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High Volume Nasal Irrigation Aids Topical Steroids to Access the Sinus Mucosa in Chronic Rhinosinusitis

Chronic Rhinosinusitis (CRS), which is associated with multiple causes, is a common illness that makes millions of people from different parts of the globe suffer. CRS poses a profound impact on the quality of patients’ lives due to its disturbing symptoms on top of the huge cost in treating the underlying cause. 

Since the nasal and sinus mucosa are persistently inflamed, nasal steroid sprays have been used for the relief of CRS especially after surgery. However, in a clinical review published in the International Forum of Allergy & Rhinology, Dr. David Jang and his fellow researchers noted that nasal steroid sprays may not deliver adequate amounts of medication to the postoperative sinus cavity. In this study, they compared the condition of the patients when on high volume steroid nasal irrigation versus off-irrigation periods using conventional nasal steroid sprays only. It was found that patients had worsening of symptoms when they were not on high volume steroid nasal irrigation.

Dr. Auddie Sweis and a team of researchers also did a retrospective chart review of 90 patients with chronic rhinosinusitis to evaluate steroid nasal saline irrigation using budesonide or mometasone prior to surgery. In this study published in May 2020 at the International Forum of Allergy & Rhinology, Dr. Sweis and colleagues found that after a trial of steroid nasal irrigation, 64.4% had significant improvement enough to avoid surgery.

The use of devices that deliver large volume with positive pressure irrigation aids topical steroids to effectively access the sinus mucosa. This also provides an efficient lavage through enhanced mechanical removal of mucus, bacteria and inflammatory agents.

Findings from the study by Dr. Kornkiat Snidvongs and colleagues published in the International Forum of Allergy & Rhinology supported the strategy of utilizing high volume delivery system for irrigation to ensure that intranasal corticosteroids are appropriately delivered to the sinus mucosa. The study was done on 111 patients with CRS who underwent Endoscopic Sinus Surgery (ESS) and found that intranasal corticosteroid is an effective therapy when appropriately delivered using a high-volume delivery system.

In a controlled trial published in May 2020 in the Indian Journal of Otolaryngology Head and Neck Surgery, Dr. Maheshbabu Thanneru and his colleagues showed that in patients with chronic allergic rhinosinusitis who underwent surgery, the use of budesonide nasal irrigation after surgery led to significant reduction of symptom scores by an average of 70% compared to the 44% reductions seen in patients who just had standard care after surgery.

In July 2020, a controlled trial by Dr. Lisa Cherian and colleagues which was published in Rhinology compared the oral steroid prednisolone, nasally irrigated steroid budesonide, and the oral antibiotic doxycycline for patients with chronic rhinosinusitis. The results of treatment that lasted for 3 weeks revealed that clinical improvement was significant with both oral and irrigated steroid but not with the antibiotic doxycycline.

While some investigators have used saline solution as the vehicle in delivering topical steroids through large volume irrigation, some clinical experts recommend Ringer-Lactate as a more appropriate solution for sinunasal irrigation.

Murat Ünal and colleagues wrote in a study published in The Journal of Laryngology & Otology, “Ringer’s Lactate has a composition that more closely approximates the extracellular fluids and is more deserving of the adjective physiological”. It was explained that Ringer-Lactate, a solution composed mainly of Sodium Chloride, Potassium Chloride and Calcium Lactate Pentahydrate, closely mimics the body’s own extracellular fluid that bathes the cells. Ringer-Lactate solution has no negative effect on Ciliary Beat Frequency (CBF), which is one of the most important parameters of mucociliary clearance.

As emphasized in various clinical reviews, the treatment of CRS underscores not only the aim of reducing the underlying mucosal inflammation by corticosteroids, but also the overarching goal of restoring normal sinus physiology.

References:


Jang, D. W., Lachanas, V. A., Segel, J., & Kountakis, S. E. (2013). Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis. International Forum of Allergy & Rhinology.

Sweis AM, Locke TB, Douglas JE, et al. Management of chronic rhinosinusitis with steroid nasal irrigations: A viable nonsurgical alternative in the COVID-19 era.

