Influence of intranasal sterile isotonic sea water applications on xylometazoline administration: An experimental study in pigs



      The aim of this study was to investigate how isotonic sea water solution (Physiomer) affects the structure of porcine nasal mucosa when it is applied simultaneously with vasoconstrictors (xylometazoline) for a prolonged period of time.


      Twenty pigs of the PMR-Landraze breed formed the study group. A solution of xylometazoline 0, 1% (Otrivin spray, Novartis) was sprayed every 8 h in both nasal cavities of the pigs, with two applications into each nostril for 28 days. Between the applications (4 h later), the right nasal cavity was washed with sterile isotonic sea water (Physiomer Normal, Geomar). Biopsies were taken under endoscopic guidance from the nasal mucosa of each nasal cavity separately at specific times. Five histological parameters were microscopically examined for each biopsy section: (1) inflammation, (2) fibrosis, (3) metaplasia of the epithelium, (4) reactive atypia of the epithelium and (5) necrosis.


      Statistically significant differences regarding grade of inflammation on days 7 (p = 0.0009), 12 (p = 0.01), 20 (p = 0.02) and 28 (p = 0.0005), regarding grade of fibrosis on day 28 (p = 0.026) and regarding epithelial metaplasia on day 5 (p = 0.052) were found between the nasal mucosa treated only with vasoconstrictors and the nasal mucosa treated with vasoconstrictors and sea water washing. In all cases, samples from the nasal cavities that had been washed with Physiomer appeared with a lower grade of inflammation, fibrosis and metaplasia compared to the samples from nasal mucosa where no nasal washing was performed.


      Nasal irrigations with isotonic sea water, when are applied 4 h after vasoconstrictors for a long period of time, prevent nasal mucosa from histological damage.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Auris Nasus Larynx
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Suh S.H.
        • Chon K.M.
        • Min Y.G.
        • Jeong C.H.
        • Hong S.H.
        Effects of topical nasal decongestants on histology of nasal respiratory mucosa in rabbits.
        Acta Otolaryngol. 1995; 115: 664-671
        • Papsin B.
        • McTavish A.
        Saline nasal irrigation: its role as an adjunct treatment.
        Can Fam Physician. 2003; 49: 168-173
        • Traissac L.
        • Ohayon-Courtes C.
        • Dufour P.
        • Bordenave L.
        Nasal washing with Physiomer 10 years later: 1988–1998.
        Rev Laryngol Otol Rhinol (Bord). 1999; 120: 133-135
        • Seppey M.
        • Schweri T.
        • Hausler R.
        Comparative randomised clinical study of tolerability and efficacy of Rhinomer Force 3 versus a reference product in post-operative care of the nasal fossae after endonasal surgery.
        ORL J Otorhinolaryngol Relat Spec. 1996; 58: 87-92
        • Martineau-Doize B.
        • Caya I.
        Ultrastructural charactarization of the nasal respiratory epithelium in the piglet.
        Anat Rec. 1996; 246: 169-175
        • Larochelle R.
        • Martineau-Doize B.
        Distribution of epithelia in the nasal cavity of piglets.
        Acta Anat (Basel). 1990; 139: 214-219
        • Adams D.R.
        Epithelium lining the rostral portion of the porcine nasal mucosa.
        Rev Vet Sci. 1990; 49: 61-65
        • Tas A.
        • Yagiz R.
        • Yalcin O.
        • et al.
        Use of mometasone furoate aqueous nasal spray in the treatment of rhinitis medicamentosa: an expirimental study.
        Otolaryngol Head Neck Surg. 2005; 132: 608-612
        • Graf P.
        Rhinitis medicamentosa: a review of causes and treatment.
        Treat Respir Med. 2005; 4: 21-29
        • Lacroix J.
        • Lundberg J.
        Sympathetic vascular control of the pig nasal mucosa: adrenoreceptor mechanisms in blood flow and volume control.
        Br J Pharmacol. 1989; 97: 1075-1084
        • Knothe J.
        • Aschoff E.
        Experimental studies on the effect of various mucosa decongesting nose drops.
        Dtsch Gesundheitsw. 1969; 24: 2384-2388
        • Lin C.Y.
        • Cheng P.H.
        • Fang S.Y.
        Mucosal changes in rhinitis medicamentosa.
        Ann Otol Rhinol Laryngol. 2004; 113: 147-151
        • Ramey J.
        • Bailen E.
        • Lockey R.
        Rhinitis Medicamentosa.
        J Invest Allergol Clin Immunol. 2006; 16: 148-155
        • Min Y.G.
        • Kim H.S.
        • Suh S.H.
        • Jeon S.Y.
        • Son Y.I.
        • Yoon S.
        Paranasal sinusitis after long-term use of topical decongestants.
        Acta Otolaryngol. 1996; 116: 465-471
        • Akerlund A.
        • Klint T.
        • Olen L.
        • Rundcrantz H.
        Nasal decongestant effect of oxymetazoline in the common cold: an objective dose–response study in 106 patients.
        J Laryngol Otol. 1989; 103: 743-746
        • Graf P.
        • Hallen H.
        • Juto J.E.
        Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers.
        Clin Exp Allergy. 1995; 25: 395-400
        • Knipping S.
        • Holzhausen H.J.
        • Goetze G.
        • Riederer A.
        • Bloching M.B.
        Rhinitis medicamentosa: electron microscopic changes of human nasal mucosa.
        Otolaryngol Head Neck Surg. 2007; 136: 57-61
        • Tomooka L.T.
        • Murphy C.
        • Davidson T.M.
        Clinical study and literature review of nasal irrigation.
        Laryngoscope. 2000; 110: 1189-1193
        • Georgitis J.W.
        Nasal hyperthermia and simple irrigation for perennial rhinitis: changes in inflammatory mediators.
        Chest. 1994; 106: 1487-1492
        • Proksch E.
        • Nissen H.P.
        • Bremgartner M.
        • Urquhart C.
        Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin.
        Int J Dermatol. 2005; 44: 151-157
        • Friedman M.
        • Vidyasagar R.
        • Joseph N.
        A randomised, prospective, double-blind study on the efficacy of Dead sea salt nasal irrigations.
        Laryngoscope. 2006; 116: 878-882
        • Bachmann G.
        • Hommel G.
        • Michel O.
        Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease.
        Eur Arch Otorhinolaryngol. 2000; 257: 537-541
        • Michel O.
        • Essers S.
        • Heppt W.J.
        • Johannssen V.
        • Reuter W.
        • Hommel G.
        The value of Ems Minerals Salts in the treatment of rhinosinusitis in children. Prospective study on the efficacy of mineral salts versus xylometazoline in the topical nasal treatment of children.
        Int J Pediatric Otorhinolaryngol. 2005; 69: 1359-1365
        • Tabary O.
        • Muselet C.
        • Yvin J.C.
        • Halley-Vanhove B.
        • Puchelle E.
        • Jacquot J.
        Physiomer reduces the chemokine interleukin-8 production by activated human respiratory epithelial cells.
        Eur Respir J. 2001; 18: 661-666
        • Slapak I.
        • Skoupa J.
        • Strnad P.
        • Hornik P.
        Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children.
        Arch Otolaryngol Head Neck Surg. 2008; 134: 67-74
        • Akerlund A.
        • Bende M.
        Sustained use of xylometazoline nose drops aggrevates vasomotor rhinitis.
        Am J Rhinol. 1991; 5: 157-160