xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

psoriasis, 1245,1246 and is also considered a treatment option for non-allergic rhinitis. 1247 Capsaicin affects the unmyeli nated sensory C fibers of the nasal mucosa. These nerve fibers play a role in the neurogenic reflex mechanisms in the nasal mucosa, which when stimulated lead to a local release of neuropeptides, including substance P, C-peptide, calcitonin gene-related peptide (CGRP), and vasoactive intestinal peptide (VIP). 1248–1250 It is hypothesized that repeated administration of high doses of capsaicin to the nasal mucosa leads to degeneration of these unmyelinated sensory C fibers. 1251 The vasodilation and increase in nasal secretions triggered by stimulation of these nerves with cap saicin has been demonstrated to be higher in patients with non-allergic rhinitis compared to asymptomatic controls. 1250,1252 High tissue concentration of neuropep tides such as CGRP in nasal mucosa has been shown to be directly correlated with the intensity of nasal obstruc tion and rhinorrhea symptoms. 1252,1253 It is theorized that sensory neuropeptide release in the nasal mucosa may trigger hyperproliferation and hypertrophy of the mucosa that even contributes to polyp formation, 1254 such that downregulation of this response may lead to improvement. In the case of non-allergic rhinitis, a Cochrane database review involving 5 studies indicated that capsaicin has ben eficial effects on overall nasal symptoms up to 36 weeks after treatment. 1247 Three studies were identified in the literature that assessed the effect of topical capsaicin on nasal polyposis. In a randomized, placebo-controlled trial, Zheng et al. 1255 reported a significant improvement in subjective nasal obstruction and endoscopic staging of polyps in patients treated with topical capsaicin following limited ESS vs con trols. In their double blind, placebo-controlled study, Fil iaci et al. 1256 also showed significant improvement in sub jective nasal symptoms such as obstruction, secretions, and sneezing, as well as improvement in objective findings, including endoscopic polyp scores and nasal airway resis tance by anterior rhinomanometry. Similarly, Baudoin et al. 1257 reported an improvement in nose/sinus air volume, endoscopy scores, and subjective symptoms scores at 4 weeks post-treatment in patients with nasal polyposis in their case series. In all of these studies, an assessment of underlying CRS was not part of the study, but rather patients were included if they demonstrated nasal poly posis. In 2 of the studies, patients were excluded from the study group if they had a history of asthma, allergy, or atopy. 1255,1257 Treatment schedules varied between the studies from daily application of capsaicin to weekly, sim ilar to the wide range of capsaicin doses, concentrations, frequencies, and durations seen in other studies involving the use of this topical medication for non-allergic rhinitis and other pathologies.

TABLE IX-42 Evidence for CRS management with colloidal silver Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Scott 1241 2017 2 DBRCT Crossover Adults with recalcitrant CRSsNP - Nasal spray with saline, 4 sprays BID (n = 8) - Nasal spray with CAg, 4 sprays BID (n = 12) Symptom/QoL score (SNOT-22) Endoscopic score (Lund Kennedy) No significant differences between the 2 groups Culture negativity Symptom score/QoL score (VAS and SNOT-22) No difference in culture negativity, symptom, and endoscopy scores

between the 2 groups. Twice daily CAg

irrigations is safe but

not superior to culture directed oral antibiotics.

Endoscopic scores (Lund Kennedy)

- Culture directed oral antibiotics (10-14 days) + NSIBID(n = 11)

- Nasal CAg irrigation (0.015 gm/mL) BID for 10 days (n = 10)

Ooi 1242 2018 2 RCT Adults with CRS who had prior sinus surgery, active sinus infection and positive bacterial culture