Snidvongs, K., Pratt, E., Chin, D., Sacks, R., Earls, P., & Harvey, R. J. (2012). Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis. International Forum of Allergy & Rhinology.

Thanneru M, Lanke S, Kolavali S. The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Allergic Rhinosinusitis with Polyps. Indian J Otolaryngol Head Neck Surg.

Cherian LM, Bassiouni A, Cooksley CM, Vreugde S, Wormald PJ, Psaltis AJ. The clinical outcomes of medical therapies in chronic rhinosinusitis is independent of microbiomic outcomes: a double-blinded, randomised placebo-controlled trial.

Ünal, M., Görür, K., & Özcan, C. (2001). Ringer-Lactate solution versus isotonic saline solution on mucociliary function after nasal septal surgery. The Journal of Laryngology & Otology, 115(10).

Get to Know Xylitol: The Sugar Substitute with Protective Benefits

Xylitol is a sugar-like substance with a sweetness similar to that of table sugar. However, due to some differences in chemistry and the way the body metabolizes it, xylitol supplies 40% fewer calories than table sugar. This makes xylitol a suitable low-calorie sugar substitute that has been widely used since the 1930s.

Xylitol is naturally sourced from plants and trees

Xylitol derives its name from the Ancient Greek “xylon” meaning wood which points to its natural source. Current production of xylitol involves extraction from hardwoods, softwoods and even from agricultural products such as rice, corn and wheat.

Xylitol helps protect the mouth and nose from infections 

Xylitol is now being commonly added to a variety of dental applications such as chewing gums and toothpaste due to its protective actions against cavity-causing bacteria. A similar benefit is also seen when xylitol is used to irrigate the nasal passages, where it can play multiple roles in protecting against infections. Xylitol solutions can dilute the salts that have been negatively affecting the innate or natural antimicrobial substances of the nose. Xylitol also disrupts bacterial growth and metabolism, and prevents the formation of biofilms that bacteria use to shield against antibiotics.

Xylitol nasal rinses have been found helpful in treating patients with long-standing nasal and sinus infections 

Chronic rhinosinusitis is a long-standing inflammatory condition affecting the nose and sinuses. The condition is managed with antibiotics, steroids and nasal irrigations. Some studies show that the addition of xylitol with the irrigating solution may improve treatment outcomes. In two separate clinical trials published in 2011 and 2018, it was shown that nasal irrigations with xylitol have led to better resolution of symptoms compared with irrigations with plain salt water solutions.

References:

Lin L, Tang X, Wei J, Dai F, Sun G. Xylitol nasal irrigation in the treatment of chronic rhinosinusitis. Am J Otolaryngol.

Weissman JD, Fernandez F, Hwang PH. Xylitol nasal irrigation in the management of chronic rhinosinusitis: a pilot study. 

Clinical Researchers Investigate the Benefits of Saline Nasal Solutions as an Aid in the Management of COVID-19

Clinical Researchers Investigate the Benefits of Saline Nasal Solutions as an Aid in the Management of COVID-19

The morbidity and mortality associated with the dreadful novel COVID- 19 has seriously affected the whole world, posing a continuing challenge for the clinical researchers to discover ways to treat and prevent the spread of the disease. In the absence of a cure for COVID-19, researchers are prompted to focus their efforts in preventing viral transmission.

In the early stages of COVID-19, it is the nasopharyngeal mucosa which carries high viral loads. This sparked enormous interest to investigate the potential role of saline nasal irrigation solutions in reducing viral load and transmission.

COVID-19 and the Potential of Nasal Saline Irrigation

In an article published in July 2020 in the JAMA Otolaryngology-Head & Neck Surgery, clinical researchers from the Oregon Health & Science University and the Washington University School of Medicine discussed the benefits and safety of nasal saline irrigations for the COVID-19 pandemic. They reviewed the current evidence regarding the association of nasal saline irrigations with viral upper respiratory disease.

