Comparison of Nasal Saline Irrigation Bottle Contamination Between Two Solutions

Rhinosinusitis is one of the most prevalent diseases in the United States with an estimated
31 million adults diagnosed with this condition. The annual health care burden has been
estimated to exceed 5.8 billion dollars. Unfortunately, the underlying etiology of
rhinosinusitis is not fully understood and may encompass multiple factors including:
anatomic variations, impaired immune function, ciliary dysfunction, seasonal allergies,
aspirin allergy, and bacterial biofilms. There are a wide variety of treatment options aimed
at reducing the symptoms of rhinosinusitis with nasal saline irrigations (NSI) being one of
the foundations for therapeutic intervention.

The benefits of NSI in rhinosinusitis in reducing nasal symptoms have been demonstrated in
multiple reports. The mechanisms in which NSI exerts its beneficial effects are not fully
understood, though multiple theories exist including: improvement in mucociliary function,
decreased nasal mucosal edema, and removal of infectious debris and allergens. NSI are
administered intranasally with the use of an irrigation bottle with a wide variety of brands
commercially available for patients to select. In the Department of Otolaryngology-Head and
Neck Surgery Clinic at the University of Virginia Health System, NeiMed bottles are provided
to patients who are diagnosed with rhinosinusitis. In addition, the patients are given an
informational sheet regarding the care and cleaning of these irrigation bottles.
Unfortunately, irrigation bottles can become colonized with bacteria including:
Staphylococcus aureus, Streptococcus pneumonia, Pseudomonas aeruginosa, and Candida species.
The contamination of irrigation bottles can be a nidus for continued bacterial introduction
into the nasal cavity and therefore decreasing the beneficial effects of NSI.

Recently, a novel commercially available irrigation solution, the ChitoRhino, has been
developed with chitosan, a natural polysaccharide demonstrated to have antibacterial and
antifungal properties. This polysaccharide has beneficial properties in multiple clinic
applications including wound healing and post-operative sinus surgery. Chitosan's
antimicrobial function develops from its polycationic structure. Chitosan interacts with the
negatively charge bacterial wall, leading to disruption and cell lysis. There is a paucity
of literature examining the beneficial effect of chitosan in decreasing bacterial
contamination in irrigation bottles. This project represents a pilot study investigating the
antimicrobial effects of chitosan in irrigation bottles for patients with rhinosinusitis.

Inclusion Criteria:

- participants will be: 18 years old or older,

- diagnosed with rhinosinusitis based on history and physical examination performed for
clinical care

- intervention to be prescribed would include nasal irrigation,

- able to understand and comply with the study protocol instructions, including the
return the irrigation bottles

Exclusion Criteria:

- children less than 18 years old,

- unable to understand or perform the saline irrigations, or protocol instructions
including the return the irrigations bottles after 1 month of use

- prisoners

- those with shellfish allergies