# Treatment and Impacts of Chronic Sinusitis with the Confluence of Biyuan Tongqiao Granules and Saline Nasal Irrigation

Authors: Fei Ma; Lian Xu; Ping Ai
Journal: Journal of Healthcare Engineering
 (2022)

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## Abstract

In this research study, we will study the clinical effect of Biyuan Tongqiao granules with saline nasal irrigation for treatment of chronic sinusitis. It will also study its impacts on the computed tomography (CT) score of the nasal sinus and negative reactions in patients. For this purpose, ninety (90) patients with chronic sinusitis were admitted to the hospital (June 2019 to June 2020). They were selected as the research subjects and divided into experimental and control groups randomly with 45 cases in each group. Control group patients were treated with nasal irrigation with normal saline. While, Biyuan Tongqiao granules combined with nasal irrigation with normal saline was treated by the experimental group. The CT scores of nasal sinus, clinical effect, the incidence of adverse reactions, recurrence rate, duration of nasal mucosal epithelialization, and nasal ciliary transmission speed of both the groups were compared. The patients’ pain was assessed by the visual analogue scale (VAS), and the symptoms of sinusitis were scored by the SNOT-20 scale. The experimental group showed significantly lower sinus CT scores and better clinical effects. Adverse reactions were not observed in both the groups’ probability (P>0.05). The experimental group presented a significantly lower recurrence rate, shorter duration of nasal mucosal epithelialization, faster nasal ciliary transmission, and sharply lowers VAS scores and SNOT-20 scores than in the control group (P<0.05). This proves Biyuan Tongqiao granules and nasal irrigation with normal saline can effectually boost the clinical efficacy and lessen the computed tomography score of nasal sinus in chronic sinusitis patients. It has a worthy clinical application and promotion.


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## Body

## 1. Introduction

Chronic sinusitis is one of the most widespread illnesses in the world. Every year, millions of people suffer from this disease. Although there are many cures to this disease, yet the quality of life remains limited. This disease relates to otorhinolaryngology. It can be divided into chronic and acute sinusitis according to the clinical diagnosis. The human head has four paired cavities. This disease occurs when the inside empty spaces of the nose or head are blocked with fluid and they are swollen for a longer time. Resultantly, the sinuses make mucus that is drained out from the nostrils. Chronic sinusitis has a high incidence and lasts for a long course. Normally, there are two types of treatments; the first one is a clinical treatment that often relies on drugs, while the second one is surgical treatment. The surgical treatment is most favored and accepted by the patients. With the adverse effects of headache, nasal obstruction, and facial pain, chronic sinusitis may seriously hinder patients’ quality of life if they fail to receive the treatment in the early stages [1–3]. At present, notwithstanding the positive therapeutic effect of surgery for sinusitis, it invariably results in great trauma, and the patients suffer a propensity for a variety of complications after surgery. Therefore, patients mostly prefer conservative treatment whose efficacy is rather mediocre. Therefore, it is indispensable to explore an effective treatment of chronic sinusitis to relieve the pain of patients. Biyuan Tongqiao granules have the effects of dispelling wind (relaxing of tendons), clearing heat (control inflammation reaction), dispersing lung (easy inflow and outflow of air), and dredging orifice (open nasal channel), with a promising therapeutic effect for the treatment of chronic sinusitis. Normal saline was used to effectively remove secretions in the nasal cavity of patients. It is conducive to nasal ventilation and drainage. Moreover, saline washing costs less and would not cause trauma to patients [1, 4, 5]. This study analyzes the clinical efficacy of Biyuan Tongqiao granules along with saline nasal irrigation for chronic sinusitis patients. Also, the adverse effects and CT score of nasal sinus were compared. The results are reported as follows.This research study is structured as follows: Section2 will explain the materials and methods used in this research. Sections 3 and 4 will discuss the results extracted from the research and discussion on this research. Last, Section 5 will include the concluding remarks for this study.


## 2. Materials and Methods

This section will elaborate the general material and tools used in this study. Furthermore, the methods for using different materials and tools will also be explained in this section.


### 2.1. General Information

Ninety (90) chronic sinusitis patients who were admitted to the hospital (June 2019 to June 2020) were selected for research. They were divided into control and experimental groups randomly. Each group had 45 cases.


#### 2.1.1. Inclusion Criteria

It includes patients having the following characteristics:(i)
All patients must have the relevant criteria in the Guidelines for Diagnosis and Treatment of Chronic Sinusitis in China [6](ii)
The patients’ ages ranged from 20 to 60 years old(iii)
This research was accepted by the hospital ethics committee. The patient’s families were informed about purpose and process of the study. They signed the consent form.