The researchers looked into the effect of saline nasal rinses in viral respiratory infections associated with mucus stasis due to the inflammatory reaction induced by the virus. It was explained that saline solutions may be helpful in disrupting and removing the mucus and other invading foreign materials in the mucosal layer. As the nasal lining is hydrated by the saline solution, the inflammatory substances in mucus also gets diluted and the sweeping actions of the cilia, the hair-like structures of nasal cells which helps clears out the mucus, is improved. These effects were seen to be particularly helpful during a viral respiratory infection wherein the movement of mucus has slowed down due to the inflammatory changes such as localized swelling and thickened secretions. The researchers, citing a recent clinical trial on the common cold, shared that rinsing the nose with saline solution may help in reducing the duration of illness, the transmission among household members, and even viral shedding.

The researchers also acknowledged the concern regarding the potential contamination of the nasal rinsing devices leading to increased transmission through contact-induced infections and advised that disinfection of these devices can be done with 75% ethanol, chlorine, UV light or heat. Indeed, good hand hygiene before and after nasal rinsing as well as decontamination of surfaces like the sink remains important.

Clinical Trials on Saline Nasal Rinses are Underway

In May 2020, researchers from the Vanderbilt University Medical Center, have initiated a clinical trial to see whether nasal saline irrigation would be able to reduce the viral load of patients with COVID-19 as well as contribute to their symptom relief. Interestingly, some of studies recently suggested the possible effect of nasal saline irrigations in reducing viral shedding in patients with coronaviruses treated with saline irrigations when compared with the control group.

Another clinical trial on saline nasal rinses for patients with COVID-19 was started in the same month by another group of researchers at the University of Edinburgh. In the ongoing study named the ELVIS (Edinburgh-Lothians Viral Intervention Study) – COVID-19, the researchers are seeking to determine if nasal washing and gargling with salt water would help individuals with COVID-19 get better faster. It also supports their earlier study which found that cells lining the nose can create an antiviral effect by producing hypochlorous acid, a form of bleach, from chloride ions which are in salt (i.e. sodium chloride).

If these saline nasal irrigations have a similar effect on the novel COVID-19 as they do on other viral respiratory infections – is what the clinical investigators and the rest of the world are eager to know.

Currently, clinical trials are actively recruiting participants with results anticipated in a few months.

References:


Farrell NF, Klatt-Cromwell C, Schneider JS. Benefits and Safety of Nasal Saline Irrigations in a Pandemic—Washing COVID-19 Away. JAMA Otolaryngol Head Neck Surg.

Kimura K. Impact of Nasal Saline Irrigations on Viral Load in Patients with COVID-19.

University of Edinburgh. Hypertonic Saline Nasal Irrigation and Gargling in Suspected or Confirmed COVID-19 (ELVIS COVID-19).

Helpful Tips for Sore Throat

Does your throat feel achy, painful, burning, or irritated? You might be experiencing a sore throat.

Sore throat could be a bothering ailment that would call for remedies for relief and to prevent worsening of the condition. Here are some easy to follow and practical means to deal with that bothersome “sore in your throat”:

1. STRENGTHEN YOUR IMMUNE SYSTEM DEFENSE. Have a healthy diet, enough rest and adequate sleep. 

2. PRACTICE GOOD HYGIENE to avoid infection. Regularly perform proper hand and oral hygiene to eliminate germs that may cause sore throat.

3. REST YOUR VOICE adequately.

4. Drink plenty of fluids to STAY HYDRATED and to keep your throat moist.

5. AVOID DRINKS such as coffee and alcohol that may dehydrate your body.

6. STAY AWAY FROM CIGARETTE SMOKE AND CHEMICALS that can irritate the throat.

7. Take warm liquids and use naturally sourced PRODUCTS WITH SOOTHING PROPERTIES, LIKE HONEY AND PROPOLIS.

8. GARGLE WITH WARM SALTWATER solution that can help soothe your throat.

9. AVOID CLOSED, CONGESTED OR HUMID environments.


It is always best to consult your doctor if you feel persisting, worsening or recurring symptoms of throat irritations such as hoarse voice,, itchy, dry, scratchy or painful throat, difficulty in swallowing and fever.

FAQs on PROPOLIS

What is Propolis?

