Sage Journals: Discover world-class research

Abstract

Sinusitis, one of the most prevalent and undertreated disorders, is a term used to describe inflammation of the paranasal sinuses caused by either infectious or non-infectious sources. Bacterial, viral, or fungal infections can all cause sinusitis. Sinusitis is classified into 3 types: acute, subacute, and chronic. Acute sinusitis lasts for less than 1 month, subacute sinusitis lasts from 1 to 3 months, and chronic sinusitis persists for over 3 months. This condition affects a significant portion of the population, imposing a substantial burden on the healthcare system. Antibiotics are the gold standard of bacterial sinusitis treatment. However, due to the rise of antimicrobial resistance, especially in immune-compromised patients, it is necessary to investigate potential adjunctive therapies. Based on the literature, vitamins (eg, vitamin D) have antioxidant, anti-inflammatory, and immune-modulatory properties and may effectively treat sinusitis and reduce mucous membrane inflammation. Besides vitamins, many other supplements like quercetin, sinupret, and echinacea have immunomodulatory effects and have shown promising results in sinusitis treatment. In this review, we look at the therapeutic role, safety, and efficacy of vitamins and nutritional supplements in sinusitis treatment.

Keywords

Sinusitis upper respiratory tract vitamins nutritional supplements zinc supplements sinupret

Introduction

Sinusitis is the inflammation of the paranasal sinuses and nasal mucosa that leads to nasal discharge, impairment of the sense of smell, and facial pain.¹ Sinusitis accounts for many general physician visits and prescriptions of antibiotics worldwide.² The prevalence of sinusitis varies from 1% to 12%,³ and despite its ubiquity and negative effect on quality of life, its etiology is not well-understood.⁴ However, recent research suggests that many factors, such as infectious agents, structural abnormalities (nasal polyps), inflammatory and allergic processes, and dysfunctions in the host immune system, contribute to this condition.⁴ The main treatment goals include eliminating the underlying infection and reducing inflammation. The primary treatment for sinusitis includes antibiotics, nasal corticosteroids, decongestants, and surgery for refractory cases.^5,6 These current treatments have issues, such as the emergence of antibiotic-resistant bacteria due to excessive antibiotic prescription and surgery complications, especially in children.⁶ Because of these problems, new treatments for sinusitis are needed.⁶

Vitamin supplementation is suggested as an adjunctive therapy for inflammatory conditions, including sinusitis. Recent evidence confirms the anti-inflammatory role of certain vitamins, such as vitamin D or E.^7-9 Besides its beneficial impact on bone health and its role in calcium and phosphate metabolism, vitamin D has an immunological and anti-inflammatory role and affects macrophages, T-cells, and dendritic cells.⁷ Numerous studies have been conducted on ways to reduce or eliminate the symptoms of neurological and behavioral problems brought on by alterations in vitamin and other nutrient levels, including omega-3 and iron supplements.¹⁰ Evidence has shown that patients with sinusitis have lower vitamin D levels, and vitamin D supplementation alleviates their symptoms.^7,11 Vitamin E is a potent antioxidant that regulates reactive oxygen species formation and modulates cell-mediated and humoral immune responses.¹² The goal of this review is to highlight the possible therapeutic effects of vitamins and other supplements on sinusitis.

Vitamin A

Vitamin A, also known as retinol, is a fat-soluble vitamin found in various foods such as meat,¹³ fish,¹⁴ and vegetables (provitamin A in form of certain carotenoids).¹⁵ Its presence is crucial for the efficient functioning of organs such as the lungs, kidneys, and heart.⁹

In a study by Unal et al,¹⁶ no significant differences were found between the study group and the control group in terms of the impact of vitamin A on sinus inflammation. However, in a study conducted by Dhanawat,¹⁷ it was reported that there was a significant effect on improving general health and reducing sinus inflammation in individuals with sinusitis when vitamin A was used in conjunction with vitamin E and vitamin C. Linday et al⁶ used multivitamin-mineral and flavored cod liver oil with selenium for children with sinusitis. A suggestion was made that the use of this product can prevent sinusitis in children or at least reduce its severity.⁶

Vitamin C

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that plays a crucial role in immune system regulation and the prevention of viral infections. Tomatoes, potatoes, citrus fruits such as limes, lemons, and oranges,^18,19 broccoli,^20,21 and kiwi^22,23 are some of the known sources containing a high amount of this compound. Vitamin C content in fruit is related to some variables such as fruit color, size, and firmness^19,24; cultivar^24,25; technological treatment^21,23; and harvest date.²⁶ Researchers reported that vitamin C suppresses the secretion of inflammatory mediators.^27,28

The effectiveness of mucociliary clearance and hydration of the mucosal surface depends on epithelial ion transport. Cystic fibrosis transmembrane conductance regulator (CFTR) would be considered a chloride and bicarbonate channel. Vitamin C plays an important role in maintaining the normal level of airway surface liquid, thus improving the effectiveness of mucociliary clearance. Furthermore, researchers have observed that vitamin C can biologically affect CFTR-mediated chloride secretion.^29-31

Considering the possible role of CFTR in chronic rhinosinusitis (CRS), Cho et al³¹ experienced the effect of L-ascorbate on a distinct type of sinonasal tissues that comprised sinus mucosa from CRS, nasal mucosa from CRS, normal sinus mucosa, and normal nasal mucosa. They declared that the administration of L-ascorbate improves chloride secretion. The reduced function of CFTR-mediated chloride secretion might play a role in the progression of CRS, leading researchers to conclude that vitamin C could have a therapeutic effect by enhancing mucociliary clearance. In another ex vivo study, Zhang et al³² assessed nasal mucus derived from 12 patients. They showed that the combination of scutellaria baicalensis, eleutherococcus senticosus, and vitamin C might suppress Th-1, Th-2, and Th-17 involved in chronic paranasal disease. Given that these cells play an essential role in the acute inflammation of CRS, suppressing them might be effective.

Unal et al¹⁶ studied serum levels of antioxidant vitamins in 24 children who suffered from CRS. This case-control study showed that the group of patients had lower levels of vitamin C and vitamin Prabhakar Reddy et al³³ assessed serum levels of vitamin C in CRS. The study results showed that the patient group had a lower level of vitamin C than the control group. Besides, the study reported that vitamin C decreased inflammation and allergic responses.

