xRead - Nasal Obstruction (September 2024) Full Articles

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432

International consensus statement on rhinosinusitis

TABLE IX-41 Evidence for CRS management with xylitol Study Year

LOE Study Design Study Groups

Clinical Endpoint

Conclusions Xylitol vs saline irrigation significantly

Lin 1238

Symptom/QoL score (VAS and SNOT-22). NasalNO

2017

2

RCT

Adult CRS patients that had sinus surgery, irrigation with:

reduced VAS and SNOT-22 scores.

1. xylitol (n = 15) 2. saline (n = 15)

Weissman 1237 2011

2

DBRCT

Adult CRS patients that had sinus surgery

Symptom/QoL score (SNOT-20)

Greater

improvement in SNOT-20 with xylitol vs saline irrigation.

1. xylitol (n = 10) 2. saline (n = 10)

biomass of S. epidermidis and inhibit biofilm formation of S. aureus and P. aeruginosa . 1234 In a human study, Zabner et al. demonstrated that xylitol nasal spray administered for 4 days in normal volunteers resulted in greater reduction of coagulase-negative Staphy lococcus colony forming units than did saline spray. 1235 A subsequent in vitro study demonstrated that xylitol sig nificantly decreased the viscoelasticity and viscosity of wet mucus derived from CRS patients more than saline controls. 1236 In that same study, postoperative mucus crust dissolution was also measured. Xylitol was found to sig nificantly reduce mucus crust border definition in CRS patients to a greater degree than saline, indicating its potential efficacy as a mucolytic agent. 1236 Thus far, there have been 2 clinical studies evaluating the effect of xylitol in patients with CRS. The studies did not specify whether patients had CRSsNP or CRSwNP. Weiss man et al. 1237 performed a prospective DBRCT crossover pilot study. The subjects were adults with a history of CRS who had undergone sinus surgery. After a 3-day washout period, subjects were given either xylitol or isotonic saline irrigations daily for 10 days. This was followed by another 3-day washout period, followed by 10 days of the other treatment. Ten subjects were allocated to each group; 15 (75%) completed the study. The xylitol group showed a greater improvement in SNOT-20 scores than the saline group. However, there was no difference in the visual ana log scale (VAS) scores between the 2 groups. A systematic review by Rudmik et al., evaluated the evidence of using topical irrigations with xylitol based on Weissman’s study, and the authors concluded that the benefit-harm assess ment was unknown. 1141 Subsequently, Lin et al. performed an RCT comparing sinonasal symptoms (VAS and SNOT-22 scores) and nasal NO in CRS patients who had undergone sinus surgery. 1238 Patients were randomly assigned to a 30-day regimen of xylitol (n = 15) or saline nasal irrigation (n = 15) post operatively. Twenty-five subjects completed the study. VAS and SNOT-22 scores were significantly reduced in the xyl itol group compared to the saline group following the 30

day study period. There were no adverse events with use of xylitol rinses in either study apart from 1 patient who reported minor stinging. 1237 In summary, there have been 2 RCTs with small sam ple sizes and 17% to 25% dropout that have shown limited significant symptom benefit with xylitol. In vitro studies have demonstrated enhancement of innate immunity and mucolytic properties. Potential harm is limited to minor irritation and cost of therapy is low. Xylitol for CRS Aggregate Grade of Evidence: B (Level 2: 2 studies; Table IX-41). Benefit: Symptomatic improvement in the 2 small RCTS conducted on postoperative CRS patients. Harm: Occasional local discomfort (stinging). Cost: Low. Benefits-Harm Assessment: Preponderance of mild benefit over harm. Value Judgments: None. Policy Level: Option. Intervention: Xylitol is an option for treating CRS. IX.D.12.d. Topical Alternative Therapies for CRS: Colloidal Silver Because of limited data, CRSsNP and CRSwNP are com bined in this analysis and recommendations. Silver is known to possess broad antimicrobial proper ties, with effectiveness against gram-negative and gram positive bacteria, fungi, protozoa and some viruses. It is among the most toxic elements to microorganisms, many of which do not develop resistance to its effects. Because of this, silver is used in a number of medical and non medical products including wound dressings, catheters, water purification devices and textiles.