Seawater with silver ions in the elimination therapy of polypous sinusitis

Introduction. The main mechanism of the pathological process in polypous rhinosinusitis involves mucous membrane remodelling due to alterations followed by the formation of polypous vegetations that are likely to relapse.

Aim. To conduct a clinical evaluation of the efficacy of the use of seawater spray with silver ions as part of the elimination therapy of polypous sinusitis.

Materials and methods. We conducted a prospective randomized clinical trial involving 66 patients aged 20 to 46 years on an outpatient basis. The inclusion criterion included a diagnosis of chronic polypous rhinosinusitis in the exacerbation phase with attachment of a bacterial infection. All patients were randomly divided into 2 groups. The efficacy and safety of the use of seawater spray with silver ions was assessed on Days 3, 5 and 7 of treatment in Group 1 (n = 32) as compared to Group 2 (n = 34) which used the standard seawater spay.

Results and discussion. On Day 7, the nasal breathing improved in 96.5% of patients in Group 1 and in 45% of patients in Group 2. 97.5% of patients in Group 1 reported the absence of nasal discharge on Day 7 as compare with 56.5% of patients in Group 2. The absence of postnasal drip was noted on Day 7 of therapy in 98.5% of patients in Group 1 and in 2.5% of patients in Group 2, respectively. The SF-36 QoL trend scores showed a more significant improvement of the patients’ health status on Day 7 of the therapy from 89.4 to 98.9 scores and from 84.6 to 91.1 points in patients of Groups 1 and 2, respectively.

Conclusions. The clinical assessment of the efficacy of the use of seawater spray with silver ions as part of the elimination therapy of polypous sinusitis discovered a significant reduction in clinical symptoms.

1. Lopatin AS. Acute rhinosinusitis in EPOS 2020 and updated guidelines of the Russian Rhinologic Society. Pharmacology & Pharmacotherapy. 2022;S1:30–36. (In Russ.) https://doi.org/10.46393/27132129_2022_S_30.

2. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(S29):1–464. https://doi.org/10.4193/Rhin20.600.

3. Пискунов ГЗ, Арефьева НА, Карпищенко СА, Карпова ЕП, Лопатин АС, Моисеева ЮП и др. Полипозный риносинусит. Клинические рекомендации. 2022. Режим доступа: https://rhinology.ru/wp-content/uploads/2022/10/ПРС-Клинические_рекомендации_финал.pdf.

4. Korkmazov MYu, Kazachkov EL, Lengina MA, Dubinets ID, Korkmazov AM. Cause-effect factors of rhinosinusitis poliposa development. Russian Rhinology. 2023;31(2):124–130. (In Russ.) https://doi.org/10.17116/rosrino202331021124.

5. Korkmazov MYu, Lengina MA, Korkmasova АM, Kravchenko AYu. Effect of post-COVID syndrome on the quality of life of patients with allergic rhinitis and eosinophilic phenotype of chronic polyposis rhinosinusitis. Medical Journal of the Russian Federation. 2023;29(4):277–290. (In Russ.) https://doi.org/10.17816/medjrf472079.

6. Bessonova EA, Nurieva NS. Classical and digital option to index assessment of the oral hygiene. Stomatologiya. 2022;101(6):14–17. (In Russ.) https://doi.org/10.17116/stomat202210106114.

7. Yeremenko YuE, Titov LP, Sidelova SI, Nosova ES, Shestakova EV, Dubovik PI. Features of microbial landscape of patients with acute and chronic rhinosinusitis caused by biofilms. Voennaya Medicina. 2021;(4):12–17. (In Russ.) https://doi.org/10.51922/2074-5044.2021.4.12.

8. Chalermwatanachai T, Vilchez-Vargas R, Holtappels G, Lacoere T, Jáuregui R, Kerckhof FM et al. Chronic rhinosinusitis with nasal polyps is characterized by dysbacteriosis of the nasal microbiota. Sci Rep. 2018;8(1):7926. https://doi.org/10.1038/s41598-018-26327-2.

9. Shchetinin SA, Korkmazov MYu, Gizinger OA, Kochengina SA, Sokol EV. Efficiency of therapy ofchronic recurrent adenoiditisfor the children of resident in city Chelyabinsk on results front active rhinomanometriaandcytokine profile of washings of from the surface of oesophageal amygdale. Bulletin of the Chelyabinsk Regional Clinical Hospital. 2015;3(30):59–63. (In Russ.) Available at: https://elibrary.ru/yjjnhh.

10. Tomassen P, Vandeplas G, Van Zele T, Cardell LO, Arebro J, Olze H et al. Inflammatory endotypes of chronic rhinosinusitis based on cluster analysis of biomarkers. J Allergy Clin Immunol. 2016;137(5):1449–1456.e4. https://doi.org/10.1016/j.jaci.2015.12.1324.

