Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde
Klinikum der Universität zu Köln, Germany

Nasal irrigation has proven in several recently published articles its clinical effectiveness and its neglectable rate of side effects even in children and during pregnancy. In most guidelines for the treatment of various nasal pathological conditions nasal irrigation is recommended as stand alone or as additional therapy. Although no common treatment protocol exists, a isotonic (0.9 %) or slightly hypertonic solution (3 - 5 %) is suggested because of its positive influence upon mucociliary clearance. Buffered solutions bring a more pleasant feeling during rinsing, which explains also the beneficial effect of natural brine solutions. In children, nasal irrigation can save antibiotics and reduce decongestant to nil. Important is the hygienic application in order not to introduce additional pathogenic germs into the nasal system.

Michel O.

Mucociliary clearance and buffered hypertonic saline solution
ENT Department, Sydney Hospital, Australia

Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.

Talbot AR, Herr TM, Parsons DS

Nasal irrigation for the alleviation of sinonasal symptoms
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI 53792-7375, USA

OBJECTIVE: To determine the effect of nasal irrigation on sinonasal symptoms. STUDY DESIGN AND SETTING: A total of 150 adult subjects with chronic sinusitis symptoms were recruited from the community and assigned to 1 of 3 treatment groups: nasal irrigation with bulb syringe, nasal irrigation with nasal irrigation pot, or control treatment with reflexology massage. Groups 1 and 2 performed daily hypertonic saline irrigation with 1 device for 2 weeks and then with the other device for 2 weeks. Group 3 performed reflexology massage daily for 2 weeks. Prospective data collected included pretreatment Medical Outcomes Study Short Form, pretreatment and posttreatment Rhinosinusitis Outcomes Measure, daily medication use, subjective treatment efficacy, and preference of irrigation method. RESULTS: There was a significant and equivalent improvement in Rhinosinusitis Outcomes Measure 31 score after 2 weeks of intervention in each treatment group; 35% of subjects reported decreased use of sinus medication. CONCLUSION: Daily nasal irrigation using either a bulb syringe, nasal irrigation pot, and daily reflexology massage were equally efficacious and resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects. Medication usage was decreased in approximately one third of participants regardless of intervention.

Heatley DG, McConnell KE, Kille TL, Leverson GE

Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study

Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study. Ten children were randomized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season, which had lasted 6 weeks. Ten patients were allocated to receive no nasal irrigation and were used as controls. A mean daily rhinitis score based on the presence of nasal itching, rhinorrea, nasal obstruction and sneezing was calculated for each week of the pollen season. Moreover, patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated. In patients allocated to nasal irrigation, the mean daily rhinitis score was reduced during 5 weeks of the study period. This reduction was statistically significantly different in the 3th, 4th and 5th week of therapy. Moreover, a decreased consumption of oral antihistamines was observed in these patients. This effect became evident after the second week of treatment and resulted in statistically significant differences during the 3th, 4th and 6th week. This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective.

Garavello W, Romagnoli M, Sordo L, Gaini RM, Di Berardino C, Angrisano A

The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms
Department of Family Medicine, University of Wisconsin Medical School-Madison, 53715, USA

OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. STUDY DESIGN AND SETTING: The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinonasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 +/- 2.6 points to 80.6 +/- 2.4 points (P < 0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 +/- 3.9 points to 79.7 +/- 3.7 points (P < 0.05), SNOT-20 scores improved from 43.5 +/- 5.7 points to 28.4 +/- 4.8 points, and SIA scores improved from 4.2 +/- 0.3 points to 2.6 +/- 0.3 points (P < 0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms.

Rabago D, Pasic T, Zgierska A, Mundt M, Barrett B, Maberry R

Nasal irrigations: good or bad?
Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1093

PURPOSE OF REVIEW: Nasal irrigations are often mentioned as adjunctive measures in treating many sinonasal conditions. Despite their widespread use, much mystique and uncertainty exist about the indications and therapeutic mechanisms of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence challenges some of the assumptions underlying the use of nasal irrigations. RECENT FINDINGS: Studies of nasal irrigations continue to report the benefits in managing sinonasal complaints. Apart from improved patient symptomatology, prescription medication use is often decreased. When nasal irrigations are combined with other medical modalities, patients with chronic sinusitis may not require surgical intervention as often. In particular, patients using hypertonic saline nasal irrigations reported better outcomes. Different devices and techniques exist. Positive-pressure and negative-pressure methods are probably more effective than nebulizers. Furthermore, the popular belief that nasal irrigations need to be sterile is in question. SUMMARY: Nasal irrigations should no longer be considered merely adjunctive measures in managing sinonasal conditions. They are effective and underutilized. Some of the persisting unanswered questions will only be answered by further research.

Brown CL, Graham SM

Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study
Department of Family, University of Wisconsin Madison, Madison, Wisconsin 53715, USA

PURPOSE: We qualitatively assessed attitudes regarding use of hypertonic saline nasal irrigation (HSNI) for frequent rhinosinusitis and chronic sinonasal symptoms in a 3-part, multimethod study. METHODS: We conducted semistructured, in-depth interviews with 28 participants who recently used nasal irrigation in studies assessing HSNI. RESULTS: Four themes emerged: (1) HSNI improved self-management of sinus symptoms, creating a sense of empowerment; (2) HSNI produced rapid and long-term improvement in quality of life; (3) participants identified discomfort, time, and mild side effects as barriers to HSNI use; and (4) participants identified aspects of training and at-home use that overcame these barriers. CONCLUSION: HSNI is a safe, well-tolerated, inexpensive, effective, long-term therapy that patients with chronic sinonasal symptoms can and will use at home with minimal training and follow-up. Success with HSNI will likely be improved by patient education.

Rabago D, Barrett B, Marchand L, Maberry R, Mundt M.