Seawater solution with brown algae extract: treatment of acute rhinosinusitis in children

Irrigation therapy is widely used for the treatment of acute rhinosinusitis. Objective. To compare the efficacy and safety of seawater solution with brown algae extract and standard seawater solution without additives in children with acute rhinosinusitis. Patients and methods. The study included 99 children aged 1 to 7 years with acute rhinosinusitis: 50 children received a seawater solution with brown algae extract (group 1), 49 children received standard seawater solution without additives (group 2). Both products were used as a single dose in each nostril 4 times a day. Nasal congestion, difficulty in breathing, mucous discharge, nasal mucosa swelling, and hyperemia were assessed before the first use and after 3, 5, and 7 days of treatment on a 10-point scale. In parallel with the clinical part of the study, the same seawater solution with brown algae extract was studied in vitro on macrophages. THP-1 cells treated with phorbol-12-myristate-13-acetate were used as macrophages. The cells were incubated with slightly hypertonic seawater solution with brown algae extract or with moderately hypertonic seawater solution without additives. Autophagy was assessed using monodansylcadaverine. Bacterial aggression was mimicked using E. coli lipopolysaccharide. Cellular inflammatory response was evaluated by the concentration of IL-1b and TNF-a in cell supernatants. Results. Both groups showed a significant decrease in the severity of nasal congestion, difficulty in nasal breathing, nasal discharge, mucosa swelling and hyperemia by the third day of irrigation therapy compared with baseline. However, in group 1 the symptom reduction occurred significantly faster compared to group 2. On the 3rd day of therapy, the results were as follows: difficulty in nasal breathing 3.0 [2.0–4.0, Group 1)] and 5.0 [4.0–6.0, Group 2] points, nasal mucosa swelling 4.0 [3.0–6.00, Group 1] and 6.0 [5.0–7.0, Group 2] points, mucosa hyperemia 4.0 [2.3–5.0, Group 1] and 6.0 [4.0–7.0, Group 2] points, nasal mucous discharge 2.0 [0.0–2.0, Group 1] and 4.0 [3.0–5.0, Group 2] points ; p < 0.001 for all comparisons. No serious adverse events were registered. In vitro studies have shown that seawater solution with brown algae extract stimulates autophagy in macrophages, which helps to remove intracellular pathogens and also prevents inflammatory response after bacterial stimulation. Conclusion. Thus, compared to seawater solutions without additives, a solution enriched with brown algae extract may be more effective for irrigation therapy in acute rhinosinusitis in children. Key words: irrigation therapy, children, rhinosinusitis, seawater, brown algae