Effectiveness of Hyaluronic Acid Nasal Drops in Post Functional Endoscopic Sinus Surgery
Keywords:Endoscopic features, functional endoscopic sinus surgery, clinical symptom, hyaluronic acid
Functional Endoscopic Sinus Surgery (FESS) is commonly performed on patients with chronic rhinosinusitis (CRS) that has not improved through medical treatment. Hyaluronic acid (HA) has a vital role in wound healing and mucosa repair. This study aimed to determine the effectiveness of nasal drops using HA on clinical symptom scores, quality of life, and endoscopic features in post-FESS patients. This study was conducted with a pre- and post-test randomized control group design in 50 CRS patients undergoing FESS (25 males, 25 females, aged 18 to 55 years) at Dr. Kariadi General Hospital Medical Center Semarang from May to November 2019. The treatment group received additional HA therapy, while the control group only received standard therapy. Subjects were assessed with clinical symptom scores, quality of life, and endoscopic features before and after treatment. The statistical analysis was performed between the control and treatment groups using the Mann-Whitney test. There were significant differences between the control and treatment groups on clinical symptom scores (nasal congestion p = 0.001, runny nose p = 0.027) and endoscopic features (edema p = 0.001, secret p = 0.001, crusts p = 0.001). The therapy in post-FESS patients was using nasal drops, the treatment group was given HA, and the control group was given a placebo. Nasal drops using HA in the treatment group show improvement in clinical symptom scores of nasal congestion and runny nose, as well as the endoscopic appearance of edema, secret, and crusts.
Epstein VA and Lanza DC. The Diagnosis of Rhinosinusitis. In: Kennedy DW and Hwang PH (Eds). Rhinology Diseases of the Nose, Sinuses, and Skull Base. New York: Thieme Medical Publishers; 2012: p. 110–125.
Fokkens WJ, Lund VJ, Mullol J, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. A Summary Otorhinolaryngologists. Rhinology. 2012; 50(1): 1–12.
Psaltis AJ, Li G, Vaezeafshar R, Cho KS, and Hwang PH. Modification of the Lund-Kennedy Endoscopic Scoring System Improves Its Reliability and Correlation with Patient-Reported Outcome Measures. Laryngoscope. 2014; 124(10): 2216–2223.
Suh J and Chiu A. Medical Management of Chronic Sinusitis. In: Johnson J and Rosen C (Eds). Bailey's Head and Neck Surgery Otolaryngology 5th edition. Philadelphia: Lippincot Williams and Wilkins; 2014: p. 586–592.
Chan Y. The Nose, Acute, and Chronic Sinusitis. In: Lee K (Ed). Essential Otolaryngology Head and Neck Surgery. 10th edition. United States of America: McGraw-Hill; 2012: p. 397-415.
Ryan M. Chronic Rhinosinusitis with Nasal Polyposis. In: Johnso J and Rosen C (Ed). Bailey's Head and Neck Surgery Otolaryngology 5th edition. Philadelphia: Lippincot Williams and Wilkins; 2014: p. 525–34.
Cantone E and Iengo M. Effect of Sodium Hyaluronate Added to Topical Corticosteroids in Chronic Rhinosinusitis with Nasal Polyposis. American Journal of Rhinology & Allergy. 2016; 30(5): 340–343.
Gelardi M, Guglielmi AVN, de Candia N, Maffezzoni E, Berardi P, and Quaranta N. Effect of Sodium Hyaluronate on Mucociliary Clearance after Functional Endoscopic Sinus Surgery. European Annals of Allergy and Clinical Immunology. 2013; 45(3): 103–108.
Snidvongs K, Dalgorf D, Kalish L, Sacks R, Pratt E, and Harvey RJ. Modified Lund Mackay Postoperative Endoscopy Score For Defining Inflammatory Burden In Chronic Rhinosinusitis. Rhinology. 2014; 52(1): 53–59.
Kurniasih C and Ratnawati LM. Distribusi Penderita Rinosinusitis Kronis yang Menjalani Pembedahan di RSUP Sanglah Denpasar Periode Tahun 2014 – 2016. MEDICINA. 2019; 50(1): 133–137.
Song WJ, Lee JH, Won HK, and Bachert C. Chronic Rhinosinusitis with Nasal Polyps in Older Adults: Clinical Presentation, Pathophysiology, and Comorbidity. Current Allergy and Asthma Reports. 2019; 19(10): 1–8.
Shusterman D. Toxicology of Nasal Irritants. Current Allergy and Asthma Reports. 2003; 3(3): 258–265.
Guo S and DiPietro LA. Critical Review in Oral Biology & Medicine: Factors Affecting Wound Healing. Journal of Dental Research. 2010; 89(3): 219–229.
Galluzzi F, Pignataro L, Maddalone M, and Garavello W. Recurrences of Surgery for Antrochoanal Polyps in Children: A Systematic Review. International Journal of Pediatric Otorhinolaryngology. 2018; 106: 26–30.
Cooper M, Cheng T, Truong T, Kuchibhatla M, Hachem RA, and Jang DW. Factors Associated with Revision Surgery after Balloon Sinuplasty. Otolaryngology-Head Neck Surgery. 2019; 160(4): 734–739.
Safitri W, Pawarti DR, and Ahadiah TH. Efektivitas Salin Hipertonik terhadap Waktu Transpor Mukosiliar dan Skor Gejala Hidung Penderita Rinitis Alergi. Oto Rhino Laryngologia Indonesiana. 2018; 47(2): 123-131.
Boztepe OF, Gün T, Demir M, Gür ÖE, Ozel D, and Doğru H. A Novel Predictive Marker for the Recurrence of Nasal Polyposis Following Endoscopic Sinus Surgery. European Archives of Oto-Rhino-Laryngology. 2016; 273(6): 1439–1444.
Casalino-Matsuda SM, Monzon ME, Day AJ, and Forteza RM. Hyaluronan Fragments/CD44 Mediate Oxidative Stress-Induced MUC5B Up-Regulation in Airway Epithelium. American Journal of Respiratory Cell and Molecular Biology. 2009; 40(3): 277–85.
Mehle ME and Schreiber CP. Sinus Headache, Migraine, And The Otolaryngologist. Otolaryngology-Head and Neck Surgery. 2005; 133(4): 489–496.
Bassiouni A, Naidoo Y, and Wormald PJ. When FESS Fails: The Inflammatory Load Hypothesis in Refractory Chronic Rhinosinusitis. Laryngoscope. 2012; 122(2): 460–466.
Lee JT, Kennedy DW, Palmer JN, Feldman M, and Chiu AG. The Incidence of Concurrent Osteitis in Patients with Chronic Rhinosinusitis: A Clinicopathological Study. American Journal of Rhinology. 2006; 20(3): 278–282.
Bassiouni A, Chen PG, and Wormald PJ. Mucosal Remodeling and Reversibility in Chronic Rhinosinusitis. Current Opinion in Allergy and Clinical Immunology 2013; 13(1): 4–12.
Castelnuovo P, Tajana G, Terranova P, Digilio E, Bignami M, and Macchi A. From Modeling to Remodeling of Upper Airways: Centrality of Hyaluronan (Hyaluronic Acid). International Journal of Immunopathology and Pharmacology. 2016; 29(2): 160–167.
Cassano M, Russo GM, Granieri C, and Cassano P. Cytofunctional Changes In Nasal Ciliated Cells In Patients Treated With Hyaluronate After Nasal Surgery. American Journal of Rhinology & Allergy. 2016; 30(2): 83–88.
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