Abstract

Actuality: Chronic rhinosinusitis remains a significant issue in otorhinolaryngology. Traditional treatment approaches for this condition involve comprehensive and interdisciplinary strategies, including medical and surgical interventions, as well as collaboration with allergists and other related specialists. It is important to note that both the scope of functional endoscopic sinus surgery (FESS) and the selection of conservative treatment methods remain subject to numerous debates within the medical community. Addressing issues related to chronic rhinosinusitis requires a comprehensive approach that extends beyond surgical intervention alone. Therefore, the concept of topical agents, which can improve mucociliary transport and regenerative properties of ciliated epithelium, has gained significant attention. Hypertonic nasal spray containing acetylcysteine for nasal cavity cleansing may be a promising tool to enhance postoperative management in patients with chronic rhinosinusitis. Such a remedy holds considerable potential due to its concurrent mechanical and pathogenetic effects, which are beneficial for restoring normal nasal physiology.

Objective: To evaluate the effectiveness of using the medical product Flu-Acil Rhino compared to isotonic saline solutions (solution osmolarity of 0.65%) without acetylcysteine in patients who underwent nasal cavity surgery.

Materials and Methods: The study included 60 patients aged 18 to 60 years hospitalized before FESS surgery due to chronic rhinosinusitis. However, 5 patients dropped out during the study. The participants were uniformly divided into two groups: 23 individuals in the main group and 22 individuals in the control group, matched for age and gender distribution. Clinical, instrumental (anterior rhinoscopy, rigid endoscopy, rhinomanometry), laboratory, and statistical research methods were used to assess the effectiveness of using the medical product Flu-Acil Rhinoforte. These methods included the Modified Saccharin Test (Andersen test), histopathological examination, evaluation of nasal endoscopy data, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and assessment of postoperative pain and discomfort using the Visual Analog Scale (VAS).

Results: On the first day of patient consultation, the duration of the saccharin test in both groups was similar, indicating a statistically similar group distribution (p > 0.05). However, on the day of surgery, there was a significant difference in the duration of the saccharin test between the main group (14 ± 1.3 min) and the control group (16 ± 3.13 min), indicating improved mucociliary transport in the main group (p < 0.05). According to endoscopic examination findings, on the 7th postoperative day, the median scores for the main group were 4 (IQR 3–6) points, and for the control group, they were 5 (IQR 4–6) points. On the 14th postoperative day, the NOSE mean score for the control group was 73.4 (range 55–85), and for the main group, it was 74.1 (range 55–90), indicating severe nasal obstruction. However, on the 5th day of surveying, a significant difference was observed between the groups in favor of the main group, with nasal obstruction being approximately 1.5 times lower when using hypertonic saline solution with acetylcysteine.

Conclusions: The use of hypertonic saline solutions containing acetylcysteine in chronic rhinosinusitis improves mucociliary transport by directly affecting ciliated epithelium and rheological properties of mucus, as confirmed by saccharin testing and histopathological examination of mucosal tissues, with better results observed in the main group of patients.
Postoperative management of patients using acetylcysteine-containing hypertonic saline solution for nasal irrigation aims to support homeostasis and faster regeneration by enhancing mucociliary transport speed, resulting in a positive effect on the nasal mucosa. Application of Flu-Acil Rhinoforte in the postoperative period may reduce the likelihood of synechia formation in patients after FESS; however, a much larger sample of patients is needed for precise assessment.
Preoperative patient preparation with saline solutions for nasal cavity does not affect the course of the early postoperative period, as evidenced by NOSE questionnaire data indicating identical nasal obstruction in both study groups on the 3^rd postoperative day.

Keywords: chronic rhinosinusitis, FESS, nasal mucosa, irrigation therapy, saline solution, Flu-Acil Rhino.