Nasal lavage with sodium hypochlorite solution in Staphylococcus aureus persistent rhinosinusitis

Area of Science:

• Otolaryngology
• Infectious Diseases
• Biomedical Engineering

Background:

• Persistent Staphylococcus aureus (SA) infections are a common cause of chronic rhinosinusitis (CRS).
• Recurrent SA infections in CRS patients often resist conventional antibiotic therapies.
• Developing effective and safe nasal lavage solutions is crucial for managing these challenging cases.

Purpose of the Study:

• To determine an optimal concentration of sodium hypochlorite (NaOCl) in saline for nasal lavage.
• To evaluate the clinical efficacy and safety of 0.05% NaOCl nasal lavage in patients with persistent SA-associated CRS.
• To assess the impact of NaOCl lavage on sinonasal symptoms, endoscopic findings, and nasal airway resistance.

Main Methods:

• In vitro assessment of NaOCl effects on ciliary and epithelial cell viability.
• Clinical trial involving 20 patients with persistent SA-associated CRS, comparing saline lavage with 0.05% NaOCl in saline lavage.
• Symptom assessment using visual analogue scale (VAS), endoscopic evaluation, rhinomanometry (RM), and nasal nitric oxide (NO) measurements.

Main Results:

• 0.05% NaOCl demonstrated no significant cytotoxicity in vitro, unlike 0.5% NaOCl.
• Nasal lavage with 0.05% NaOCl significantly improved nasal obstruction, posterior nasal discharge, olfaction, and headache.
• Significant improvements were observed in endoscopic grading of edema, erythema, purulent discharge, and nasal crusts, along with reduced nasal airway resistance (NAR).

Conclusions:

• Nasal lavage with 0.05% NaOCl in saline is safe and well-tolerated for long-term use.
• This concentration offers a beneficial alternative to saline lavage alone for managing symptomatic CRS with recurrent SA infections.
• The treatment effectively alleviates symptoms and improves endoscopic and objective measures in patients with persistent SA-associated CRS.