#### 2.1.2. Exclusion Criteria

It includes patients having the following characteristics:(i)
Patients were allergic to the drugs used in this study(ii)
Patients were complicated with diabetes, hypertension, and other diseases(iii)
Patients were in pregnancy or lactation(iv)
Patients had low treatment compliance or a history of mental disease


### 2.2. Methods

The nasal cavity of control group patients was rinsed with normal saline. They needed to lean their heads slightly forward, breathe with their mouths open, and hold nozzle into the nasal vestibule for rinsing. After normal saline entered the nasal cavity, it flowed out through the nostrils at the other side. The irrigation was alternately performed on both sides, twice a day with continuous treatment for one month.The experimental group was treated with normal saline nasal irrigation plus Biyuan Tongqiao granules (Shandong New Era Pharmaceutical Co., Ltd., specifications: 15 g∗ 10 bags), 1 time/bag and 3 times/day. The nasal cavity was rinsed with normal saline twice a day and the treatment lasted for one month.


### 2.3. Observation Indicators

CT examination of nasal sinuses was evaluated in two groups according to the Lund–Mackey sinus CT score which was in positive relation to the severity of the disease.VAS was used to assess the pain severity of patients. It has 10 points in total. A higher score represents greater pain severity.Therapeutic effects were classified into three types: markedly effective for significant improvement of clinical symptoms, effective for improved clinical symptoms, and ineffective for no improvement and even aggravation of clinical symptoms [7].Symptoms of sinusitis were assessed by the Sinonasal Outcome Test 20 [8], which included 3 emotional outcomes, 4 sleep disorders, 5 nasal symptoms, and 8 related symptoms, totaling 20 items. A higher score represents the seriousness of patient’s distress inflicted by the disease.Both the groups’ epithelialization time of nasal surface and the change of nasal cilia transmission speed were compared. The patients were tracked for 6 months, with a detailed record of the patient’s relapse.


### 2.4. Statistical Processing

For this research, SPSS 20.0 was used to process data, and GraphPad Prism 7 was used to plot graphical analytics. The research included data and measurement data using theX2 test, t-test, and normality test.


## 2.1. General Information

Ninety (90) chronic sinusitis patients who were admitted to the hospital (June 2019 to June 2020) were selected for research. They were divided into control and experimental groups randomly. Each group had 45 cases.


### 2.1.1. Inclusion Criteria

It includes patients having the following characteristics:(i)
All patients must have the relevant criteria in the Guidelines for Diagnosis and Treatment of Chronic Sinusitis in China [6](ii)
The patients’ ages ranged from 20 to 60 years old(iii)
This research was accepted by the hospital ethics committee. The patient’s families were informed about purpose and process of the study. They signed the consent form.


### 2.1.2. Exclusion Criteria

It includes patients having the following characteristics:(i)
Patients were allergic to the drugs used in this study(ii)
Patients were complicated with diabetes, hypertension, and other diseases(iii)
Patients were in pregnancy or lactation(iv)
Patients had low treatment compliance or a history of mental disease


## 2.1.1. Inclusion Criteria

It includes patients having the following characteristics:(i)
All patients must have the relevant criteria in the Guidelines for Diagnosis and Treatment of Chronic Sinusitis in China [6](ii)
The patients’ ages ranged from 20 to 60 years old(iii)
This research was accepted by the hospital ethics committee. The patient’s families were informed about purpose and process of the study. They signed the consent form.


## 2.1.2. Exclusion Criteria

It includes patients having the following characteristics:(i)
Patients were allergic to the drugs used in this study(ii)
Patients were complicated with diabetes, hypertension, and other diseases(iii)
Patients were in pregnancy or lactation(iv)
Patients had low treatment compliance or a history of mental disease


## 2.2. Methods

The nasal cavity of control group patients was rinsed with normal saline. They needed to lean their heads slightly forward, breathe with their mouths open, and hold nozzle into the nasal vestibule for rinsing. After normal saline entered the nasal cavity, it flowed out through the nostrils at the other side. The irrigation was alternately performed on both sides, twice a day with continuous treatment for one month.The experimental group was treated with normal saline nasal irrigation plus Biyuan Tongqiao granules (Shandong New Era Pharmaceutical Co., Ltd., specifications: 15 g∗ 10 bags), 1 time/bag and 3 times/day. The nasal cavity was rinsed with normal saline twice a day and the treatment lasted for one month.