Vitamin D

Vitamin D is known for its effects on calcium metabolism. However, recent studies suggest that this molecule plays an important role in the immune system. So it may have a role in host immunity against CRS.³⁴ Konstantinidis et al,³⁵ in an experiment on the human sinonasal epithelium of patients with eosinophilic CRS, suggest that vitamin D supplementation in eosinophilic CRS patients is effective for innate immunity regulation. Mulligan et al³⁶ examined the impact of vitamin D deficiencies on inflammation in a mouse model of CRS involving aspergillus fumigatus. They found out that a low level of vitamin D in the diet selectively intensifies immunological alterations related to CRS with aspergillus fumigatus. Mostafa Bel et al,⁷ in 74 participants, determined the level of vitamin D in patients with allergic fungal sinusitis (AFRS) and CRS and found that the level of vitamin D in patients with CRS with nasal polyps and AFRS is incredibly lower than that in those with CRS without nasal polyps and healthy controls. Many other studies have confirmed that the levels of vitamin D are lower in patients with CRS with nasal polyps.^37-42 Sansoni et al ⁴³ conducted a clinical trial of 14 CRS patients with polyps and 31 CRS patients without polyps, as well as 12 control patients with noninflammatory pathology. Their blood was assayed for vitamin D and their sinonasal mucus for RANTES and basic fibroblast growth factor (bFGF). Only in CRS patients with polyps a negative correlation was observed between vitamin D status and RANTES and bFGF. They found that vitamin D might be crucial in regulating RANTES and basic fibroblast growth factor expression in CRS. The research by Wang et al⁴⁴ used cultivated fibroblasts from 3 patients’ nasal polyps. RANTES and eotaxin were produced in vitro by the cells after being activated with IL-1. Vitamin D derivatives calcitriol and tacalcitrol, which were also given to cultures, blocked this effect.

Tomaszewska et al⁴⁵ measured levels of vitamin D in serum and the expression of vitamin D receptors in 52 patients with CRS without nasal polyps and 55 patients with CRS with nasal polyps and then showed that vitamin D and the expression of its receptors may be associated with CRS. Bavi et al,⁴⁶ in another study with 166 patients with CRS with nasal polyps and 172 healthy subjects, noticed a considerable decrease in vitamin D levels in Iranian CRS patients with nasal polyps, which shows a positive relevance to disease intensity. Boeva et al,⁴⁷ in a study with 50 patients and 14 subjects comprising the control group, revealed higher levels of vitamin D in the blood serum of the control subjects compared to the patients with chronic polypous rhinosinusitis. Moreover, the patients of the latter group more frequently exhibited the variant of the LCT CT-13910 gene polymorphism, suggesting latent hypolactasia. In contrast, the subjects comprising the control group more frequently had the variant of the LCT CT-13910 gene polymorphism indicative of the normal tolerance of lactose. Duţu et al,⁴⁸ in a study with 6 CRS patients and 21 non-smoking controls, showed that both chitotriosidase and vitamin D could be considered non-invasive biomarkers whose utility in the follow-up of CRS-associated inflammation requires further investigation. Patients with polyps exhibited lower vitamin D values than those without polyps, while patients with microbial biofilms had higher mean values of chitotriosidase and a lower mean value of vitamin D than their counterparts. This finding may reveal the importance of microbial biofilms as an aggravating factor in disease pathogenesis. Hashemian et al,⁴⁹ in a study with 40 CRS patients with nasal polyps, demonstrated vitamin D supplementation’s efficacy in reducing the recurrence of polyposis after functional endoscopic sinus surgery in patients with CRS with nasal polyps. Kalińczak-Górna et al,¹¹ in a study of 40 patients suffering from chronic sinusitis, discovered a relationship between a decrease in inflammation and increased vitamin D levels and reduced mental and physical symptoms of chronic inflammation. Konstantinidis et al³⁵ showed that both CRS and CF patients have vitamin D deficiency and nasal polyps. The lower the serum vitamin D level, the more severe the mucosal disease was observed. Lee et al⁵⁰ indicated that low serum vitamin D levels may not significantly correlate with an elevated CRS frequency in Korean adults. However, CRS patients had higher serum vitamin D levels than the control group. In a meta-analysis by Li et al,⁵¹ low vitamin D levels in patients with CRS were observed, suggesting that vitamin D supplements can benefit individuals. Therefore, because of the heterogeneity of the studies, better-designed futuristic RCTs should be performed to further evaluate these findings for the common population in the future. Moreover, Baruah et al,⁵² in a study with 200 CRS patients with vitamin D deficiency and 100 patients that were given oral vitamin D supplements, found that 100 patients on placebo did not have vitamin D deficiency, and there were practically no differences in outcomes for both groups of patients.

Vitamin E

Vitamin E is one of the lipid-soluble vitamins, which comprises 4 isoforms of tocopherol and 4 isoforms of tocotrienol.⁵³ This vitamin can be found in many sources, some of which are: fruits, peanut oil, corn oil,⁵⁴ extra virgin olive oil, pomace olive oil, soybean oil, palm oil,⁵⁵ apricot seed oil, hemp seed oil, flaxseed oil, and sunflower oil.⁵⁶ Vitamin E, as an antioxidant, plays a role in cell membranes and blocks the propagation of free radical reactions.⁵⁷ Vitamin E isomers are well-known for their gene-regulation effects and anti-inflammatory properties.⁵⁸ Unal et al,¹⁶ in a study on 24 children aged 7 to 12 years with CRS and 20 healthy controls, measured serum levels of copper, magnesium, antioxidant vitamins, and zinc. They found that the serum level of vitamin E is lower in CRS patients. However, Westerveld et al⁵⁹ measured antioxidant levels in a mucosal biopsy of the uncinate process of the ethmoid bone in patients with CRS and healthy controls. There was no difference in levels of vitamin E between the 2 groups.

Other Nutritional Supplements

Echinacea

Echinacea is a dietary supplement for the common cold and other infections; the idea is that it could stimulate the immune system to act more effectively against infections.⁶⁰ Echinacea, prepared from the root of echinacea purpurea, is sometimes also derived from echinacea pallida and echinacea angustifolia.⁶¹

Ogal et al⁶⁰ and Vimalanathan et al⁶¹ showed that using echinacea in children from 3 to 12 years old can be helpful for the prevention of RTI and secondary complications such as sinusitis, bronchitis, and pneumonia. The outcome indicated significant differences between the study and control groups in the intensity of sinusitis in the studied patients.

