Abstract
Hyaluronic acid has been increasingly involved in recent research due to its many chemical and physical properties. This is a review of the literature for studies involving the use of hyaluronic acid in rhinology. Hyaluronic acid washes and irrigation have been increasingly used in chronic sinusitis medical therapy and post-operatively with mixed results. It has also been shown to play a role in the treatment of nasal polyposis, allergic rhinitis, acute rhinosinusitis and empty nose syndrome. Its effect on biofilm in many disease entities has also been studied. HA is being recently used as ancillary treatment for several rhinologic conditions such as post-operative endoscopy care and chronic sinonasal infections. The properties of HA have intrigued researchers over the past years particularly in biofilm management, healing and inflammation.
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References
Dicker KT et al (2014) Hyaluronan: a simple polysaccharide with diverse biological functions. Acta Biomater 10(4):1558–1570
Chen Y et al (2018) Conjugation of paclitaxel to C-6 hexanediamine-modified hyaluronic acid for targeted drug delivery to enhance antitumor efficacy. Carbohyd Polym 181:150–158
Wang Y et al (2014) Current hydrogel solutions for repairing and regeneration of complex tissues. Curr Med Chem 21(22):2480–2496
Choi KY et al (2010) Self-assembled hyaluronic acid nanoparticles for active tumor targeting. Biomaterials 31(1):106–114
Ciofalo A et al (2017) Pathological and cytological changes of the nasal mucosa in acute rhinosinusitis: the role of hyaluronic acid as supportive therapy. Eur Rev Med Pharmacol Sci 21(19):4411–4418
Marcuzzo AV et al (2017) Hyaluronate effect on bacterial biofilm in ENT district infections: a review. APMIS 125(9):763–772
Zhao N et al (2015) Effect of molecular weight and concentration of hyaluronan on cell proliferation and osteogenic differentiation in vitro. Biochem Biophys Res Commun 465(3):569–574
Pignataro L et al (2018) Topically administered hyaluronic acid in the upper airway: a narrative review. Int J Immunopathol Pharmacol 32:2058738418766739
Zamboni F et al (2018) The potential of hyaluronic acid in immunoprotection and immunomodulation: chemistry, processing and function. Prog Mater Sci 97:97–122
Suri S, Schmidt CE (2009) Photopatterned collagen–hyaluronic acid interpenetrating polymer network hydrogels. Acta Biomater 5(7):2385–2397
Kaderli S et al (2015) Efficacy study of two novel hyaluronic acid-based formulations for viscosupplementation therapy in an early osteoarthrosic rabbit model. Eur J Pharm Biopharm 96:388–395
Tiwari S, Bahadur P (2019) Modified hyaluronic acid based materials for biomedical applications. Int J Biol Macromol 121:556–571
DeConde AS, Soler ZM (2016) Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy 30(2):134–139
Sivasubramaniam R, Douglas R (2018) The microbiome and chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 4(3):216–221
Haxel BR (2019) Recovery of olfaction after sinus surgery for chronic rhinosinusitis: a review. Laryngoscope
Cao PP et al (2019) Pathophysiologic mechanisms of chronic rhinosinusitis and their roles in emerging disease endotypes. Ann Allergy Asthma Immunol 122(1):33–40
Graham SM (2013) Reasons for failure in endoscopic sinus surgery. Current Otorhinolaryngology Reports 1(1):45–50
Fong E et al (2017) Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis. J Laryngol Otol 131(S1):S2-s11
Rudmik L et al (2011) Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations. Int Forum Allergy Rhinol 1(6):417–430
Ha TN et al (2016) The effect of blood pressure and cardiac output on the quality of the surgical field and middle cerebral artery blood flow during endoscopic sinus surgery. Int Forum Allergy Rhinol 6(7):701–709
Berlucchi M et al (2009) Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study. Eur Arch Otorhinolaryngol 266(6):839–845
Dal T, Bahar S (2017) The clinical outcomes of using a new cross-linked hyaluronan gel in endoscopic frontal sinus surgery. Eur Arch Otorhinolaryngol 274(9):3397–3402
Macchi A et al (2013) Hyaluronan plus saline nasal washes in the treatment of rhino-sinusal symptoms in patients undergoing functional endoscopic sinus surgery for rhino-sinusal remodeling. Int J Immunopathol Pharmacol 26(1):137–145
Shi R et al (2013) The clinical outcomes of new hyaluronan nasal dressing: a prospective, randomized, controlled study. Am J Rhinol Allergy 27(1):71–76
Wormald PJ et al (2006) A prospective single-blind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery. Am J Rhinol 20(1):7–10
Miller RS et al (2003) The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 128(6):862–869
Franklin JH, Wright ED (2007) Randomized, controlled, study of absorbable nasal packing on outcomes of surgical treatment of rhinosinusitis with polyposis. Am J Rhinol 21(2):214–217
Chen J et al (2017) Influence of hyaluronan nasal dressing on clinical outcome after endoscopic sinus surgery: a systematic review and meta-analysis. Am J Rhinol Allergy 31(4):256–259
Mozzanica F et al (2019) Double-blind, randomised controlled trial on the efficacy of saline nasal irrigation with sodium hyaluronate after endoscopic sinus surgery. J Laryngol Otol 133(4):300–308
Xu J et al (2016) Effects of triamcinolone-impregnated nasal dressing on subjective and objective outcomes following endoscopic sinus surgery. Eur Arch Otorhinolaryngol 273(12):4351–4357
