Effect of FLU-ACIL RHINO nasal spray on the inflammatory process and recovery of patients after FESS

Topicality: The main method of treatment of chronic rhinosinusitis is functional endoscopic rhinosurgery (FESS). However, the regeneration of tissues damaged during surgery remains important. It has three stages – alteration (primary and secondary), exudation and proliferation – and takes place with the formation of reactive oxygen species. Therefore, determination of total NO synthase activity (NOS), inducible synthase activity (iNOS) and constitutive (cNOS) isoforms are biochemical markers of the inflammatory response. The activity of the alteration process and the degree of postoperative damage is characterized by the concentration of glycosaminoglycans and L-oxyproline. Materials and methods: This study determined the multimodal (multi-vector) effect of Flu-Acyl rhino spray (6% N-acetylcysteine in 3% hypertonic pH-controlled saline) on the inflammatory response of the nasal mucosa in the postoperative period. The study was conducted at the Department of Otolaryngology of NMU named after O.O. Bogomolets on the basis of "Alexander Clinical Hospital of Kyiv". Clinical and laboratory examinations of 52 patients aged 18 to 60 years who underwent FESS were performed. Patients were randomized into two groups. 24 patients received standard treatment (control group), 26 patients – with the addition of nasal spray Flu-Acyl rhino (main group). Results: It was found that the indicators of total activity of NO synthase (NOS) and its isoforms, as well as the concentration of glycosaminoglycans and L-oxyproline were lower in patients of the main group on days 7 and 14 of the postoperative period compared with patients in the control group (р<0,05). These results can be explained by the anti-inflammatory effect of Flu-Acyl rhino spray due to the presence of N-acetylcysteine, which is able to inhibit the activation of the transcription factor NF-kB, which leads to decreased iNOS activity on the 7th and 14th day of treatment. N-acetylicysteine also reduces the degradation of amorphous connective tissue, shifts the balance in the proteolysis / antiproteolysis system towards the predominance of the antiproteolytic component, participates in the normalization of physiological production and utilization of sulfide anion. Conclusions: The use of Flu-Acyl rhino nasal spray in the postoperative period due to multimodal action promotes physiological changes from alteration and exudation to proliferation processes, normalizes mucociliary clearance in the postoperative period, improves healing and reduces recovery and disability.