## 2.3. Observation Indicators

CT examination of nasal sinuses was evaluated in two groups according to the Lund–Mackey sinus CT score which was in positive relation to the severity of the disease.VAS was used to assess the pain severity of patients. It has 10 points in total. A higher score represents greater pain severity.Therapeutic effects were classified into three types: markedly effective for significant improvement of clinical symptoms, effective for improved clinical symptoms, and ineffective for no improvement and even aggravation of clinical symptoms [7].Symptoms of sinusitis were assessed by the Sinonasal Outcome Test 20 [8], which included 3 emotional outcomes, 4 sleep disorders, 5 nasal symptoms, and 8 related symptoms, totaling 20 items. A higher score represents the seriousness of patient’s distress inflicted by the disease.Both the groups’ epithelialization time of nasal surface and the change of nasal cilia transmission speed were compared. The patients were tracked for 6 months, with a detailed record of the patient’s relapse.


## 2.4. Statistical Processing

For this research, SPSS 20.0 was used to process data, and GraphPad Prism 7 was used to plot graphical analytics. The research included data and measurement data using theX2 test, t-test, and normality test.


## 3. Results

The results from this research are as follows.


### 3.1. Comparison of General Information

No difference was made in the age, gender, BMI, course of the disease, smoking, drinking, and residence of the patients in both the groups (P>0.05), as given in Table 1.Table 1
Comparison of general information of patients (N (%), (x ± s)).
Experimental group (n = 45)Control group (n = 45)X2 or tPAge (years)0.0860.93246.75 ± 3.3246.69 ± 3.29Gender0.1780.673Male23 (51.11)21 (46.67)Female22 (48.89)24 (53.33)BMI (kg/m2)1.1190.26626.27 ± 1.5925.89 ± 1.63Duration of disease (years)0.3000.7651.12 ± 0.21.13 ± 0.1Smoking0.0450.832Yes20 (44.44)21 (46.67)No25 (55.56)24 (53.33)Drinking0.1780.673Yes22 (48.89)24 (53.33)No23 (51.11)21 (46.67)Residence0.0500.822Urban31 (68.89)30 (66.67)Rural14 (31.11)15 (33.33)


### 3.2. Comparison of Sinus CT Scores

In the experimental group, lower sinus CT scores were seen (P<0.05). It is shown in Figure 1.Figure 1
Comparison of Lund–Mackey sinus CT scores between the two groups (x̄ ±s). Note: the experimental group Lund–Mackey sinus CT scores before and after intervention were (7.14 ± 1.31) and (3.12 ± 0.79), respectively. The control group Lund–Mackey sinus CT scores before and after intervention were (7.21 ± 1.27) and (4.83 ± 1.14), respectively.


### 3.3. Comparison of VAS Scores

VAS scores of the experimental group after the intervention were lower than the control group (P<0.05), as shown in Figure 2.Figure 2
Comparison of VAS scores before and after intervention between the two groups (x ± s). Note: the experimental group’ VAS scores before and after intervention were (8.23 ± 1.03) and (3.14 ± 0.33), respectively. The control group’ VAS scores before and after intervention were (8.11 ± 1.01) and (5.66 ± 0.83), respectively. ∗There was a difference in VAS scores in the experimental group before and after intervention (t = 31.570, P≤0.001). ∗∗Significant difference in VAS scores in the control group before and after intervention (t = 12.572, P≤0.001). ∗∗∗Significant difference in VAS scores between the two groups after intervention (t = 18.926, P≤0.001).


### 3.4. Comparison of Treatment Effects

A higher effective rate was observed in the experimental group as compared to the control group (P<0.05), as shown in Figure 3.Figure 3
Comparison of treatment effects. Note: in the experimental group, the markedly effective rate was 68.89% (31/45), the effective rate was 28.89% (13/45), and the invalid rate was 2.22% (1/45), while the total effective rate was 97.78% (44/45). In the control group, the markedly effective rate was 51.11% (21/45), the effective rate was 35.56% (16/45), and the invalid rate was 17.78% (8/45), with the total effective rate of 82.22% (37/45). There was a significant difference between the two groups after treatment (x2 = 6.049, P=0.014).
(a)(b)


### 3.5. Comparison of SNOT-20 Scores

The experimental group showed significantly lower SNOT-20 scores as compared to the control group (P<0.05), as given in Table 2.Table 2
Comparison of SNOT-20 scores between the two groups (x ± s).
GroupnNasal symptomsRelated symptomsSleep disorderEmotional endingObservation group452.08 ± 0.273.08 ± 0.371.67 ± 0.633.18 ± 0.62Control group454.58 ± 0.575.82 ± 1.613.24 ± 0.695.41 ± 0.82t26.59011.12611.27214.552P≤0.001≤0.001≤0.001≤0.001