N-acetylcysteine

N-acetyl cysteine is a tolerable and safe dietary supplement.⁶² It is the precursor to L-cysteine, an amino acid that is used to form glutathione molecules.⁶³ N-acetyl cysteine is the antidote to acetaminophen toxicity and a mucolytic agent.⁶⁴ Furthermore, it protects endothelial and mucus cells from free radicals by its sulfhydryl group and increases glutathione levels.⁶³ Evidence has shown that N-acetyl cysteine inhibits bacterial aggregate formation (biofilms), which are involved in many infections, such as bacterial sinusitis.⁶⁵

Several studies have shown the positive impacts of N-acetyl cysteine on sinusitis treatment due to its antioxidant and antimicrobial effects.^63,65,66 Bezshapochniy et al⁶³ examined the positive effect of N-acetyl cysteine on treating viral sinusitis. They combined 6% N-acetyl cysteine with 3% normal saline and added it to the usual sinusitis treatment (topical corticosteroids). In this study, 56 participants (29 patients in the experimental group and 27 patients in the control group) received classical sinusitis treatment with either 3% normal saline or 3% normal saline plus 6% N-acetyl cysteine. In this research, the combination of N-acetyl cysteine and normal saline improved patients’ symptoms with viral sinusitis. Another study investigated the role of N-acetyl cysteine in bacterial biofilms and its possible benefits in treating bacterial sinusitis. Blasi et al⁶⁵ reviewed both in vitro and clinical studies. They showed that N-acetyl cysteine inhibits the formation of biofilms and may have some therapeutic effect on sinusitis.

Sinupret

Sinupret is a well-known herbal medicine with evidence-based efficacy for several respiratory disorders, such as sinusitis or acute and chronic bronchitis.^67,68 Primula veris, verbena officinalis, sambucus nigra, gentiana lutea, and rumex acetosa are among the plants used to make Sinupret.⁶⁹ Since 1934, this herbal preparation has been used to repair and maintain the physiological activity of the mucosa in the paranasal sinuses in both liquid and sugar-coated tablet form.^69,70 Antibacterial, antiviral, secretolytic, mucolytic, and immunological activities are all found in sinupret extract.^67,69,71,72 It reduces cyclo-oxygenase-rhino2 expression and prostaglandin E-2 synthesis, resulting in strong anti-inflammatory effects when taken orally.⁷³ Sinupret’s general safety has been thoroughly documented.⁶⁹ In some related studies, Zhang et al⁶⁸ observed that sinupret raises airway surface liquid depth, enhances ciliary beat frequency, and promotes transepithelial chloride secretion, which is expected to improve mucociliary clearance. Sinupret, according to their findings, could be employed as a new therapeutic strategy for common respiratory disorders, including sinusitis.

Quercetin

Quercetin (3,3′,4′,5,7-pentahydroxyflavone) is a kind of flavonoid compound. It is derived from phenylalanine and produced through the phenylpropanoid pathway. Quercetin can be found in a variety of sources, including different kinds of berries,⁷⁴ tomatoes,⁷⁵ vegetables, fruits, nuts, and beverages,⁷⁶ onions,⁷⁷ apples, capers, grapes, and tea,⁷⁸ shallots,⁷⁹ and honey.^80,81 Researchers studied whether it might have a role in improving mental and physical function and reducing infection risk.⁸²

Since medical plants have lower prices and fewer side effects, they are more popular.⁸³ Some studies have mentioned that some plants decrease inflammatory factors and have an inhibitory effect on a transcription factor that enhances the secretion of mediators.⁸² Studies have found that quercetin inhibits lipid peroxidation, platelet aggregation, and capillary permeability.⁸⁴ Additionally, a new review published in 2020 by Jafarinia et al⁸⁵ showed some anti-inflammatory effects of quercetin. Zhang et al⁸⁶ investigated the effect of quercetin on chloride secretion and ciliary bite frequency. Their results indicated that quercetin can increase chloride secretion and ciliary beat frequency.

Zinc supplements

Zinc is necessary for cells to develop and function properly by mediating nonspecific immunity, including neutrophils and natural killer cells.⁸⁷ The availability and importance of zinc in diseases and its essential presence in biological fluids should not be ignored.⁸⁸

A study by Mohammadhossein et al,⁸⁹ which used 50 patients with nasal polyposis, suggested that there is no significant difference in sinusitis, but there are signs showing zinc may be useful in the prevention of sinusitis. However, with that being said, in the study by Akbari Dilmaghani et al⁹⁰ it is reported that the treatment group had mild superiority in general health improvement but not in symptoms. Add-on therapy with zinc sulfate supplementation showed no remarkable improvement in patients suffering from CRS and nasal polyposis.

Conclusion

Multiple therapies are required to treat sinusitis patients, including nutritional interventions. In this review, we discussed the possible therapeutic effects of vitamins and a wide range of nutrition on sinusitis. We indicated their pathogenetic role in sinusitis. As shown in Table 1 and Figure 1, vitamin C, vitamin D, echinacea, N-acetyl cysteine, sinupret, and quercetin have shown promise in the treatment of sinusitis based on growing positive evidence. The effects of vitamins and nutritional supplements on sinusitis need further evaluation due to a lack of sufficient evidence. Clinicians are encouraged to consider these useful supplements in sinusitis management whenever possible. By complementing these add-on therapies, additional antimicrobial resistance is avoided, and the final treatment outcome might be improved. However, studies on the efficacy of many of these supplements are insufficient, and more research, especially clinical trials with large study samples, is required to assess their effectiveness and potential side effects.

Table 1.

Therapeutic effects of vitamins and other nutritional supplements on sinusitis.

