syndrome: a Systematic Review

Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

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