Propolis is a natural substance produced by honeybees from plants which is recognized for its numerous health benefits.  

Propolis is made by honeybees from a complex mixture of resins, waxes and oils gathered from various plants and trees. Propolis is also known as “bee glue” which the honeybees use to seal the entrances and cracks of their beehives as well as to sanitize and protect them against infection.    

This protective function of propolis is also reflected in the origin of the term which was derived from the Greek words “pro” which is translated to “at the entrance to” and “polis” for “community or city.”

What are the benefits of Propolis?

As a compound, propolis contains numerous bioactive plant substances called flavonoids that make propolis multifunctional in promoting oral health and in protecting the oral cavity against disease causing microorganisms.

Owing to its known multiple actions, propolis has been studied and prepared either as an ointment, spray or gargle to soothe inflamed throats, reduce mouth sores and promote healing of oral cavity irritations such as stomatitis, aphthous ulcers and mucositis. A gargle preparation of propolis was even found to be beneficial in the healing of postsurgical wounds as seen in tonsillectomies or the surgical removal of the tonsils.

1. Healing and Soothing Properties

Propolis is also known for its antioxidant properties. The bioactive flavonoids present in propolis have been shown to act as potent antioxidants capable of counteracting or neutralizing the damaging free radicals. In this regard, antioxidants could be seen to help protect the different body cells from further injury. The antioxidative properties of flavonoids in propolis also contribute to its anti-inflammatory actions.

Aside from aiding in the healing of oral sores and wounds, applying preparations of propolis on irritated tissues has been shown to help reduce pain. This has been attributed to the inhibitory activities of propolis against the release of precursor inflammatory compounds from injured tissues.

 2. Antimicrobial Actions

Antimicrobial activities against certain bacteria, viruses, and fungi have also been documented in studies with the compound propolis. In a laboratory setting, multiplication of both cultured gram positive and gram-negative bacteria was inhibited while the entry of viruses into the cells was reduced with the use of various preparations of propolis and its extracts. 

What are the adverse effects of propolis?

Although rare, adverse effects have been reported with the use of the compound propolis in general like hypersensitivity reactions among individuals allergic to bee products.

What are the precautions that should be observed when taking propolis?

• Persons allergic to bee products such as honey, bee pollen and royal jelly should not use propolis.
• Care should be taken when used by individuals with a history of hypersensitivity conditions such as allergies and asthma.
•Pregnancy and breastfeeding: There are no information available about use of propolis during pregnancy or while breastfeeding.


References:


Wagh VD. Propolis: a wonder bees product and its pharmacological potentials. Adv Pharmacol Sci.

Przybyłek I, Karpiński TM. Antibacterial Properties of Propolis. Molecules.

Debiaggi M, Taleo F, Pagani L, Luini M, Romero E. Effects of propolis flavonoids on virus infectivity and replication. Microbiologica.

Moon JH, Lee MY, Chung YJ, Rhee CK, Lee SJ. Effect of Topical Propolis on Wound Healing Process After Tonsillectomy: Randomized Controlled Study. Clin Exp Otorhinolaryngol.

Braakhuis A. Evidence on the Health Benefits of Supplemental Propolis. Nutrients.

Vaccine vs. COVID-19: Where Are We Now?

As the world continues to struggle with the overwhelming impact of the current COVID-19 pandemic, vaccine researchers around the globe are diligently working on developing the means to definitively control the further spread of the deadly virus, SARS-CoV-2.

There are generally three phases of vaccine testing on humans prior to being licensed for use. As the U.S. Food and Drug Administration explains, Phase 1 or initial human studies are done to determine safety and ability of the vaccine to induce an immune response and is performed in a small number of closely monitored subjects.  Phase 2 studies are done with different dosages of the vaccine and may have to enroll hundreds of subjects.  Finally, Phase 3 trials typically enroll thousands of individuals to critically document the effectiveness and important additional safety data required for licensing.

In the draft landscape of COVID-19 line-up of vaccines released by the WHO on 20 July 2020, 24 candidate vaccines are already at various phases of testing in humans.