### 3.6. Comparison of the Duration of Nasal Mucosal Epithelialization and Nasal Ciliary Transmission Speed

Nasal mucosal epithelialization lasted longer in the control group as compared to the experimental group (P<0.05). The experimental group was dramatically faster than the control group in nasal ciliary transmission, as given in Table 3.Table 3
Comparison of time of nasal mucosal epithelialization and nasal ciliary transmission velocity between the two groups (x ± s).
GroupnNasal mucosal epithelialization time/dNasal ciliary transport velocity (mm/min)Observation group4557.76 ± 10.488.31 ± 0.23Control group4588.13 ± 12.176.07 ± 0.64t12.68522.095P≤0.001≤0.001


### 3.7. Comparison of Relapse Rates

The experimental group presented a lower recurrence rate as compared to the control group (P<0.05), as given in Table 4.Table 4
Comparison of relapse rates between the two groups (n (%)).
Groupn1 month3 months6 monthsTotal recurrence rateExperimental group450 (0.00)0 (0.00)2 (4.44)2 (4.44)Control group452 (4.44)4 (8.89)6 (13.33)12 (26.67)X28.459P0.004


## 3.1. Comparison of General Information

No difference was made in the age, gender, BMI, course of the disease, smoking, drinking, and residence of the patients in both the groups (P>0.05), as given in Table 1.Table 1
Comparison of general information of patients (N (%), (x ± s)).
Experimental group (n = 45)Control group (n = 45)X2 or tPAge (years)0.0860.93246.75 ± 3.3246.69 ± 3.29Gender0.1780.673Male23 (51.11)21 (46.67)Female22 (48.89)24 (53.33)BMI (kg/m2)1.1190.26626.27 ± 1.5925.89 ± 1.63Duration of disease (years)0.3000.7651.12 ± 0.21.13 ± 0.1Smoking0.0450.832Yes20 (44.44)21 (46.67)No25 (55.56)24 (53.33)Drinking0.1780.673Yes22 (48.89)24 (53.33)No23 (51.11)21 (46.67)Residence0.0500.822Urban31 (68.89)30 (66.67)Rural14 (31.11)15 (33.33)


## 3.2. Comparison of Sinus CT Scores

In the experimental group, lower sinus CT scores were seen (P<0.05). It is shown in Figure 1.Figure 1
Comparison of Lund–Mackey sinus CT scores between the two groups (x̄ ±s). Note: the experimental group Lund–Mackey sinus CT scores before and after intervention were (7.14 ± 1.31) and (3.12 ± 0.79), respectively. The control group Lund–Mackey sinus CT scores before and after intervention were (7.21 ± 1.27) and (4.83 ± 1.14), respectively.


## 3.3. Comparison of VAS Scores

VAS scores of the experimental group after the intervention were lower than the control group (P<0.05), as shown in Figure 2.Figure 2
Comparison of VAS scores before and after intervention between the two groups (x ± s). Note: the experimental group’ VAS scores before and after intervention were (8.23 ± 1.03) and (3.14 ± 0.33), respectively. The control group’ VAS scores before and after intervention were (8.11 ± 1.01) and (5.66 ± 0.83), respectively. ∗There was a difference in VAS scores in the experimental group before and after intervention (t = 31.570, P≤0.001). ∗∗Significant difference in VAS scores in the control group before and after intervention (t = 12.572, P≤0.001). ∗∗∗Significant difference in VAS scores between the two groups after intervention (t = 18.926, P≤0.001).


## 3.4. Comparison of Treatment Effects

A higher effective rate was observed in the experimental group as compared to the control group (P<0.05), as shown in Figure 3.Figure 3
Comparison of treatment effects. Note: in the experimental group, the markedly effective rate was 68.89% (31/45), the effective rate was 28.89% (13/45), and the invalid rate was 2.22% (1/45), while the total effective rate was 97.78% (44/45). In the control group, the markedly effective rate was 51.11% (21/45), the effective rate was 35.56% (16/45), and the invalid rate was 17.78% (8/45), with the total effective rate of 82.22% (37/45). There was a significant difference between the two groups after treatment (x2 = 6.049, P=0.014).
(a)(b)


## 3.5. Comparison of SNOT-20 Scores

The experimental group showed significantly lower SNOT-20 scores as compared to the control group (P<0.05), as given in Table 2.Table 2
Comparison of SNOT-20 scores between the two groups (x ± s).
GroupnNasal symptomsRelated symptomsSleep disorderEmotional endingObservation group452.08 ± 0.273.08 ± 0.371.67 ± 0.633.18 ± 0.62Control group454.58 ± 0.575.82 ± 1.613.24 ± 0.695.41 ± 0.82t26.59011.12611.27214.552P≤0.001≤0.001≤0.001≤0.001