Author	Type of study	Intervention or measured compound		Participants	Outcome
Ünal et al⁹¹	Animal study	Intervention	Vitamin A	20 animals	There was no difference between the study and control groups’ sinus inflammation changes.
Fang et al⁹²	Within-subject control study	Intervention	Vitamin A	30 patients	Antrostomy stenosis prevention, mucociliary promotion, and adhesion reduction are achieved by topical vitamin A.
Guven et al⁹³	Prospective controlled animal trial	Intervention	Vitamin A	20 New Zealand hybrid rabbits	There is no significant statistical difference between the control and study groups.
Unal et al¹⁶	Case-control	Measured	Vitamin A, vitamin E, vitamin C, zinc, and copper	24 patients between 7 and 12 y	In the patients’ group, the levels of vitamin E, vitamin C, copper (Cu), and zinc (Zn) were found to be significantly lower compared to the control group. However, no significant difference was observed in the levels of vitamin A and magnesium (Mg) between the 2 groups.
Tomiki⁹⁴	Case-control	Intervention	Vitamin A and vitamin D	265 school children	Vitamin A was ineffective in the treatment but useful in preventing CRS in children.
Dhanawat¹⁷	Clinical trial	Intervention	Prabhakar Reddy et al	53 patients with allergic rhinitis	Vitamins A, E, and C’s role (antioxidant, anti-inflammatory) in the treatment of allergic rhinitis was significant.
Prabhakar Reddy et al³³	Case-control	Measured	Vitamin C	40 cases and 40 controls	A lower vitamin C level in the cases was observed.
Ogal et al⁶⁰	Randomized clinical trial	Intervention	Vitamin C and Echinacea	94 Children (intervention group) and 93 children (control group)	Echinacea prevents RTI better than vitamin C.
Zhang et al³²	In vitro	Intervention	Combination of Vitamin C with Scutellaria baicalensis And Eleutherococcus senticosus	Nasal mucosal tissue of 12 patients	Suppression of Th-1, Th-2, and Th-17.
Baruah et al⁵²	Cross-sectional	Intervention	Vitamin D	100 CRS patients were given oral Vitamin D, and 100 CRS patients were treated with placebo	At baseline, the pretreatment TNSS exhibited an average score of 11.92. Following a duration of 3 mo, the scores experienced a notable reduction with an average decrease of 10.65 points, demonstrating a statistically significant difference.
Bavi et al⁴⁶	Cross-sectional	Measured	Vitamin D	166 CRS patients with nasal polyps and 172 healthy subjects	Decreased vitamin D levels in Iranian patients with CRS with nasal polyps, with an association to disease intensity
Boeva et al⁴⁷	Cross-sectional	Measured	Vitamin D	50 patients with sinusitis and 14 healthy subjects	Higher levels of vitamin D in the control subjects compared to patients with chronic polypous rhinosinusitis.
Duţu et al⁴⁸	Cross-sectional	Measured	Vitamin D	6 CRS patients and 21 non-smoking controls	Reducing inflammation increases vitamin D levels.
Elbistanlı et al⁹⁵	Prospective case-control	Measured	Vitamin D	Group 1 consisted of fifteen pediatric patients with ARS-induced preseptal cellulitis complication, Group 2 consisted of fifteen ARS patients without complication, and Group 3 consisted of fifteen healthy volunteers. At the first admission of research participants, serum vitamin D levels (nmol/l) were assessed in addition to regular blood testing.	There was a statistically significant difference according to the existence of ARS (Group-1 and Group 2) and absence of ARS (Group-3) based on categorization in which vitamin D levels were compared with normal values (p 0.05). Between Group 1 and Group 3, a statistically significant difference was also discovered.
Faghih Habibi et al⁹⁶	Cross-sectional controlled study	Measured	Vitamin D	32 CRS patients with nasal polyps, 35 CRS patients without nasal polyps, and 50 healthy controls	The serum level of Vitamin D was considerably lower in CRS patients compared with the other group.
Hashemian et al⁴⁹	Cross-sectional	Intervention	Vitamin D	40 patients with CRS with nasal polyposis	Vitamin D efficiently reduced the recurrence of polyposis after FESS in CRS patients with nasal polyps.
Kalińczak-Górna et al¹¹	Cross-sectional	Measured	Vitamin D	40 CRS patients	Reducing inflammation increases vitamin D levels.
Konstantinidis et al³⁵	Cross-sectional	Measured	Vitamin D	27 CF patients with nasal polyps, 31 CF patients without nasal polyps, 32 CRS patients with nasal polyps, 30 patients without nasal polyps, and 32 healthy controls	Vitamin D deficiency with nasal polyps appears similar in those with CRS and CF. The lower the serum vitamin D level, the more severe the mucosal disease.
Mostafa Bel et al⁷	Case-control	Measured	Vitamin D	25 patients with allergic fungal rhinosinusitis, 15 CRS patients with nasal polyps, 15 CRS patients without nasal polyps, and 19 healthy controls	Vitamin D levels in CRS patients with nasal polyps and AFRS were meaningfully lower than those in CRS patients without nasal polyps.
Schlosser et al³⁷	Case-control	Measured	Vitamin D	Blood and sinus tissue	CRS Patients with nasal polyps and AFRS patients both have decreased sinonasal vitamin D.
Shanaki et al⁴⁰	Case-control	Measured	Vitamin D	45 CRS patients with nasal polyps and 45 controls	CRS patients with nasal polyps have lower levels of vitamin D in their serum compared to controls.
Zand et al⁴¹	Case-control	Measured	Vitamin D	93 CRS patients with nasal polyps	An association between vitamin D levels and disease intensities in CRS patients with nasal polyps.
Tomaszewska et al⁴⁵	Case-control	Measured	Vitamin D	52 CRS patients without nasal polyps, 55 CRS patients with nasal polyps, and 59 controls	Vitamin D and its receptor expression may be associated with CRS.
Thakur and Potluri⁴²	Case-control	Measured	Vitamin D	30 CRS patients without nasal polyps, 30 CRS patients with nasal polyps, and 31 controls	Vitamin D was a predictive factor for the Occurrence of CRS.
Ma et al⁹⁷	Clinical trial	Measured	Vitamin D	Human sinonasal epithelium of fifteen patients with eosinophilic CRS and healthy controls	Topical vitamin D in CRS patients was beneficial for the innate immune system.
Mulligan et al³⁶	Clinical trial	Intervention	Vitamin D	Female mice (8 wk old)	Loss of vitamin D in the diet intensified immunological changes related to Aspergillus fumigatus-CRS.
Sansoni et al⁴³	Clinical trial	Measured	Vitamin D	57 patients in groups of CRS with and without nasal polyposis	Vitamin D may have a role in the regulation of the immune system.
Westerveld⁵⁹	Cross-sectional	Measured	Vitamin E	Mucosa samples of 9 patients with CRS and 10 healthy persons	There was no difference in levels of vitamin E between patients and the healthy group.
Ishrefova et al⁹⁸	Cohort	Intervention	Echinacea	A number of children in the time 2008 to 2014	Using Echinacea lowers the rate of complications of RTI such as sinusitis, bronchitis, and adenoiditis.
Popov et al⁶⁶	Clinical trial	Intervention	N-acetyl cysteine	48 patients in the intervention group 50 patients in the control group	N-acetyl cysteine alleviated the symptoms, decreased relapses, and increased the efficacy of surgery among the study group.
Bezshapochniy et al⁶³	Clinical trial	Intervention	N-acetyl cysteine	29 patients in the intervention group 27 patients in the control group	Saline and N-acetyl cysteine solutions alleviated the symptoms.
Perić et al⁹⁹	Randomized comparative study	Intervention	Sinupret	20 CRS patients without nasal polyps and 20 patients who used fluticasone spray	Sinupret may be a safe and effective alternative to intranasal corticosteroids for the treatment of CRS patients without nasal polyps.
Sen’kevich et al¹⁰⁰	Randomized prospective comparative clinical study	Intervention	Sinupret	107 children aged 4 to 5 y with ARS	The use of Sinupret in the treatment of children with acute rhinosinusitis (ARS) caused by a viral etiology is associated with a more pronounced favorable outcome.
Vishnyakov and Sinkov¹⁰¹	Cohort	Intervention	Sinupret	25 patients and 25 control group	Overall satisfaction with the treatment was higher in the herbal medication group compared to the antibiotic drug control group.
Popovych et al¹⁰²	Randomized comparative study	Intervention	Sinupret	292 children aged 6 to 11 y with ARS	Sinupret was beneficial for ARS in both adults and children.
Passali et al⁶⁹	Prospective open-label Study	Intervention	Sinupret	30 patients with ARS were treated with sinupret, and 30 patients used fluticasone	Symptoms improved significantly in all of the patients using sinupret.
Neubauer and März⁷⁰	Clinical trial	Intervention	Sinupret	160 patients with acute bacterial sinusitis	Sinupret improved sinusitis symptoms.
Palm et al⁶⁷	Clinical trial	Intervention	Sinupret	929 patients with CRS	Sinupret extract was found to be effective in treating CRS patients.
Jund et al¹⁰³	Clinical trial	Intervention	Sinupret	589 patients with acute viral rhinosinusitis	Sinupret is an effective and safe herbal drug for viral sinusitis therapy.
Mohammadhossein et al⁸⁹	Case-control	Intervention	Zinc supplements	50 participants with nasal polyposis and 50 participants as the control group	The serum level of zinc was low in patients suffering from nasal polyposis.
Akbari Dilmaghani et al⁹⁰	Randomized clinical trial	Intervention	Zinc supplements	44 participants	Using zinc supplements offers several advantages for improving general health.