Since there is no specific treatment yet for a novel disease like COVID-19, the news about development of vaccines for this dreadful disease that has inflicted millions provides a ray of hope amidst the gloomy pandemic.  The world now is in watchful anticipation of genuine outcomes.

US CDC and WHO Advise Public on the Prevention and Control of Dengue

International health authorities are reminding the public on the preventive and control measures that should be taken to prevent the spread of dengue infection most especially amidst the current COVID-19 pandemic.

In the most recent bulletin from the WHO for the Western Pacific Region dated 16 July 2020, there are already 52,601 recorded cases of dengue in the Philippines for the year. Following are the pertinent health facts gathered from the Department of Health (DOH), United States Center for Disease Control (US CDC) and World Health Organization (WHO) to serve as guide in dealing with this disease.

Basic Steps to Prevent Dengue

• The best way to prevent dengue is to protect oneself from mosquito bites.
• To avoid infecting other people, patients with dengue should avoid getting further mosquito bites during the first week of illness as the virus may be circulating in the blood during this time.

Control of Transmission

Important measures to control or prevent the transmission of dengue virus by combatting the mosquito vectors through:

• Stopping mosquitoes from laying eggs in or near water source by eliminating mosquito breeding sites and preventing mosquitoes from accessing egg-laying habitats through various environmental cleanliness measures
• Proper disposal of solid waste and removing habitats that can hold water
• Covering, emptying and cleaning of domestic water storage containers such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
•Use appropriate insecticides to water storage outdoor containers and stagnant water sites.


Protecting Oneself from Infection

• Primary mosquito vectors bite throughout the day; use personal household protection measures, such as window screens, repellents, insecticide treated materials, coils and vaporizers both inside and outside of the home (e.g. at work or school)
• Wear long or large clothes such as long-sleeved shirts or long pants to minimize skin exposure to mosquitoes. Dress children in clothing that covers arms and legs
• Use protective covers at home when sleeping such as mosquito nets. The strollers and baby carriers must be covered with mosquito netting as well.
• When using insect repellent on children, always follow label instructions. Do not use products containing oil of lemon eucalyptus (OLE) or para-methane-diol (PMD) on children under 3 years old.


Community Engagement

• Participate in health education and awareness campaigns in the community to mitigate the risks of mosquito-borne diseases
• Engage with the rest of the community to improve participation and mobilization for sustained vector control
• Health authorities may also employ emergency vector control measures such as applying insecticides as space spraying during outbreaks

Controlling the spread of dengue in the community is a multi-system approach. It isn’t limited to just protecting oneself from the bite of a mosquito, rather it takes a concerted effort from different stakeholders to maintain the environment free from dengue-carrying mosquitoes. Most importantly, this approach is enhanced by the prompt recognition of symptoms and the immediate action to seek medical attention.


References:


Dengue prevention, What we know. (CDC) 

Key facts about Dengue, (WHO, International) 

Amino Acids: The Building Blocks of Life Boost the Body’s Immunocompetence

Amino acids which are called  the building blocks of life, constitute body proteins. Proteins are of prime importance to the human body as they are the basic nutrients required for the formation, growth, maintenance and repair of the different body structures. Proteins are essential for the production of compounds vital for normal body functions, such as hormones, neurotransmitters, enzymes and immunoglobulins commonly known as antibodies. In this respect, amino acids, serving as building blocks of the antibodies, tissues and organs of the immune system, are regarded as immune system builders.

A lot of studies have emphasized the significant role of amino acids as fundamental components of the body’s immune system. The key role of amino acids in promoting the health of the immune system has been widely appreciated in clinical practice particularly in the management of  patients with deficient diet, infectious diseases and those who underwent operative procedures.

