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      The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study Translated title: Efeito de diferentes soluções para irrigação nasal após septoplastia e radiofrequência das conchas nasais: estudo prospectivo e randomizado

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          Abstract

          Introduction

          Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing.

          Objective

          The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency.

          Methods

          The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score.

          Results

          There was no significant difference found in the preoperative and 7th and 15th postoperative days’ mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group ( p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group ( p < 0.001).

          Conclusion

          Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.

          Resumo

          Introdução

          Soluções para irrigação nasal são amplamente utilizadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzindo a probabilidade de formação de sinéquias e acelerando a cicatrização da mucosa.

          Objetivo

          O objetivo do presente estudo foi comparar os efeitos das soluções para irrigação nasal com diferentes conteúdos após septoplastia e turbinoplastia com radiofrequência.

          Método

          O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos à septoplastia e turbinoplastia bilateral com radiofrequência. Os pacientes foram divididos em quatro grupos de acordo com a solução nasal utilizada: água da torneira, solução salina isotônica tamponada, solução salina com xilitol e água do mar hipertônica. Os pacientes foram examinados no 7° e 15° dias do pós-operatório. O teste de sacarina foi utilizado para determinar a atividade mucociliar pré-operatória e no 7° e 15° dias do pós-operatório. Os pacientes foram questionados sobre a sensação de secura e obstrução nasais utilizando uma escala visual analógica de 10 cm. Além disso, os pacientes foram examinados para determinar o escore em relação à crostas.

          Resultados

          Não houve diferença significativa entre o pré-operatório e os 7° e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo utilizando água do mar hipertônica ( p < 0,001). As sensações de secura e obstrução nasais no 7° e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica ( p < 0,001).

          Conclusão

          A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.

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          Most cited references17

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          Mucociliary clearance and buffered hypertonic saline solution.

          Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.
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            Effect of hypertonic saline, amiloride, and cough on mucociliary clearance in patients with cystic fibrosis.

            In patients with cystic fibrosis (CF), dehydration of airway secretions leads to a decrease in mucociliary clearance (MCC). We examined the acute effect of MCC of a single administration by aerosolization of hypertonic saline (7%) (HS), amiloride (0.3% in 0.12% NaCl) (AML) and a combination of AML and HS (AML + HS) in 12 patients with CF using a radioaerosol technique. Isotonic saline [0.9%] (IS) was used as a control solution. As both the AML and HS solutions induced cough in some patients, the last nine patients studied also underwent a cough clearance day. This was to eliminate the possible confounding effect of cough on MCC measurement. Patients ranged from 18 to 28 yr (mean +/- SD, 22 +/- 3) with an FEV1 of 27 to 112% predicted (61 +/- 30%). Following deposition of the radioaerosol, baseline clearance was assessed for 30 min. This was followed by a 30-min intervention period. Assessment of post-intervention clearance for a further 30 min was then performed. Comparison of the amount of radioaerosol cleared from the right lung was made at 60 min (%C60) and 90 min (%C90) using repeated measures ANOVA. The percent cleared at 60 and 90 min was significantly increased with HS (%C60 = 26.5%, %C90 = 29.4%) and the combination of AML + HS (%C60 = 23.1%, %C90 = 27.4%) compared with both IS (%C60 = 14.7%, %C90 = 17.5%) and COUGH (%C60 = 18.0%, %C90 = 19.5%), p < 0.01. Inhalation of hypertonic saline is a potentially useful treatment in patients with cystic fibrosis.
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              The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients.

              To compare the effect of two saline nasal sprays on nasal patency and mucociliary clearance in patients with rhinosinusitis. Randomized double-blind trial. Eighty patients with rhinosinusitis at a tertiary care academic center had nasal patency and mucociliary clearance measured. Each patient was then treated with either physiological or hypertonic saline. Nasal patency and mucociliary clearance measurements were repeated after treatment. Subjective evaluation was also performed. Both solutions improved saccharine clearance times (P < 0.0001). Buffered physiological saline significantly affected nasal airway patency (P = 0.006). Both solutions improved symptoms of nasal stuffiness (P < 0.0001) and nasal obstruction (P < 0.0001). Buffered hypertonic saline caused increased nasal burning/irritation compared with buffered physiological saline (P < 0.0001). Buffered physiological and buffered hypertonic saline nasal sprays both improve mucociliary clearance, which is beneficial for treatment of rhinosinusitis. Additionally, buffered physiological saline improves nasal airway patency, whereas buffered hypertonic saline has no effect. Both solutions provide symptomatic relief, but buffered hypertonic saline is more irritating.
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                Author and article information

                Contributors
                Journal
                Braz J Otorhinolaryngol
                Braz J Otorhinolaryngol
                Brazilian Journal of Otorhinolaryngology
                Elsevier
                1808-8694
                1808-8686
                22 February 2017
                Mar-Apr 2018
                22 February 2017
                : 84
                : 2
                : 185-190
                Affiliations
                [0005]Turgut Ozal University Faculty of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Ankara, Turkey
                Author notes
                [* ]Corresponding author. hkurtaran@ 123456gmail.com
                Article
                S1808-8694(17)30027-7
                10.1016/j.bjorl.2017.01.005
                9449243
                28325622
                1db23576-b720-4189-876e-d0e1e7e70a4b
                © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 2 October 2016
                : 23 January 2017
                Categories
                Original Article

                septoplasty,nasal irrigation,mucociliary clearance,crusting,obstruction,septoplastia,irrigação nasal,clearance mucociliar,crostas,obstrução

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