No Benefit to Using Povidone-Iodine over Saline as a Nasal Irrigation After Sinonasal Surgery

by Linda Kossoff •

How effective is post-operative nasal irrigation with povidone-iodine (PVP-I) solution in patients undergoing sinonasal surgery?

BOTTOM LINE

A dilute 0.1% PVP-I nasal irrigation as a post-operative care modality after sinonasal surgery does not provide additional benefit compared with normal saline irrigation.

BACKGROUND: Topical therapies play an integral role in sinonasal disease management. Saline irrigation is recommended in several conditions, including chronic rhinosinusitis (CRS), and in post-operative care following endoscopic sinus surgery (ESS). PVP-I, a chemical complex that exhibits bactericidal, microbicidal, and anti-inflammatory effects, can be used as a nasal irrigation solution.

STUDY DESIGN: Randomized controlled study.

SETTING: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.

SYNOPSIS: Researchers enrolled patients with CRS and hypertrophic inferior turbinates who underwent ESS and inferior turbinate reduction. Patients were evaluated using the Taiwanese 22-item Sino-Nasal Outcome Test (TWSNOT-22), rhinomanometry, endoscopic examination, and bacterial cultures. One week post-op, patients were randomly assigned to a 0.1% PVP-I nasal irrigation group (27 patients) or a control (saline) irrigation group (28 patients). Both groups used the same irrigation volume and procedure and performed twice-daily nasal irrigations for three months post-operatively. The TWSNOT-22 score in both groups, and the total nasal resistance (TNR) in the PVP-I group, showed significant improvement at one month post-operatively compared to pre-operative measurements. The TWSNOT-22, Lund-Kennedy endoscopic score, and TNR results revealed significant improvements in both groups at three months post-operatively compared with pre-operative measurements. Results showed no significant differences in TNR between the groups at one month and three months post-op. All patients had positive bacterial culture results. Study limitations included the impossibility of blinding subjects to the irrigation treatment due to appearance differences between PVP-I and saline solutions.

CITATION: Wu PH, Cheng PC, Chang CM, et al. Efficacy of povidone-iodine nasal irrigation solution after sinonasal surgery: a randomized controlled study. Laryngoscope. 2022;132:1148-1152.