Aside from serving as building blocks in the production of antibodies, studies have noted that amino acids help in the body’s fight against infection by supporting the proliferation and activation of white blood cells, which are called “the body’s soldiers”. Amino acids allow the formation of signaling molecules, the protein substances that function for a coordinated immune function

Peng Li, together with a team of researchers, detailed in a scientific review published in the British Journal of Nutrition in 2007, the results of various studies indicating the important role of amino acids in boosting the immune responses by regulating some immune system mechanisms including  the activation of white blood cells such as T lymphocytes, B lymphocytes, natural killer cells and macrophages; gene expression and lymphocyte proliferation; and the production of antibodies, and other signaling proteins of the immune system.1 

It has been long recognized that the lack or deficiency of proteins in the diet can adversely affect the immune function and increase the body’s susceptibility to infection. As explained by Peng Li and his co-authors, decreased concentrations of amino acids in the plasma following protein malnutrition compromises the production and function of immune cells.1

When the diet fails to meet the body’s requirement for amino acids, or when the body is in a state of nutrient losses which increases protein requirements, as in serious or chronic illnesses, infections and trauma, supplementation of essential amino acids becomes inevitable.

Supplementation with amino acids is specifically valuable during states of increased protein demand by the body and considerable protein or nutrient losses such as in infectious diseases and when the body does strenuous physical activities. Increased protein loss and increased protein requirements are also associated with stressful conditions, pregnancy, wounds, bone fracture, burns, post-operative states, period of convalescence, restrictive diet, anorexia and starvation.  

Among amino acids considered for supplementation, studies have paid particular attention to the branched-chain amino acids or BCAAs referring to the group of three essential amino acids: valine, leucine, and isoleucine.

In a scientific review written in 2006 for the Journal of Nutrition by Oxford Academic, researcher Philip Calder explained that the cells involved in immune system functions incorporate branched chain amino acids into proteins. During infection, there is a significant increase in the demand of the immune system for substrates such as amino acids that become precursors for the manufacture of protective protein molecules.2

Various studies have shown that supplementation of BCAAs, Isoleucine, Leucine, and Valine, helps prevent symptoms of infection among athletes and improve survival of septic patients.

Reinaldo Abunasser Bassit and his colleagues from the Institute of Biomedical Sciences, University of São Paulo, Brazil did a research on the benefits of BCAA supplementation in athletes participating in a triathlon and found that BCAA led to significantly lower incidences of infection (33.84%) when compared with those of receiving placebo.3

Meanwhile, in a study published in Critical Care Medicine in 1997researchers from Madrid, Spain led by Dr. Abelardo García-de-Lorenzo found that placing septic patients on parenteral nutrition with more branched chain amino acids significantly lowered mortality rates, thereby improving survival.4 

Appreciating the fundamental link between protein intake and the body’s ability to fight off  illnesses and infections, it becomes imperative to ensure the individual’s adequate supply of amino acids, the building blocks of the protein components of the immune system, to optimize the body’s immunocompetence.

References:


Li P, Yin YL, Li D, Kim SW, Wu G. Amino acids and immune function. Br J Nutr.

Calder PC. Branched-chain amino acids and immunity. J Nutr.

Bassit RA, Sawada LA, Bacurau RF, Navarro F, Costa Rosa LF. The effect of BCAA supplementation upon the immune response of triathletes. Med Sci Sports Exerc.

García-de-Lorenzo A, Ortíz-Leyba C, Planas M, et al. Parenteral administration of different amounts of branch-chain amino acids in septic patients: clinical and metabolic aspects. Crit Care Med.

Xylitol: A Sweet Solution to Control Nasal Infections

A solution of xylitol, a natural sugar-like substance, was found to be better than standard salt solution as a nasal irrigating solution for patients with repeated bouts of nose and sinus infections or chronic rhinosinusitis.  This was revealed by Dr. Lin Lin and his team of researchers in their clinical trial published in the American Journal of Otolaryngology Head and Neck Medicine and Surgery in 2017.

Dr. Lin found that patients treated for 30 days with xylitol had significantly better outcomes and symptom control than those treated with standard salt solution.  Xylitol, once considered only for sugar-free candies, could now be considered as a means to effectively irrigate the sinunasal cavities and manage nasal infections.1

What is Xylitol?