Abbreviation: AFRS, allergic fungal rhinosinusitis; ARS, acute rhinosinusitis; CF, cystic fibrosis; CI, chloride; CRS, chronic rhinosinusitis; FESS, functional endoscopic sinus surgery; RTI, respiratory tract infection; TNSS, total nasal symptom score.

Figure 1.

A review of therapeutic effects of vitamins and various nutrition on sinusitis. Vitamins and nutritional supplements can reduce sinusitis symptoms.

Footnotes

Author Contributions

Conceived and designed the analysis: Mohammad Ghaheri, Narjes Sadat Farizani Gohari and Dorsa Abolhasani. Collected data: Sadaf Parvin, Mohammad Mahdi Ghodrati and Shekoufeh Mohammadpour. Contributed data or analysis tools: Erfan Kazemi, Fatemeh Mohammadyari and Armin Alinezhad. Performed the analysis: Farhad Nikzad, Shahin Sabbaghi and Sara Saeedpour. Designed the study: Mohadeseh Poudineh, Sepehr Olangian-Tehrani and Farbod Heydarasadi. Wrote the paper: Mohadeseh Poudineh, Farhad Nikzad, Sadaf Parvin, Mohammad Ghaheri, Shahin Sabbaghi, Erfan Kazemi, Mohammad Mahdi Ghodrati, Fatemeh Mohammadyari, Sara Saeedpour, Shekoufeh Mohammadpour, Narjes Sadat Farizani Gohari, Farbod Heydarasadi, Dorsa Abolhasani, Sepehr Olangian-Tehrani and Armin Alinezhad. All authors reviewed the results and approved the final version of the manuscript.

Declaration Of Conflicting Interests:

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding:

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Stokes

Rimmer

The relationship between serum vitamin D and chronic rhinosinusitis: a systematic review. Am J Rhinol Allergy. 2016;30:23-28.

Battisti

Modi

Pangia

Sinusitis. StatPearls Publishing LLC; 2021.

Quan

Faris

, et al Prevalence and incidence of diagnosed chronic rhinosinusitis in Alberta, Canada. Otolaryngol Head Neck Surg. 2016;142:1063-1069.

Philpott

Erskine

Hopkins

, et al Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study. Respir Res. 2018;19:129.

Schilling

Carcella

Moore

, et al Compatibility of a thermoresponsive and controlled release system for promoting sinonasal cilia regeneration. Macromol Biosci. 2021;21:2100277.

Linday

Dolitsky

Shindledecker

RD.

Nutritional supplements as adjunctive therapy for children with chronic/recurrent sinusitis: pilot research. Int J Pediatr Otorhinolaryngol. 2004;68:785-793.

Mostafa Bel

Taha

Abdel Hamid

Omran

Lotfi

Evaluation of vitamin D levels in allergic fungal sinusitis, chronic rhinosinusitis, and chronic rhinosinusitis with polyposis. Int Forum Allergy Rhinol. 2016;6:185-190.

Bishop

Ismailova

Dimeloe

Hewison

White

JH.

Vitamin D and immune regulation: antibacterial, antiviral, anti-inflammatory. JBMR Plus. 2021;5:e10405.

Reifen

Vitamin A as an anti-inflammatory agent. Proc Nutr Soc. 2002;61:397-400.

10.

Olangian-Tehrani

Poudineh

Parvin

, et al The effects of vitamin therapy on ASD and ADHD: a narrative review. CNS Neurol Disord Drug Targets. 2023;22:711-735.

11.

Kalińczak-Górna

Radajewski

Burduk

Relationship between the severity of inflammatory changes in chronic sinusitis and the level of vitamin D before and after the FESS procedure. J Clin Med. 2021;10:2836.

12.

Lee

Han

SN.

The role of vitamin E in immunity. Nutrients. 2018;10:1614.

13.

