title: Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient.
abstract: BACKGROUND
  Symptoms of postnasal drainage and thickened mucus are commonly seen in patients with chronic rhinosinusitis (CRS) recalcitrant to sinus surgery and conventional medical therapies. Chemical surfactants can act as a mucolytic by reducing water surface tension and have the potential to serve as an antimicrobial agent. Baby shampoo is an inexpensive, commercially available solution containing multiple chemical surfactants. This is an in vitro study of its antimicrobial effects on Pseudomonas biofilms with translation to a clinical study for use as an adjuvant nasal wash in patients with CRS who remain symptomatic despite adequate sinus surgery and conventional medical therapies.
  
  
  METHODS
  In vitro testing was performed to determine the optimal concentration of baby shampoo that disrupted preformed bacterial biofilms and inhibited biofilm formation. This concentration was then used in a prospective study of symptomatic post-functional endoscopic sinus surgery (FESS) patients who irrigated twice a day for 4 weeks. Validated outcome forms and objective smell testing was performed before and after therapy.
  
  
  RESULTS
  One percent baby shampoo in normal saline was the optimal concentration for inhibition of Pseudomonas biofilm formation. Baby shampoo had no effect on the eradication of preformed Pseudomonas biofilms. Eighteen patients with CRS with an average of 2.8 surgeries were studied after irrigating with 1% baby shampoo solution. Two patients discontinued use because of minor nasal and skin irritations; 46.6% of patients experienced an overall improvement in their subjective symptoms, and 60% of patients noted improvement in specific symptoms of thickened mucus and postnasal drainage.
  
  
  CONCLUSIONS
  Baby shampoo nasal irrigation has promise as an inexpensive, tolerable adjuvant to conventional medical therapies for symptomatic patients after FESS. Its greatest benefit may be in improving symptoms of thickened nasal discharge and postnasal drainage.
authors.affiliation: Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Alexander.chiu@uphs.upenn.edu
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
authors.forename: Laurel
authors.initials: L
authors.lastname: Doghramji
authors.forename: Michael B
authors.initials: MB
authors.lastname: Cohen
authors.forename: Anthony
authors.initials: A
authors.lastname: Prince
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
mesh_terms: D000281:Administration, Intranasal; D018441:Biofilms / Q000187:drug effects*; D002908:Chronic Disease; D015169:Colony Count, Microbial; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000502:physiology; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D012915:Soaps / Q000008:administration & dosage*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D012915:Soaps