Xylitol is a naturally-occurring sugar-like compound.  It got its name from the Ancient Greek xylon meaning wood since it was first extracted from beech trees.2

Although xylitol has a similar degree of sweetness to table sugar, it is low on calories and even proven to be protective against dental cavities.  Xylitol is poorly metabolized by the body – roughly 60% of the calorie yield of table sugar, hence its appeal as a low-calorie sweetener for weight management.  These benefits have made xylitol a widely used sugar substitute.3

Xylitol Supports the Salt-sensitive Immune Defense of the Nose

Clues to the potential benefits of xylitol for the nose emerged with the broader understanding of how the nose typically protects itself from infections.  The cells of the nose were found to be capable of naturally producing antimicrobial compounds like lysozymes and lactoferrins that act to kill the infection-causing germs trapped in the mucus layering the nose.

However, it was discovered that these natural antimicrobial compounds are sensitive to the levels of salts in mucus.  The higher the salt content of mucus, the lower the activity of these antimicrobial compounds becomes, making the body susceptible to infections.  It was also found that the problem of highly salted mucus is more pronounced in cases associated with thickened mucus that results from irritation and inflammation of the nasal passages.  In addressing these concerns, the potential of xylitol was recognized by researchers. 

As determined in 2000 by researchers from the University of Iowa and the Washington University led by Dr. Joseph Zabner, xylitol has some properties that allow it to decrease the salt concentration of mucus and enhance the natural antimicrobial defense of the nasal lining. One, xylitol can act as an osmolyte, an agent that can hold water in a solution, which in effect will prevent the mucus from becoming too thick and concentrated with salt.  Xylitol is also absorbed by the body for several hours allowing it to maintain the water in mucus for a longer period of time.  Two, xylitol maintains the bacterial killing action of the antimicrobial compounds found in nasal secretions in contrast to salt.  This was further supported by the finding that bacterial counts in the noses of healthy volunteers were significantly lowered by xylitol sprays compared to salt solution.  Three, xylitol, although similar to sugar, will not support bacterial growth because it is poorly utilized by bacteria.4

Xylitol May Also Make Bacteria Less Resistant

Some infection-causing bacteria are able to avoid harm by forming biofilms.  Biofilms are a collection of bacteria clumped together in their own secretion of a slimy and sticky organic material.  A common example of biofilm is dental plaque.  Inside biofilms, bacteria are protected from harmful environmental factors such as dehydration, chemicals, the body’s immune system and even antibiotics.  Biofilm formation is a major issue in bacterial resistance particularly for repeated nasal and sinus infections.  Fortunately, Xylitol has also been identified as one of the compounds that has potential in managing bacterial biofilms.  Dr. Ravi Jain and his team of researchers from the University of Auckland in 2016 showed that Xylitol effectively works against biofilms by inhibiting its formation and by disrupting the established biofilms of the usual bacteria implicated for chronic rhinosinusitis.5

Is Xylitol Safe?

The safety of xylitol can be attested by its long history of being used as a sugar substitute even in children’s chewing gum.  The US FDA classifies xylitol as GRAS (Generally Recognized as Safe).  Even at high dosages of 45 g per day in children or 100 g per day in adults, the primary concern is only diarrhea.  Clinical trials using xylitol in irrigating solutions found it well tolerated among patients without dangerous effects.6

While xylitol started out as a sweet substitute for the calorie-conscious, it is now emerging as a viable option in the management of nasal infections.  Our increasing understanding of the different factors that determine the ability of our nose to combat infections has allowed us to explore for unique solutions and in this case, the solution may be actually be sweet in the form of xylitol.

References:


Lin L, Tang X, Wei J, Dai F, Sun G. Xylitol Nasal Irrigation in the Treatment of Chronic Rhinosinusitis. Am J Otolaryngol.

Zacharis C. Sweeteners and Sugar Alternatives in Food Technology. 2nd ed. John Wiley & Sons;

Salli K, Lehtinen MJ, Tiihonen K, Ouwehand AC. Xylitol’s Health Benefits Beyond Dental Health: A Comprehensive Review. Nutrients.

Zabner J, Seiler MP, Launspach JL, et al. The Osmolyte Xylitol Reduces the Salt Concentration of Airway Surface Liquid and May Enhance Bacterial Killing. Proc Natl Acad Sci U S A.