Carazo

Macáková

Matoušová

, et al Vitamin A update: forms, sources, kinetics, detection, function, deficiency, therapeutic use and toxicity. Nutrients. 2021;13:1703.

14.

Schwartz

Wang

Chavis

Kuriyan

Abariga

SA.

Vitamin A and fish oils for preventing the progression of retinitis pigmentosa. Cochrane Database Syst Rev. 2020;6:Cd008428.

15.

Debelo

Novotny

Ferruzzi

MG.

Vitamin A. Adv Nutr. 2017;8:992-994.

16.

Unal

Tamer

Pata

, et al Serum levels of antioxidant vitamins, copper, zinc and magnesium in children with chronic rhinosinusitis. J Trace Elem Med Biol. 2004;18:189-192.

17.

Dhanawat

GS.

Rhinitis, sinusitis and ocular disease – 2100. New approach to treat allergic rhinitis with vitamin E, cod liver oil and vitamin C with use of nasal steroidal spray. World Allergy Organ J. 2013;6:175-175.

18.

Valdés

Vitamina C. Actas Dermosifiliogr. 2006;97:557-568.

19.

Giuffrè

Nobile

Citrus bergamia, Risso: the peel, the juice and the seed oil of the bergamot fruit of Reggio Calabria (South Italy). Emirates J Food Agric. 2020;32:522-532.

20.

Kathi

Laza

Singh

, et al Vitamin C biofortification of broccoli microgreens and resulting effects on nutrient composition. Front Plant Sci. 2023;14:1145992.

21.

Meng

Malik

Zhang

Wang

Maintaining the quality of postharvest broccoli by inhibiting ethylene accumulation using diacetyl. Front Nutr. 2022;9:1055651.

22.

Kumar

Sen

The role of vitamin C: from prevention of pneumonia to treatment of covid-19. Mater Today Proc. Published online November 18, 2022. doi:10.1016/j.matpr.2022.11.213

23.

Bhat

Hussain

Wani

, et al The impact of different drying methods on antioxidant activity, polyphenols, vitamin C and rehydration characteristics of Kiwifruit. Food Biosci. 2022;48:101821.

24.

Ali

Serçe

Vitamin C and fruit quality consensus in breeding elite European strawberry under multiple interactions of environment. Mol Biol Rep. 2022;49:11573-11586.

25.

Giuffrè

AM.

Bergamot (Citrus bergamia, Risso): the effects of cultivar and harvest date on functional properties of juice and Cloudy Juice. Antioxidants. 2019;8:221.

26.

Dobón-Suárez

Giménez

Castillo

García-Pastor

Zapata

PJ.

Influence of the phenological stage and harvest date on the bioactive compounds content of green pepper fruit. Molecules. 2021;26:3099.

27.

Ruiz-Valdepeñas Montiel

Sempionatto

Vargas

, et al Decentralized vitamin C & D dual biosensor chip: toward personalized immune system support. Biosens Bioelectron. 2021;194:113590.

28.

Khan

Hussain

Samad

Cure and prevention of diseases with vitamin C into perspective: an overview. J Crit Rev. 2020;7:289-293.

29.

Fischer

Schwarzer

Illek

Vitamin C controls the cystic fibrosis transmembrane conductance regulator chloride channel. Proc Natl Acad Sci. 2004;101:3691-3696.

30.

Fischer

Illek

Vitamin C and flavonoids potentiate CFTR CL transport in human airway epithelia. In: Schultz

, ed. Defects of Secretion in Cystic Fibrosis. Springer; 2005;129-144.

31.

Cho

Hwang

Illek

Effect of L-ascorbate on chloride transport in freshly excised sinonasal epithelia. Am J Rhinol Allergy. 2009;23:294-299.

32.

Zhang

Van Crombruggen

Holtappels

Bachert

A herbal composition of Scutellaria baicalensis and Eleutherococcus senticosus shows potent anti-inflammatory effects in an ex vivo human mucosal tissue model. Evid Based Complement Alternat Med. 2012;2012:673145-673149.

33.

Prabhakar Reddy

Muthukumaraswamy

Venkataramanan

Sai Ravi Kiran

Mohanalakshmi

. Evaluation of thyroid profile and oxidative stress and antioxidants parameters in chronic sinusitis. Int J Pharm Sci Res. 2017;8:455-458.

34.

Shahangian

Schlosser

RJ.

Role of vitamin D in pathogenesis of chronic sinusitis with nasal polyposis. Adv Otorhinolaryngol. 2016;79:86-90.

35.

Konstantinidis

Fotoulaki

Iakovou

, et al Vitamin D₃ deficiency and its association with nasal polyposis in patients with cystic fibrosis and patients with chronic rhinosinusitis. Am J Rhinol Allergy. 2017;31:395-400.

36.

Mulligan

Pasquini

Carroll

, et al Dietary vitamin D3 deficiency exacerbates sinonasal inflammation and alters local 25(OH)D3 metabolism. PLoS One. 2017;12:e0186374.

37.

Schlosser

Carroll

Soler

Pasquini

Mulligan

JK.

Reduced sinonasal levels of 1α-hydroxylase are associated with worse quality of life in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol. 2016;6:58-65.

38.

Wang

Lee

Chien

, et al Serum 25-hydroxyvitamin D levels are lower in chronic rhinosinusitis with nasal polyposis and are correlated with disease severity in Taiwanese patients. Am J Rhinol Allergy. 2013;27:e162-e165.

39.

Schlosser

Soler

Schmedes

Storck

Mulligan

JK.

Impact of vitamin D deficiency upon clinical presentation in nasal polyposis. Int Forum Allergy Rhinol. 2014;4:196-199.

40.

Shanaki

Doulabi

SRM

Dilmaghani

Circulatory levels of 25-OHD and vitamin D binding protein in patients with chronic rhinosinusitis with polyposis: A case-control study. Biomed Res. 2017;28:4625-4629.

41.

Zand

Baradaranfar

Vaziribozorg

, et al Correlation of serum vitamin D levels with chronic rhinosinusitis disease severity. Iran J Otorhinolaryngol. 2020;32:35-41.

42.

Thakur

Potluri

Association of serum vitamin D with chronic rhinosinusitis in adults residing at high altitudes. Eur Arch Otorhinolaryngol. 2021;278:1067-1074.

43.

Sansoni

Sautter

Mace

, et al Vitamin D3 as a novel regulator of basic fibroblast growth factor in chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol. 2015;5:191-196.