11. Korkmazov AM, Korkmazov MY. Methods of correction of the functional infringements of phagocytes and local manifestations of oxidative stress in the multiple shell of the nose region with use of ultrasound cavitation. Russian Journal of Immunology. 2018;21(3):325–328. (In Russ.) https://doi.org/10.31857/S102872210002404-9.

12. Chalermwatanachai T, Zhang N, Holtappels G, Bachert C. Association of Mucosal Organisms with Patterns of Inflammation in Chronic Rhinosinusitis. PLoS ONE. 2015;10(8):e0136068. https://doi.org/10.1371/journal.pone.0136068.

13. Korkmazov MYu, Kornova NV, Lengina MA, Smirnov AA, Korkmazov AM, Dubinets ID. Effective antibiotic therapy for community-acquired otorhinolaryngological respiratory infection (clinical description). Meditsinskiy Sovet. 2022;(20):73–81. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-20-73-81.

14. Soler ZM, Oyer SL, Kern RC, Senior BA, Kountakis SE, Marple BF, Smith TL. Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: an evidenced-based review with recommendations. Int Forum Allergy Rhinol. 2013;3(1):31–47. https://doi.org/10.1002/alr.21064.

15. Korkmazov MYu, Lengina MA, Korkmazov АM, Kornova NV, Beloshangin АS. Treatment and prevention of various forms of laryngitis on the background of acute respiratory infections. Meditsinskiy Sovet. 2022;16(8):79–87. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-8-79-87.

16. Kiparisov YuS, Nurieva NS. Experimental study of the effectiveness of fixation of forming and replacement prostheses of acquired defects of the maxillofacial region. Clinical Dentistry (Russia). 2018;(1):68–71. (In Russ.) https://doi.org/10.37988/1811-153X_2018_1_68.

17. Korkmazov MYu. Chronic tonsillitis and analysis of physical methods of exposure. Vestnik Oto-Rino-Laringologii. 2006;(S5):299–300. (In Russ.) Available at: https://elibrary.ru/sicbel.

18. Ianov Iu K, Krivopalov AA, Korneyenkov AA, Shcherbuk YuA, Artyushkin SA, Vakhrushev SG. The modern epidemiological characteristics of oto- and rhinosinusogenic intracranial complications. Vestnik Oto-Rino-Laringologii. 2015;80(6):32–37. (In Russ.) https://doi.org/10.17116/otorino201580632-37.

19. Korkmazov MYu, Angelovich MS, Lengina MA, Belousov SYu. Clinical case of angiosarcoma of ethmoidal labyrinth and frontal sinus, issues of morphological verification of diagnosis. Russian Vestnik Oto-Rino-Laringologii. 2022;87(4):102–106. (In Russ.) https://doi.org/10.17116/otorino202287041102.

20. Gizinger OA, Korkmazov MYu, Shchetinin SA. The specific aspects of anamnesis of children with chronic adenoiditis. Rossiiskaya Otorinolaringologiya. 2017;(3):24–29. (In Russ.) https://doi.org/10.18692/1810-4800-2017-3-24-29.

21. Gizinger OA, Korkmazov MU, Shchetinin SA. Immunostimulating therapy for chronic adenoiditis in children. Vrach. 2015;(9):25–28. (In Russ.) Available at: https://www.elibrary.ru/ukxagz.

22. Zyryanova KS, Dubinets ID, Korkmazov MYu, Solodovnik AV. Differentiated approach to the treatment of exudative otitis media with application mucoregulatory therapy in childhood. Rossiiskaya Otorinolaringologiya. 2014;(2):31–34. (In Russ.) Available at: https://www.elibrary.ru/ryyujp.

23. Zyryanova KS, Dubinets ID, Ershova IS, Korkmazov MYu. Initial therapy of acute otitis media in children. Vrach. 2016;(1):43–45. Available at: https://www.elibrary.ru/vrxvph.

24. Barillo DJ, Marx DE. Silver in medicine: a brief history BC 335 to present. Burns. 2014;40(1):3–8. https://doi.org/10.1016/j.burns.2014.09.009.

25. Ebrahiminezhad A, Raee MJ, Manafi Z, Sotoodeh Jahromi A, Ghasemi Y. Ancient and Novel Forms of Silver in Medicine and Biomedicine. J Adv Med Sci Appl Technol. 2016;2(1):122–128. https://doi.org/10.18869/nrip.jamsat.2.1.122.

26. Alexander JW. History of the medical use of silver. Surg Infect. 2009;10(3):289–292. https://doi.org/10.1089/sur.2008.9941.

27. Scott JR, Krishnan R, Rotenberg BW, Sowerby LJ. The effectiveness of topical colloidal silver in recalcitrant chronic rhinosinusitis: a randomized crossover control trial. J Otolaryngol Head Neck Surg. 2017;46(1):64. https://doi.org/10.1186/s40463-017-0241-z.

28. Eremeeva KV, Petrova EI, Svistushkin VM. Silver proteinate in ENT practice: is the new a well-forgotten old? RMJ. 2015;23:1381–1383. (In Russ.) Available at: https://www.rmj.ru/articles/otorinolaringologiya/Proteinat_serebra_v_LOR-praktike_novoe_eto_horoshozabytoe_staroe.

29. Chernousova S, Epple M. Silver as antibacterial agent: ion, nanoparticle, and metal. Angew Chem Int Ed Engl. 2013;52(6):1636–1653. https://doi.org/10.1002/anie.201205923.

30. Korkmazov MYu. The theory of bioresonance and the possibility of its application in ENT practice. Rossiiskaya Otorinolaringologiya. 2009;(2):92–96. (In Russ.) Available at: https://www.elibrary.ru/mgszax.

31. Krivopalov AA, Yanov YuK, Shatalov VA, Rubin AN, Shcherbuk AYu, Artyushkin SA et al. Clinicodiagnostic features of otorhinosinusogenic intracranial pyoinflammatory diseases complicated by sepsis. Vestnik Khirurgii Imeni I.I. Grekova. 2016;175(6):13–19. (In Russ.) https://doi.org/10.24884/0042-4625-2016-175-6-13-19.

32. Miroshnichenko NA, Nikolaeva YuO, Savranskaya KV, Ryzhkova NS. Maintaining Normal Indicators of Mucociliary Transport Is the Basis for the Adequate and Correct Use of Local Antiseptics. Effective Pharmacotherapy. 2024;20(16):10–13. (In Russ.) Available at: https://umedp.ru/articles/sokhranenie_normalnykh_pokazateley_mukotsiliarnogo_transporta_osnova_adekvatnogo_i_korrektnogo_ispol.html.

33. Jung WK, Koo HC, Kim KW, Shin S, Kim SH, Park YH. Antibacterial activity and mechanism of action of the silver ion in Staphylococcus aureus and Escherichia coli. Appl Environ Microbiol. 2008;74(7):2171–2178. https://doi.org/10.1128/aem.02001-07.

34. Bhusal M, Pathak I, Bhadel A, Shrestha DK, Sharma KR. Synthesis of silver nanoparticles assisted by aqueous root and leaf extracts of Rhus chinensis Mill and its antibacterial activity. Heliyon. 2024;10(13):e33603. https://doi.org/10.1016/j.heliyon.2024.e33603.

35. Morones-Ramirez JR, Winkler JA, Spina CS, Collins JJ. Silver enhances antibiotic activity against gram-negative bacteria. Sci Transl Med. 2013;5(190):190ra81. https://doi.org/10.1126/scitranslmed.3006276.

36. Gurov AV, Yushkina MA. The opportunities of local therapy of pyoinflammatory diseases of the nasal cavity. RMJ. 2017;(6):410–413. (In Russ.) Available at: https://www.rmj.ru/articles/otorinolaringologiya/Vozmoghnosti_mestnoy_terapii_gnoyno-vospalitelynyh_zabolevaniy_polosti_nosa/.

37. Derbeneva ML, Guseva AL. Silver-based drugs in the treatment of inflammatory diseases of the nose. Meditsinskiy Sovet. 2015;(15):20–23. (In Russ.) Available at: https://www.med-sovet.pro/jour/article/view/377.

38. Zhang XF, Liu ZG, Shen W, Gurunathan S. Silver Nanoparticles: Synthesis, Characterization, Properties, Applications, and Therapeutic Approaches. Int J Mol Sci. 2016;17(9):1534. https://doi.org/10.3390/ijms17091534.

39. Krivopalov AA, Riazantsev SV, Eremin SA, Zakharova GP, Shabalin VV, Shamkina PA, Chernushevich II. The question about the topical antibiotic therapy of acute rhinosinusitis. Russian Vestnik Oto-Rino-Laringologii. 2019;84(2):50–56. (In Russ.) https://doi.org/10.17116/otorino20198402150.

40. Korkmazov AM, Dubinets ID, Lengina MA. Possibilities of topical antioxidant protection of operated cavities in practical otorhinolaryngology. Vestnik Oto-Rino-Laringologii. 2017;82(S5):14–15. (In Russ.) Available at: https://www.elibrary.ru/ylwhjs.

41. Ryazansev SV, Krivopalov AA, Eremin SA, Zakharova GP, Shabalin VV, Shapkina PA, Chufistova AV. Topical antibacterial therapy of acute rhinosinusitis. RMZH. 2020;(4):2–7. Available at: https://www.rmj.ru/articles/otorinolaringologiya/Topicheskaya_antibakterialynaya_terapiya_ostrogo_rinosinusita/.

42. Shin SH, Ye MK. The effect of nano-silver on the activation of nasal polyp epithelial cells by Alternaria, Der P1 and staphylococcal enterotoxin B. Int Immunopharmacol. 2011;11(11):1691–1696. https://doi.org/10.1016/j.intimp.2011.05.028.

43. Hadrup N, Lam HR. Oral toxicity of silver ions, silver nanoparticles and colloidal silver--a review. Regul Toxicol Pharmacol. 2014;68(1):1–7. https://doi.org/10.1016/j.yrtph.2013.11.002.