Jain R, Lee T, Hardcastle T, Biswas K, Radcliff F, Douglas R. The in Vitro Effect of Xylitol on Chronic Rhinosinusitis Biofilms. Rhinology.

National Center for Biotechnology Information. PubChem Database. Xylitol, CID=6912.

Expert Groups Recommend Nasal Washing to Prevent Viral Respiratory Infections

Handwashing has always been our primary way of warding off a wide range of disease-causing viruses and bacteria.  With our hands being always at risk of making contact with surfaces covered with these germs, it goes without saying that the simple act of washing our hands with soap and water will stop these viruses and bacteria from being carried into our body’s gateways like the mouth, nose and eyes.

However, some viruses can bypass this layer of protection by being carried directly into the nose by droplets in the air released by coughing, sneezing or even talking which causes respiratory tract infections like the common colds, flu, or even the currently dreaded coronavirus of COVID-19 also known as SARS-CoV-2.

In an effort to protect healthcare workers from COVID-19, the China Dermatologist Association, Chinese Society of Dermatology and National Clinical Research Center for Skin and Immune Diseases jointly published in March 2020 a consensus for protecting the skin, eyes, as well as the linings of the nose and mouth.  Among the recommendations is to regularly clean the inside of the nose with normal salt solution especially after visiting isolation wards with COVID-19 patients.1

The nose is recognized to be particularly vulnerable to SARS-CoV-2.  It was found that angiotensin converting enzyme‐2 (ACE2), the exact bodily enzyme which coronaviruses use to enter and infect cells are found on the tissues of the nasal lining.2

This finding is further strengthened in a more recent study published in Nature in May 2020, wherein a group of international researchers led by Dr. Waradon Sungnak of Wellcome Sanger Institute, UK, found that the level of this ACE2 which allows infection of SARS-CoV-2 are actually highest among nasal cells compared with the rest of the body.3

Rinsing the nasal cavities to dislodge these germs before they get the chance of attaching to the cells and causing an infection then becomes a logical consideration. 

Use of salt-based wash or saline, particularly with sodium chloride or potassium chloride, appears appropriate for the purpose of nasal rinsing to protect against viral infection.  In 2018, Virologist Dr. Sandeep Ramalingam and other researchers from the University of Edinburgh, UK, showed in their study that cells are able to absorb chloride and turn it into a form of bleach to neutralize viruses.4 

Numerous studies support the use of nasal washing in managing various nasal conditions, including those caused by viral infections.  In one particular study in 2008 by Dr. Ivo Slapak, pediatric otorhinolaryngologist, and a group of researchers in the Czech Republic, the effectivity of using saline wash for the nose to prevent reappearance of cold and flu was explored. In their study, 401 children aged 6-10 affected with cold or flu were divided into groups with one group receiving a nasal wash while the other had standard treatment.  Aside from showing faster resolution of symptoms among those who did nasal washing, it was found that these children on nasal washing had fewer sick days (31% under nasal washing vs. 75% under standard treatment) and school absences (17% under nasal washing vs. 35% under standard treatment).5

Vaccines and anti-viral agents remain to be the definitive measures against viral respiratory infections.  However, for some conditions like COVID-19, these are still unavailable.  Together with regular handwashing, physical distancing, a healthy diet and exercise, regular nasal washing with the appropriate salt solution may be considered as a safe, economical and accessible means to confer additional protection from respiratory infections.  Nasal washing devices prepared under stringent standards like nasal sprays and large-volume irrigating kits are already readily available.  Nasal sprays which deliver a fine mist of saline solution into the nose are designed to be handy and on-the-go.  Meanwhile, large-volume irrigating kits are intended for a more thorough cleansing of the nose and sinuses.  Indeed, more studies are under way to fully establish their role in preventing these viral infections.  To find out more on how to be effectively and safely protected from viral respiratory conditions, it still is best to have a talk with your personal doctor.

References:

Yan Y, Chen H, Chen L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019.

Sungnak W, Huang N, Bécavin C, et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med.

Ramalingam S, Cai B, Wong J, et al. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci Rep.

Slapak I, Skoupá J, Strnad P, Horník P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg.