Developing a Novel Solute for Sinonasal Irrigation in Chronic Rhinosinusitis
Grace Tawhai, Student, The University of Auckland, New Zealand
Authors List
Introduction
Chronic rhinosinusitis (CRS) is a common multifactorial condition that presents with long-term inflammation of the sinonasal cavity. Nasal irrigation is a safe, well-established management, with positive effects on symptom reduction at all stages of CRS. Despite new evidence suggesting that complex ion solutions and novel additives can significantly improve CRS symptom relief, this evidence has not yet made its way into the commercial market. We hypothesise that novel agents can be incorporated to form an irrigation solute which better targets the needs of long-term symptom control and recalcitrant disease management in CRS.
Aims
Design an evidence-based solute for nasal irrigation, optimised for CRS.
Methods
Literature was reviewed to establish additives resulting in clinical symptom reduction and in vitro promise of action against bacterial biofilms in CRS. Feasible treatment doses were determined based on efficacy, safety, and tolerability, while an investigation into the physical characteristics of commercial sinus rinses was used to assist in novel development. The Calgary Biofilm Device was used to assess the in vitro effects of novel solutes against S. aureus and P.aeruginosa biofilms, while gaps in the commercial market were examined to design an optimised irrigation bottle.
Results
Investigation into the physical characteristics of commercial sinus rinses suggested tolerability between significantly different pH and osmolarity ranges. Ringer’s solution, xylitol, and magnesium sulphate were determined as the most likely additives to result in symptom improvement while retaining tolerability. In vitro investigations into the antibiofilm effects of solutions on preformed biofilms demonstrated the potential for a significant dispersal effect and lack of xylitol dose response. An irrigation system was developed to target pain points identified by patients, targeting issues of drying and sustainability.
Conclusion
Two novel irrigation solutes and a bottle system have been designed which we hypothesise will improve symptom control in CRS, while retaining long-term tolerability.
- Tawhai, G., Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Biswas, K., Department of Surgery, University of Auckland, New Zealand
- Wagner, B., Department of Surgery, University of Auckland, New Zealand
- Kim, R., Department of Surgery, University of Auckland, New Zealand
- Douglas, R., Department of Surgery, University of Auckland, New Zealand
Introduction
Chronic rhinosinusitis (CRS) is a common multifactorial condition that presents with long-term inflammation of the sinonasal cavity. Nasal irrigation is a safe, well-established management, with positive effects on symptom reduction at all stages of CRS. Despite new evidence suggesting that complex ion solutions and novel additives can significantly improve CRS symptom relief, this evidence has not yet made its way into the commercial market. We hypothesise that novel agents can be incorporated to form an irrigation solute which better targets the needs of long-term symptom control and recalcitrant disease management in CRS.
Aims
Design an evidence-based solute for nasal irrigation, optimised for CRS.
Methods
Literature was reviewed to establish additives resulting in clinical symptom reduction and in vitro promise of action against bacterial biofilms in CRS. Feasible treatment doses were determined based on efficacy, safety, and tolerability, while an investigation into the physical characteristics of commercial sinus rinses was used to assist in novel development. The Calgary Biofilm Device was used to assess the in vitro effects of novel solutes against S. aureus and P.aeruginosa biofilms, while gaps in the commercial market were examined to design an optimised irrigation bottle.
Results
Investigation into the physical characteristics of commercial sinus rinses suggested tolerability between significantly different pH and osmolarity ranges. Ringer’s solution, xylitol, and magnesium sulphate were determined as the most likely additives to result in symptom improvement while retaining tolerability. In vitro investigations into the antibiofilm effects of solutions on preformed biofilms demonstrated the potential for a significant dispersal effect and lack of xylitol dose response. An irrigation system was developed to target pain points identified by patients, targeting issues of drying and sustainability.
Conclusion
Two novel irrigation solutes and a bottle system have been designed which we hypothesise will improve symptom control in CRS, while retaining long-term tolerability.