## 3.6. Comparison of the Duration of Nasal Mucosal Epithelialization and Nasal Ciliary Transmission Speed

Nasal mucosal epithelialization lasted longer in the control group as compared to the experimental group (P<0.05). The experimental group was dramatically faster than the control group in nasal ciliary transmission, as given in Table 3.Table 3
Comparison of time of nasal mucosal epithelialization and nasal ciliary transmission velocity between the two groups (x ± s).
GroupnNasal mucosal epithelialization time/dNasal ciliary transport velocity (mm/min)Observation group4557.76 ± 10.488.31 ± 0.23Control group4588.13 ± 12.176.07 ± 0.64t12.68522.095P≤0.001≤0.001


## 3.7. Comparison of Relapse Rates

The experimental group presented a lower recurrence rate as compared to the control group (P<0.05), as given in Table 4.Table 4
Comparison of relapse rates between the two groups (n (%)).
Groupn1 month3 months6 monthsTotal recurrence rateExperimental group450 (0.00)0 (0.00)2 (4.44)2 (4.44)Control group452 (4.44)4 (8.89)6 (13.33)12 (26.67)X28.459P0.004


## 4. Discussion

Chronic sinusitis is prompted by the failure of patients with acute sinusitis to receive timely and effective treatment. Nevertheless, its pathogenesis has not been clarified through clinical practice. The main clinical symptoms of chronic sinusitis include headache, nasal obstruction, blurred vision of the eyes, and olfactory dysfunction. Nasal irrigation with normal saline can effectively promote the movement of nasal cilia and increase the cilia transmission speed, thereby improving the nasal mucosal function [9–13]. Patients with chronic sinusitis are prone to symptoms such as mucosal edema, thickening, and epithelial shedding. Relevant studies have proved that nasal irrigation can effectively alleviate nasal mucosal edema and reduce patients’ secretion in the nasal cavity. Biyuan Tongqiao granules, composed of Fructus Xanthii, Herba Ephedrae, Herba Menthae, Radix Salviae Miltiorrhizae, and Radix Rehmanniae, have the effects of dispelling wind (relaxing of tendons), clearing heat (control inflammation reaction), dispersing lung (easy inflow and outflow of air), and dredging orifice (open nasal channel) [14–18]. Fructus Xanthii and Flos Magnoliae contained in Biyuan Tongqiao granules are conducive to dredging orifices and stopping nasal discharge. Herba Menthae, Radix Astragali seu Hedysari, and Rhizoma Atractylodis Macrocephalae are conducive to dispelling pathogenic wind and tonifying the lung. Fructus Forsythiae and Radix Salviae Miltiorrhizae can clear away heat and toxic elements and invigorate the body. According to modern pharmacological research, the Magnolia flower has the effects of antiallergy, analgesia, and detoxification. Magnolia volatile oil has an antihistamine effect, which can shrink blood vessels in the nasal cavity, improve ventilation, and reduce the permeability of capillary blood to relieve edema of the mucosa [19–23]. Fructus Xanthii and Radix Astragali seu Hedysari can stabilize cell membrane, thereby, optimizing the allergic constitution of patients. Rhizoma Atractylodis Macrocephalae can inhibit the inflammatory reaction and effectively improve electrolyte disorder of patients, thereby, relieving nasal mucosal edema. The results of this study showed that the experimental group registered a significantly lower recurrence rate than the control group (P<0.05), which was consistent with the research results of Canotti et al. [24]. The article pointed out that “the recurrence rate of the observation group (5%) was significantly lower than that of the control group (27%) (P<0.05)” proves that Biyuan Tongqiao granule in combination with nasal irrigation with normal saline could effectively drive down the recurrence rate, conducive to improving treatment effects.


## 5. Conclusion

In summary, the research study is about the treatment of chronic sinusitis with Biyuan Tongqiao granules along with saline nasal irrigation. Problems like sinusitis have engulfed maximum population of the world. Routine methods used for this problem are painful, and most of the time, they give birth to other problems. Biyuan Tongqiao granules combined with normal saline nasal cavity irrigation for patients with chronic sinusitis can further enhance the clinical efficacy and improve the CT scores of the patients’ sinuses. It has a high safety and no adverse reactions and is worthy of clinical application and promotion. In future, it will not only help relieve the painful process but also speed up the recovery process.



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*Source: 2916700-2022-03-24.xml*