Primary atrophic rhinitis (1Ry AR) is a chronic nasal disease characterized by a loss of mucociliary clearance function, the presence of sticky secretions and dry crusts, leading to a typical foul odor, usually bilateral. A large number of treatment methods have been attempted, but there is still no consensus on long-term successful curative treatment. The purpose of this study is to evaluate the value of platelet-rich plasma as a biological stimulant for promoting the healing of primary atrophic rhinitis.
The author included a total of 78 cases clinically diagnosed with primary atrophic rhinitis. Group A (cases) and patients with poor platelets underwent nasal endoscopy, Sino Nasal Outcome Test-25 questionnaire, saccharin time trial to evaluate mucosal ciliary clearance rate, and plasma in biopsy specimen Group B (control) 1 month and 6 months before the application of platelet rich plasma.
The most common symptoms encountered by all patients in Group A before injection of platelet rich plasma included nasal scab, which showed endoscopic improvement and reduced incidence, with 36 cases (92.30%); foetor, 31 (79.48%); Nasal obstruction, 30 (76.92%); Loss of smell, 17 (43.58%); And epistaxis, 7 (17.94%) to nasal scab, 9 (23.07%); Feet, 13 (33.33%); Nasal congestion, 14 (35.89%); Loss of smell, 13 (33.33%); And epistaxis, 3 (7.69%), after 6 months, this is reflected in a decrease in the Sino Nasal Outcome Test-25 score, which averaged 40 before platelet rich plasma and decreased to 9 after 6 months. Similarly, the mucociliary clearance time was significantly shortened after injection of platelet rich plasma; The initial average saccharin transport time test was 1980 seconds, and it decreased to 920 seconds 6 months after injection of platelet rich plasma.
The use of platelet rich plasma as a biological agent may be an innovative minimally invasive method that can effectively repair tissue malnutrition through further research.
There are four main methods for treating atrophic rhinitis: narrowing the nasal cavity with various substances and implants, promoting normal mucosal regeneration using classic or modified Yang’s surgery, lubricating the nasal mucosa, or improving nasal blood vessels. Cavity. Many other treatment methods have been attempted, including nasal irrigation and flushing, glucose glycerol nasal drops, liquid paraffin, estradiol in peanut oil, anti ozaena solution, antibiotics, iron, zinc, protein, vitamin supplements, vasodilators, prostheses, vaccines, placental extracts or acetylcholine, with or without pilocarpine. However, the effectiveness of these methods varies. In clinical practice, rinsing the nasal cavity with nasal spray is the most commonly used method for treating symptoms of atrophic rhinitis, as it can moisturize the nasal mucosa and prevent scabbing.
Among the above methods, the improved Yang’s surgery has been proven to be an effective and long-lasting method for treating atrophic rhinitis. However, the resulting open mouth breathing can cause considerable discomfort to patients. Lubricants and supplements have been shown to have limited and short-term effects. Therefore, alternative methods to promote nasal mucosal regeneration or angiogenesis have been studied.
PRP is composed of plasma concentrations that exceed the platelet concentration in whole blood. PRP enhances factors that affect tissue growth, differentiation, and scar healing, such as platelet derived growth factor, transforming growth factor, fibroblast growth factor, endothelial growth factor, and insulin-like growth factor. Therefore, PRP has been proven to have acceptable positive results in various clinical studies, effectively promoting wound healing and tissue regeneration, including in the field of otolaryngology. More specifically, it has been reported that PRP is effective in improving the regeneration of the tympanic membrane, vocal cords and facial nerve, as well as the healing after myringoplasty or endoscopic sinus surgery. In addition, a pilot study was conducted a few years ago to treat atrophic rhinitis with injection of PRP lipid mixture. In addition, PRP uses autologous blood and has no allergic or immune rejection reactions. It can be easily prepared within a few minutes through two centrifugation processes.
In this study, we investigated the injection of PRP into atrophic nasal mucosa, which improved mucosal cilia clearance and symptoms during a 6-month follow-up period, especially in young patients, with more pronounced results compared to the elderly group. In many cases of atrophic rhinitis, including elderly rhinitis, mucus secretion is reduced. Therefore, mucinous thickening leads to delayed clearance of nasal mucosal cilia. Replenishing water through saline spray will affect the properties of viscous mucus, and the clearance of nasal mucosa cilia will be restored to a certain extent. However, the role of diluted nasal mucus in resolving nasal symptoms may be limited. Therefore, although conservative nasal hydration can also enhance mucociliary clearance, this treatment regimen did not significantly improve nasal symptoms. In addition, nasal spray and irrigation require physiological saline and special instruments, and should be carried out consistently to control symptoms. In contrast, PRP injection only requires one injection to achieve good results. After injection, the volume of the turbinate immediately increases. However, at the next outpatient visit (2 weeks later), there was no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. Nasal spray and irrigation require physiological saline and special instruments, and should be carried out consistently to control symptoms. In contrast, PRP injection only requires one injection to achieve good results. After injection, the volume of the turbinate immediately increases. However, at the next outpatient visit (2 weeks later), there was no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. Nasal spray and irrigation require physiological saline and special instruments, and should be carried out consistently to control symptoms. In contrast, PRP injection only requires one injection to achieve good results. After injection, the volume of the turbinate immediately increases. However, at the next outpatient visit (2 weeks later), there was no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. PRP injection only requires one injection to achieve good results. After injection, the volume of the turbinate immediately increases. However, at the next outpatient visit (2 weeks later), there was no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. PRP injection only requires one injection to achieve good results. After injection, the volume of the turbinate immediately increases. However, at the next outpatient visit (2 weeks later), there was no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. There is no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect. There is no difference in the volume and shape of the inferior turbinate. Therefore, the temporary increase in volume caused by injection is considered negligible. In addition, as shown in the sub domain analysis of SNOT-22, there was no significant improvement in the emotional sub domain of PRP injection patients. The results were not accompanied by an improvement in the emotional sub domain, indicating that the placebo effect was not significant in a certain aspect.
The persistent pain and discomfort related symptoms of atrophic rhinitis are not serious in medicine. Therefore, the socio-economic losses are underestimated. However, from the perspective of actual patients, it is a socially critical disease. In addition, with the aging of the population, the number of patients with senile rhinitis is increasing exponential growth. Therefore, it is very important to provide appropriate treatment for atrophic rhinitis, including elderly rhinitis.
The aim of this study is to propose a new regenerative method for treating atrophic rhinitis through autologous PRP injection, and to compare the improvement of symptoms between the PRP treatment group and the conservative treatment group using a control group. Due to atrophic rhinitis being a clinical definition, more research is needed to infer its mode of action. However, in order to prevent socio-economic losses and a decline in patient quality of life, it is necessary to provide research results with potential therapeutic effects.
However, this study has several limitations. This study was designed prospectively and cannot be randomized controlled as some participants refused the nasal injection program. In terms of ethics, invasive operations for academic purposes in the control group should be restricted to protect the rights and interests of patients. Therefore, assigning patients based on their preferences makes the research results weaker than those provided by randomized controlled studies. In addition, secondary atrophic rhinitis is caused by the deformation and removal of the original nasal structure. Performing a biopsy may exacerbate atrophy. Therefore, from an ethical perspective, it is impossible to perform corresponding nasal tissue biopsy in patients with atrophic rhinitis. The results after 6 months of follow-up may not represent long-term results. In addition, the number of patients in the subgroup is relatively small. Therefore, future research should include more patients using a randomized controlled design over a longer follow-up period.
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Post time: May-23-2023