A Comparative Study of Different Administrations of Nebulized Hyaluronic Acid After Endoscopic Endonasal Surgery for Chr
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ORIGINAL ARTICLE
A Comparative Study of Different Administrations of Nebulized Hyaluronic Acid After Endoscopic Endonasal Surgery for Chronic Rhinosinusitis Vincenzo Abbate1 • Giorgio Iaconetta2 • Fabio Maglitto1 • Giovanni Improta3 • Antonio Romano1 Paola Bonavolonta`1 • Francesco Seidita1 • Luigi Califano1 • Giovanni Dell’Aversana Orabona1
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Received: 6 July 2020 / Accepted: 25 August 2020 Ó The Author(s) 2020
Abstract Hyaluronic Acid (HA) plays many roles in wound healing in general, through different mechanisms. Several authors reported the effectiveness of hyaluronic acid in promoting mucosal healing and reducing discomfort for patients after endoscopic sinus surgery (ESS). Different methods for HA nasal administration have been reported. The aim of our study has been to evaluate the efficacy of the administration of nebulized HA through a nasal douche compared with its administration through a nasal spray with patients undergoing ESS for chronic rhinosinusitis. From January 2013 to January 2019 a prospective clinical trial was carried out in our hospital with 163 patients who had undergone ESS for chronic rhinosinusitis. The sample was divided into three groups according to the method of administration of HA. Our study confirm the efficacy of the administration of nebulized HA through nasal douche in post-operative care (6.5% vs 4.5%). The most relevant data regards the nasal dryness sign: the data revealed an unexpected percentage of worsening of that sign at time T3 (p = 0.049) particularly evident in the patients treated with HA through nasal douche compared to whom the nasal spray device was prescribed (4% vs 1%). Further studies are needed to
& Giorgio Iaconetta [email protected] 1
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100 Naples, Italy
2
Neurosurgery Unit, Department of Medicine, Surgery and Odontoiatrics, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
3
Department of Public Health, University of Naples ‘‘Federico II’’, Naples, Italy
identify the best means of administration of HA, which would satisfy the requirements for efficacy in terms of the results and, at the same time, patient compliance. Keywords Hyaluronic acid Nasal douche FESS ESS SNOT-22 Nasal spray
Introduction Hyaluronic acid (HA) is a carbohydrate, more specifically a high molecular weight mucopolysaccharide with a linear and poly repeating disaccharide structure. First discovered in 1934 (K. Meyer and J. Palmer), HA plays an important role in the formation of the extracellular matrix and in intracellular environment. The viscoelastic nature of HA, added to its biocompatibility and non-immunogenicity, has led to its use in various clinical applications in different medical fields such as dermatology, aesthetic medicine, ophthalmology, joint surgery and tissue engineering [1]. The main biological functions of HA are: the maintenance of the connective fluid tissue consistency
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