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Corticosteroid and NAC nasal douching significantly reduced symptom severity more than two-fold, resolved mucosal edema, and restored mucociliary function in recurrent acute rhinosinusitis patients compared to steroid with ambroxol, leading to better long-term satisfaction ( A detailed review of literature has found increased oxidative stress in acute as well as chronic infections of the ear, nose, and sinuses and the rationale for adding an antioxidant to the therapy ( 9.4 Role of NAC in viral infections including COVID 19 N-acetylcysteine inhibits replication of influenza A and other respiratory viruses in cell cultures and suppresses inflammatory mediators (CXCL8, CXCL10, CCL5, H 2 O 2 , IL-6) by blocking NF-B and p38 MAPK activation ( N-acetylcysteine inhibits multiple Influenza A strains, and intravenous NAC improves outcomes in acute respiratory distress syndrome and acute lung injury ( n = 20,980) showed NAC significantly reduced CRP and D-dimer levels, increased P/F ratios, and decreased hospital stay and mortality in COVID-19 patients ( N-acetylcysteine has a high safety profile, and the studies do not report any major or serious adverse effect of NAC

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The RNA seq data used in the study were freely available at Expression Atlas, URGI and NCBI databases