Huang TW, Li ST, Young TH (2019) Chitosan-hyaluronan: promotion of mucociliary differentiation of respiratory epithelial cells and development of olfactory receptor neurons. Artif Cells Nanomed Biotechnol 47(1):564–570
Zhang H et al (2021) The postoperative outcomes of patients with chronic rhinosinusitis with nasal polyps by sustained released steroid from hyaluronic acid gel. Eur Arch Otorhinolaryngol 278(4):1047–1052
Monzani D et al (2020) Evaluation of performance and tolerability of nebulized hyaluronic acid nasal hypertonic solution in the treatment of chronic rhinosinusitis. Am J Rhinol Allergy 34(6):725–733
Gelardi M, Iannuzzi L, Quaranta N (2013) Intranasal sodium hyaluronate on the nasal cytology of patients with allergic and nonallergic rhinitis. Int Forum Allergy Rhinol 3(10):807–813
Casale M et al (2014) The potential role of hyaluronan in minimizing symptoms and preventing exacerbations of chronic rhinosinusitis. Am J Rhinol Allergy 28(4):345–348
Savietto E et al (2020) Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: a prospective, randomized, double-blind, controlled study. Am J Otolaryngol 41(4):102502
Scadding GK et al (2008) BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 38(2):260–275
Panogeorgou T et al (2016) Hyaluronan synthases and hyaluronidases in nasal polyps. Eur Arch Otorhinolaryngol 273(7):1801–1808
Cassandro E et al (2015) Hyaluronan in the Treatment of Chronic Rhinosinusitis with Nasal Polyposis. Indian J Otolaryngol Head Neck Surgery 67(3):299–307
Hatziri A et al (2013) Presence of hyaluronidase isoforms in nasal polyps. Eur Rev Med Pharmacol Sci 17(2):247–252
Smith SS et al (2015) The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis. Laryngoscope 125(1):57–69
Harvey R, et al. (2007) Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. No.3. p. Cd006394
Meltzer EO, Bachert C, Staudinger H (2005) Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol 116(6):1289–1295
Ocak E et al (2021) Effect of adjunctive sodium hyaluronate versus surfactant nasal irrigation on mucociliary clearance in allergic rhinitis: a single-blind, randomised, controlled study. J Laryngol Otol 135(6):529–532
Pulsipher A et al (2017) Prevention of sinonasal inflammation by a synthetic glycosaminoglycan. Int Forum Allergy Rhinol 7(2):177–184
Savage JR et al (2016) A Modified glycosaminoglycan, GM-0111, inhibits molecular signaling involved in periodontitis. PLoS ONE 11(6):e0157310
Ciofalo A et al (2017) Olfactory dysfunction in acute rhinosinusitis: intranasal sodium hyaluronate as adjuvant treatment. Eur Arch Otorhinolaryngol 274(2):803–808
Varricchio A et al (2014) Inhaled hyaluronic acid as ancillary treatment in children with bacterial acute rhinopharyngitis. J Biol Regul Homeost Agents 28(3):537–543
Jackson DG (2009) Immunological functions of hyaluronan and its receptors in the lymphatics. Immunol Rev 230(1):216–231
Ardizzoni A et al (2011) Influence of hyaluronic acid on bacterial and fungal species, including clinically relevant opportunistic pathogens. J Mater Sci Mater Med 22(10):2329–2338
Romling U, Balsalobre C (2012) Biofilm infections, their resilience to therapy and innovative treatment strategies. J Intern Med 272(6):541–561
Gelardi M et al (2013) Assessment of biofilm by nasal cytology in different forms of rhinitis and its functional correlations. Eur Ann Allergy Clin Immunol 45(1):25–29
Drago L et al (2011) Modulation of biofilm of strains isolated from patients with chronic obstructive pulmonary disease by levofloxacin, moxifloxacin, ciprofloxacin, amoxicillin/clavulanic acid and ceftriaxone. Int J Immunopathol Pharmacol 24(4):1027–1035
Drago L et al (2014) Antiadhesive and antibiofilm activity of hyaluronic acid against bacteria responsible for respiratory tract infections. APMIS 122(10):1013–1019
Macchi A et al (2013) Effects of sodium hyaluronate in children with recurrent upper respiratory tract infections: results of a randomised controlled study. Int J Immunopathol Pharmacol 26(1):127–135
Singhal D et al (2011) Staphylococcus aureus biofilms: nemesis of endoscopic sinus surgery. Laryngoscope 121(7):1578–1583
Giammona G, et al. (2018) Hyaluronic-based antibacterial hydrogel coating for implantable biomaterials in orthopedics and trauma: from basic research to clinical applications. In: Haider HS (Ed)
Scheithauer MO (2010) Surgery of the turbinates and “empty nose” syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg 9:Doc03
Manji J et al (2019) Environmental triggers associated with empty nose syndrome symptoms: a cross-sectional study. Ann Otol Rhinol Laryngol 128(7):601–607
Modrzynski M (2011) Hyaluronic acid gel in the treatment of empty nose syndrome. Am J Rhinol Allergy 25(2):103–106
Clarke RW et al (1992) The role of mucosal receptors in the nasal sensation of airflow. Clin Otolaryngol Allied Sci 17(5):383–387
Abi ZeidDaou C, Bassim M (2020) Hyaluronic acid in otology: its uses, advantages and drawbacks - A review. Am J Otolaryngol 41(2):102375
Abi ZeidDaou C, Ghaoui N, Bassim M (2021) Hyaluronic acid in the treatment of other miscellaneous conditions of the ear. Am J Otolaryngol 42(1):102630
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Abi Zeid Daou, C., Korban, Z. Hyaluronic Acid in Rhinology: Its Uses, Advantages and Drawbacks—A Review. Indian J Otolaryngol Head Neck Surg 75 (Suppl 1), 696–704 (2023). https://doi.org/10.1007/s12070-022-03255-2
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DOI: https://doi.org/10.1007/s12070-022-03255-2