Should breathing exercises be a part of the next EPOS guidelines? The relevance of nitric oxide in chronic rhinosinusitis.

Abstract

The development of chronic rhinosinusitis is a complex and multifaceted phenomenon, as recognised by the EPOS2020 guidelines (1).

It affects 1 in 10 of the population with a significant disease and economic burden (2).

As more is understood about the factors involved in this umbrella of conditions, it is clear that management needs a tailored approach with a range of therapeutic options. Nitric oxide may represent an additional target for therapy. This endogenously produced molecule may predispose to rhinosinusitis when only present in diminished concentrations. Its production can be stimulated by various breathing techniques including humming, and this may represent a future holistic adjunct to treatment, in a similar manner that an Otovent device can be used in the management of eustachian tube dysfunction. This review summarises what we know about nitric oxide, its role in the paranasal sinuses, and its induction through breathing techniques.

Key Words:

Sinusitis, nitric oxide