44.

Wang

Chien

Tai

Chiang

Chen

JY.

Vitamin D decreases the secretion of eotaxin and RANTES in nasal polyp fibroblasts derived from Taiwanese patients with chronic rhinosinusitis with nasal polyps. Kaohsiung J Med Sci. 2015;31:63-69.

45.

Tomaszewska

Sarnowska

Rusetska

, et al Role of vitamin D and its receptors in the pathophysiology of chronic rhinosinusitis. J Am Coll Nutr. 2019;38:108-118.

46.

Bavi

Movahed

Salehi

Hossaini

Bakhshaee

Chronic rhinosinusitis with polyposis and serum vitamin D levels. Acta Otorhinolaryngol Ital. 2019;39:336-340.

47.

Boeva

Kokorina

Archba

Dvoryanchikov

Kolhyubaeva

SN.

[The influence of the vitamin D3 level in the blood serum of lactase gene polymorphism on the development of chronic polypous rhinosinusitis]. Vestn Otorinolaringol. 2018;83:49-54.

48.

Duţu

Vlad

Drugan

, et al Biochemical markers of inflammatory syndrome in chronic rhinosinusitis. Rom Biotechnol Lett. 2020;25:1456-1464.

49.

Hashemian

Sadegh

Jahanshahi

Seif Rabiei

Hashemian

Effects of vitamin D supplementation on recurrence of nasal polyposis after endoscopic sinus Surgery. Iran J Otorhinolaryngol. 2020;32:21-28.

50.

Lee

Hwang

Kim

KS.

Lack of correlation between serum 25(OH)D level and endoscopy-based chronic rhinosinusitis in Korean adults. Rhinology. 2019;57:139-146.

51.

Wang

Zhou

Wen

Zou

Association between serum vitamin D and chronic rhinosinusitis: a meta-analysis. Braz J Otorhinolaryngol. 2021;87:178-187.

52.

Baruah

Gupta

Kumar

The role of oral vitamin D3 supplementation in the treatment of chronic rhinosinusitis in adults with vitamin D deficiency. J Fam Med Prim Care. 2020;9:2877-2879.

53.

Abraham

Kattoor

Saldeen

Mehta

JL.

Vitamin E and its anticancer effects. Crit Rev Food Sci Nutr. 2019;59:2831-2838.

54.

Shahidi

Pinaffi-Langley

ACC

Fuentes

Speisky

de Camargo

AC.

Vitamin E as an essential micronutrient for human health: common, novel, and unexplored dietary sources. Free Radic Biol Med. 2021;176:312-321.

55.

Giuffrè

Caracciolo

Zappia

Capocasale

Poiana

Effect of heating on chemical parameters of extra virgin olive oil, pomace olive oil, soybean oil and palm oil. Ital J Food Sci. 2018;30.

56.

Kostadinović Veličkovska

Brühl

Mitrev

Mirhosseini

Matthäus

. Quality evaluation of cold-pressed edible oils from Macedonia. Eur J Lipid Sci Technol. 2015;117:2023-2035.

57.

Herrera

Barbas

Vitamin E: action, metabolism and perspectives. J Physiol Biochem. 2001;57:43-56.

58.

Zaaboul

Liu

Vitamin E in foodstuff: nutritional, analytical, and food technology aspects. Compr Rev Food Sci Food Saf. 2022;21:964-998.

59.

Westerveld

Dekker

Voss

Bast

Scheeren

RA.

Antioxidant levels in the nasal mucosa of patients with chronic sinusitis and healthy controls. Arch Otolaryngol Head Neck Surg. 1997;123:201-204.

60.

Ogal

Johnston

Klein

Schoop

Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial. Eur J Med Res. 2021;26:33.

61.

Vimalanathan

Schoop

Suter

Hudson

Prevention of influenza virus induced bacterial superinfection by standardized Echinacea purpurea, via regulation of surface receptor expression in human bronchial epithelial cells. Virus Res. 2017;233:51-59.

62.

Mokhtari

Afsharian

Shahhoseini

Kalantar

Moini

A review on various uses of N-acetyl cysteine. Cell J. 2017;19:11-17.

63.

Bezshapochniy

Loburets

Dzhirov

Podovzhniy

OG.

Peculiarities of nasal irrigation in acute viral rhinosinusitis. World -med Biol. 2020;16:007.

64.

Šalamon

Kramar

Marolt

Poljšak

Milisav

. Medical and dietary uses of N-Acetylcysteine. Antioxidants. 2019;8:111.

65.

Blasi

Page

Rossolini

, et al The effect of N-acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections. Respir Med. 2016;117:190-197.

66.

Popov

Shcherbakov

Tyryk

Aleksanyan

TA.

[New approach to treatment of polypous rhinosinusitis]. Vestn Otorinolaringol. 2020;85:48-51.

67.

Palm

Steiner

Abramov-Sommariva

, et al Assessment of efficacy and safety of the herbal medicinal product BNO 1016 in chronic rhinosinusitis. Rhinology. 2017;55:142-151.

68.

Zhang

Skinner

Hicks

, et al Sinupret activates CFTR and TMEM16A-dependent transepithelial chloride transport and improves indicators of mucociliary clearance. PLoS One. 2014;9:e104090.

69.

Passali

Loglisci

Passali

, et al A prospective open-label study to assess the efficacy and safety of a herbal medicinal product (sinupret) in patients with acute rhinosinusitis. ORL. 2015;77:27-32.

70.

Neubauer

März

RW.

Placebo-controlled, randomized double-blind clinical trial with sinupret® sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine. 1994;1:177-181.

71.

Ross

SM.

An integrative approach to rhinosinusitis in children, Part II. Holist Nurs Pract. 2010;24:49-51.

72.

Glatthaar-Saalmüller

Rauchhaus

Rode

Haunschild

Saalmüller

Antiviral activity in vitro of two preparations of the herbal medicinal product sinupret® against viruses causing respiratory infections. Phytomedicine. 2011;19:1-7.

73.

Rossi

Dehm

Kiesselbach

, et al The novel sinupret® dry extract exhibits anti-inflammatory effectiveness in vivo. Fitoterapia. 2012;83:715-720.

74.

Häkkinen

Kärenlampi

Heinonen

Mykkänen

Törrönen

AR.

