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Hyaluronic Acid in Rhinology: Its Uses, Advantages and Drawbacks—A Review

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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

  1. Dicker KT et al (2014) Hyaluronan: a simple polysaccharide with diverse biological functions. Acta Biomater 10(4):1558–1570

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  CAS  Google Scholar 

  3. Wang Y et al (2014) Current hydrogel solutions for repairing and regeneration of complex tissues. Curr Med Chem 21(22):2480–2496

    Article  CAS  PubMed  Google Scholar 

  4. Choi KY et al (2010) Self-assembled hyaluronic acid nanoparticles for active tumor targeting. Biomaterials 31(1):106–114

    Article  CAS  PubMed  Google Scholar 

  5. 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

    CAS  PubMed  Google Scholar 

  6. Marcuzzo AV et al (2017) Hyaluronate effect on bacterial biofilm in ENT district infections: a review. APMIS 125(9):763–772

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Pignataro L et al (2018) Topically administered hyaluronic acid in the upper airway: a narrative review. Int J Immunopathol Pharmacol 32:2058738418766739

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zamboni F et al (2018) The potential of hyaluronic acid in immunoprotection and immunomodulation: chemistry, processing and function. Prog Mater Sci 97:97–122

    Article  CAS  Google Scholar 

  10. Suri S, Schmidt CE (2009) Photopatterned collagen–hyaluronic acid interpenetrating polymer network hydrogels. Acta Biomater 5(7):2385–2397

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Tiwari S, Bahadur P (2019) Modified hyaluronic acid based materials for biomedical applications. Int J Biol Macromol 121:556–571

    Article  CAS  PubMed  Google Scholar 

  13. DeConde AS, Soler ZM (2016) Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy 30(2):134–139

    Article  PubMed  Google Scholar 

  14. Sivasubramaniam R, Douglas R (2018) The microbiome and chronic rhinosinusitis. World J Otorhinolaryngol Head Neck Surg 4(3):216–221

    Article  PubMed  PubMed Central  Google Scholar 

  15. Haxel BR (2019) Recovery of olfaction after sinus surgery for chronic rhinosinusitis: a review. Laryngoscope

  16. 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

    Article  CAS  PubMed  Google Scholar 

  17. Graham SM (2013) Reasons for failure in endoscopic sinus surgery. Current Otorhinolaryngology Reports 1(1):45–50

    Article  Google Scholar 

  18. Fong E et al (2017) Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis. J Laryngol Otol 131(S1):S2-s11

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  CAS  PubMed  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. 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

    Article  PubMed  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. 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

    Article  CAS  PubMed  Google Scholar 

  37. Scadding GK et al (2008) BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 38(2):260–275

    Article  CAS  PubMed  Google Scholar 

  38. Panogeorgou T et al (2016) Hyaluronan synthases and hyaluronidases in nasal polyps. Eur Arch Otorhinolaryngol 273(7):1801–1808

    Article  CAS  PubMed  Google Scholar 

  39. 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

    Article  Google Scholar 

  40. Hatziri A et al (2013) Presence of hyaluronidase isoforms in nasal polyps. Eur Rev Med Pharmacol Sci 17(2):247–252

    CAS  PubMed  Google Scholar 

  41. Smith SS et al (2015) The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis. Laryngoscope 125(1):57–69

    Article  PubMed  Google Scholar 

  42. Harvey R, et al. (2007) Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. No.3. p. Cd006394

  43. 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

    Article  CAS  PubMed  Google Scholar 

  44. 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

    Article  CAS  PubMed  Google Scholar 

  45. Pulsipher A et al (2017) Prevention of sinonasal inflammation by a synthetic glycosaminoglycan. Int Forum Allergy Rhinol 7(2):177–184

    Article  PubMed  Google Scholar 

  46. Savage JR et al (2016) A Modified glycosaminoglycan, GM-0111, inhibits molecular signaling involved in periodontitis. PLoS ONE 11(6):e0157310

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ciofalo A et al (2017) Olfactory dysfunction in acute rhinosinusitis: intranasal sodium hyaluronate as adjuvant treatment. Eur Arch Otorhinolaryngol 274(2):803–808

    Article  PubMed  Google Scholar 

  48. 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

    CAS  PubMed  Google Scholar 

  49. Jackson DG (2009) Immunological functions of hyaluronan and its receptors in the lymphatics. Immunol Rev 230(1):216–231

    Article  CAS  PubMed  Google Scholar 

  50. 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

    Article  CAS  PubMed  Google Scholar 

  51. Romling U, Balsalobre C (2012) Biofilm infections, their resilience to therapy and innovative treatment strategies. J Intern Med 272(6):541–561

    Article  CAS  PubMed  Google Scholar 

  52. 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

    CAS  PubMed  Google Scholar 

  53. 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

    Article  CAS  PubMed  Google Scholar 

  54. Drago L et al (2014) Antiadhesive and antibiofilm activity of hyaluronic acid against bacteria responsible for respiratory tract infections. APMIS 122(10):1013–1019

    Article  CAS  PubMed  Google Scholar 

  55. 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

    Article  CAS  PubMed  Google Scholar 

  56. Singhal D et al (2011) Staphylococcus aureus biofilms: nemesis of endoscopic sinus surgery. Laryngoscope 121(7):1578–1583

    Article  PubMed  Google Scholar 

  57. 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)

  58. Scheithauer MO (2010) Surgery of the turbinates and “empty nose” syndrome. GMS Curr Top Otorhinolaryngol Head Neck Surg 9:Doc03

    PubMed  Google Scholar 

  59. 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

    Article  PubMed  Google Scholar 

  60. Modrzynski M (2011) Hyaluronic acid gel in the treatment of empty nose syndrome. Am J Rhinol Allergy 25(2):103–106

    Article  PubMed  Google Scholar 

  61. Clarke RW et al (1992) The role of mucosal receptors in the nasal sensation of airflow. Clin Otolaryngol Allied Sci 17(5):383–387

    Article  CAS  PubMed  Google Scholar 

  62. Abi ZeidDaou C, Bassim M (2020) Hyaluronic acid in otology: its uses, advantages and drawbacks - A review. Am J Otolaryngol 41(2):102375

    Article  CAS  Google Scholar 

  63. 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

    Article  CAS  Google Scholar 

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Correspondence to Zeina Korban.

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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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