Comparison of effects of baby shampoo vs. saline irrigation on endoscopic sinus surgery outcomes and quality of life

Comparison between Manuka Honey and Baby Shampoo Nasal Douching Procedures After Functional Endoscopic Sinus Surgery: a Prospective Comparative

INTRODUCTION

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of nasal and paranasal sinus mucosa where symptomatology has continued beyond 12 weeks. Manuka honey is made by bees that pollinate the native leptospermum scoparium bush (tea tree). Baby shampoo is a commercially available liquid solution containing multiple chemical surfactants that can act as a mucolytic and an antimicrobial agent.

MATERIALS AND METHODS

Fifty patients diagnosed with CRS were taken to be part of study. The modes of comparison used were the Rhinosinusitis Disability Index (RSDI) and a self-formulated Nasal Crusting Score (NCS). Individuals in Group A were given 5% Manuka Honey for nasal douching in both nasal cavities and those in Group B were given 10% Baby Shampoo.

OBSERVATIONS AND RESULTS

The average RSDI scores in Group A before & after intervention were 75.40 and 30.04, an improvement of 60.15%. The same parameters in Group B was found to be 77.36 and 37.36, an improvement of 51.70%. The NCS improved by 83.46% in the Group A and by 77.61% in Group B between POD-2 and POD-5.

CONCLUSION

As per literature available, both Manuka Honey and Baby Shampoo have improved the outcomes of Quality of Life and airway after FESS. We found that Manuka Honey is superior in clearing crusts and achieving better symptom clearance post FESS. We also present our self-formulated Nasal Crusting Score which can be used in further practice for better understanding of nasal airway.

Non-antibiotic antimicrobial agents for chronic rhinosinusitis: a narrative review

OBJECTIVE

This narrative review explores alternative non-antibiotic antimicrobial agents for CRS management in adults.

METHODS

Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded.

RESULTS

148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels.

CONCLUSION

Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.

Yardstick for the medical management of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses defined by classic symptoms, imaging findings, or endoscopic findings. There are a growing number of emerging pharmacologic therapies being evaluated to treat patients with CRS, some of which have gained indication status in the United States. There have not been updated treatment guidelines published in the United States however since 2014. This document is meant to serve as an updated expert consensus document for the pharmacologic management of patients with CRS. We review available data focusing on prospective clinical trials on oral and intranasal corticosteroids, nasal irrigation, biologics, antibiotics, and allergy immunotherapy for CRS both with and without nasal polyposis, including specific therapies for aspirin-exacerbated respiratory disease-associated CRS and allergic fungal CRS. There are multiple options to treat CRS, and clinicians should be knowledgeable on the efficacy and risks of these available therapies. Allergists-immunologists now have various therapies available to treat patients with CRS.