Content of the flavonols quercetin, myricetin, and kaempferol in 25 edible berries. J Agric Food Chem. 1999;47:2274-2279.

75.

Mitchell

Hong

Koh

, et al Ten-year comparison of the influence of organic and conventional crop management practices on the content of flavonoids in tomatoes. J Agric Food Chem. 2007;55:6154-6159.

76.

Tutel’ian

Lashneva

NV.

[Biologically active substances of plant origin. flavanols and flavones: prevalence, dietary sources and consumption]. Vopr Pitan. 2013;82:4-22.

77.

Smith

Lombard

Peffley

Liu

Genetic analysis of quercetin in onion (Allium cepa L.)’Lady Raider. Tex J Agric Nat Resour. 2003;16:24-28.

78.

Williamson

Manach

Bioavailability and bioefficacy of polyphenols in humans. II. Review of 93 intervention studies. Am J Clin Nutr. 2005;81:243s-255s.

79.

Wiczkowski

Romaszko

Bucinski

, et al. Quercetin from shallots (Allium cepa L. Var. Aggregatum) is more bioavailable than its glucosides. J Nutr. 2008;138:885-888.

80.

Petrus

Schwartz

Sontag

Analysis of flavonoids in honey by HPLC coupled with coulometric electrode array detection and electrospray ionization mass spectrometry. Anal Bioanal Chem. 2011;400:2555-2563.

81.

Colunga Biancatelli

RML

Berrill

Catravas

Marik

PE.

Quercetin and vitamin C: an experimental, synergistic therapy for the prevention and treatment of SARS-CoV-2 related disease (COVID-19). Front Immunol. 2020;11:1451.

82.

Yao

Han

, et al Quercetin, inflammation and immunity. Nutrients. 2016;8:167-167.

83.

Jafarinia

A review of medicinal properties of some Asteraceae family plants on immune system. Rep Heal Care. 2019;5:1-7.

84.

Mlcek

Jurikova

Skrovankova

Sochor

Quercetin and its anti-allergic immune response. Molecules. 2016;21:623.

85.

Jafarinia

Sadat Hosseini

kasiri

, et al Quercetin with the potential effect on allergic diseases. Allergy Asthma Clin Immunol. 2020;16:36.

86.

Zhang

Smith

Schuster

, et al Quercetin increases cystic fibrosis transmembrane conductance regulator–mediated chloride transport and ciliary beat frequency: therapeutic implications for chronic rhinosinusitis. Am J Rhinol Allergy. 2011;25:307-312.

87.

Prasad

Fitzgerald

Hess

, et al Zinc deficiency in elderly patients. Nutrition. 1993;9:218-224.

88.

Prasad

AS.

Discovery and importance of zinc in human nutrition. Fed Proc. 1984;43:2829-2834.

89.

Mohammadhossein

Mohammad

Mohammadhossein

Mojtaba

Vahid

, et al Evaluation of the zinc, copper and iron serum levels in patients with nasal polyposis. Exp Rhinol Otolaryngol. 2018;2.

90.

Akbari Dilmaghani

Alani

Fazeli

. A randomized clinical trial of elemental zinc add-on therapy on clinical outcomes of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Iran J Pharm Res Summer. 2019;18:1595-1601.

91.

Ünal

Öztürk

Aslan

Aydin Görür

The effect of high single dose parenteral vitamin A in addition to antibiotic therapy on healing of maxillary sinusitis in experimental acute sinusitis. Int J Pediatr Otorhinolaryngol. 2002;65:219-223.

92.

Fang

Wang

Chen

Huang

TW.

Reduction of adhesions and antrostomy stenosis with topical vitamin A after endoscopic sinus surgery. Am J Rhinol Allergy. 2015;29:430-434.

93.

Guven

Aladag

Eyibilen

, et al Experimentally induced acute sinusitis and efficacy of vitamin A. Acta Otolaryngol. 2007;127:855-860.

94.

Tomiki

Conservative treatment of chronic sinusitis in children. Nippon Jibiinkoka Gakkai Kaiho. 1958;61:685-693.

95.

Elbistanlı

Koçak

Güneş

, et al Vit D deficiency is a possible risk factor in ARS. Eur Arch Otorhinolaryngol. 2017;274:3391-3395.

96.

Faghih Habibi

Gerami

Banan

, et al Serum 25-hydroxy vitamin D in chronic rhinosinusitis with and without nasal polyposis: a case-control study. Iran J Otorhinolaryngol. 2019;31:19-24.

97.

Ende

Alvarado

, et al Topical vitamin D may modulate human sinonasal mucosal responses to house dust mite antigen. Am J Rhinol Allergy. 2020;34:471-481.

98.

Ishrefova

Lyalina

Lioznov

, et al Argumentation of acute respiratory viral infections nonspecific prevention in groups of children. Russ J Infect Immun. 2016;6:184-188.

99.

Perić

Gaćeša

Aleksić

Kopacheva-Barsova

Perić

AV.

Herbal drug BNO 1016 versus fluticasone propionate nasal spray in the treatment of chronic rhinosinusitis without nasal polyps: a preliminary report. Eur J Ther. 2020;26:192-201.

100.

Sen’kevich

Sidorenko

Ditrikh

. [Comparative efficacy of various treatment regimens for children 2-5 years old with symptoms of acute viral rhinosinusitis]. Vestn Otorinolaringol. 2021;86:46-50.

101.

Vishnyakov

Sinkov

DE.

Herbal medicine as add-on therapy in acute rhinosinusitis. Z Civilistische Phytother. 2014;34:262-265.

102.

Popovych

Beketova

Koshel

, et al An open-label, multicentre, randomized comparative study of efficacy, safety and tolerability of the 5 plant - extract BNO 1012 in the delayed antibiotic prescription method in children, aged 6 to 11 years with acute viral and post-viral rhinosinusitis. Am J Otolaryngol. 2020;41:102564.

103.

Jund

Mondigler

Stammer

Stierna

Bachert

Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis. Acta Otolaryngol. 2015;135:42-50.

Therapeutic Effects of Vitamins and Nutritional Supplements on Sinusitis: A Narrative Review

Abstract

Keywords

Introduction

Vitamin A

Vitamin C

Vitamin D

Vitamin E

Other Nutritional Supplements

Echinacea

N-acetylcysteine

Sinupret

Quercetin

Zinc supplements

Conclusion

Footnotes

Author Contributions

Declaration Of Conflicting Interests:

Funding:

References