Nasal saline for chronic sinonasal symptoms - A Randomized controlled trial

Baylor University, Waco, Texas, United States
Archives of Otolaryngology - Head and Neck Surgery (Impact Factor: 2.33). 11/2007; 133(11):1115-20. DOI: 10.1001/archotol.133.11.1115
Source: PubMed


To determine if isotonic sodium chloride (hereinafter "saline") nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays at improving quality of life and decreasing medication use.
A prospective, randomized controlled trial.
A total of 127 adults with chronic nasal and sinus symptoms.
Patients were randomly assigned to irrigation performed with large volume and delivered with low positive pressure (n = 64) or spray (n = 63) for 8 weeks.
Change in symptom severity measured by mean 20-Item Sino-Nasal Outcome Test (SNOT-20) score; change in symptom frequency measured with a global question; and change in medication use.
A total of 121 patients were evaluable. The irrigation group achieved lower SNOT-20 scores than the spray group at all 3 time points: 4.4 points lower at 2 weeks (P = .02); 8.2 points lower at 4 weeks (P < .001); and 6.4 points lower at 8 weeks (P = .002). When symptom frequency was analyzed, 40% of subjects in the irrigation group reported symptoms "often or always" at 8 weeks compared with 61% in the spray group (absolute risk reduction, 0.2; 95% confidence interval, 0.02-0.38 (P = .01). No significant differences in sinus medication use were seen between groups.
Nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays for treatment of chronic nasal and sinus symptoms in a community-based population.

Download full-text


Available from: Shraddha S Mukerji,
  • Source
    • "Both pre-surgical and post-ESS studies were included. All seven pre-surgical RCTs48,51–55,57 demonstrated improved symptoms and health-related quality of life, although the study by Heatley et al53 showed no difference between reflexology as placebo and saline irrigation groups. Of the three post-ESS studies, two RCTs showed improved outcomes with intranasal saline,49,50 while the third showed no difference in patient symptom scores between normal saline, hypertonic saline, and no irrigation groups.56 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms persisting for greater than 12 weeks. The etiology of CRS is incompletely understood. Current understanding supports inflammation, rather than infection, as the dominant etiologic factor. CRS significantly impacts patients' quality of life and health care expenditure. There is no standard management of CRS. Treatment strategies differ based on divergent etiologies of the various CRS subclasses. Both systemic and topical agents are used. These interventions differ in CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP) and specific situations such as allergic fungal rhinosinusitis or aspirin-exacerbated respiratory disease. Antibiotics are the most commonly prescribed medication for CRS, but their role in management is not strongly supported by high-level studies. This paper provides a succinct review of the evidence supporting or refuting common therapeutic agents in the management of CRS. Novel and emerging strategies will also be discussed.
    Infection and Drug Resistance 01/2013; 6:1-14. DOI:10.2147/IDR.S26134
  • Source
    • "This expert endorsement is in line with the increased recognition of the benefits of saline therapy over the last 5 to10 years in the management of sinonasal disease. Multiple studies report the benefit of saline irrigation in patients with CRS [20-22], ARS [23], and in allergic, acute and chronic rhinosinusitis [24]. The use of saline irrigation as adjunct therapy is primarily based upon reported symptomatic improvement and its good safety profile. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute bacterial rhinosinusitis (ABRS) and chronic rhinosinusitis (CRS) frequently present in clinical practice. Guidelines for management of these conditions have been published extensively in the past. However, a set of guidelines that addressed issues specific to the Canadian environment while offering clear guidance for first-line clinicians was needed, and resulted in the recent publication of Canadian clinical practice guidelines for ABRS and CRS. In addition to addressing issues specific to Canadian physicians, the presented guidelines are applicable internationally, and offer single algorithms for the diagnosis and management of ABRS and CRS, as well as expert opinion in areas that do not have an extensive evidence base. This commentary presents major points from the guidelines, as well as the intended impact of the guidelines on clinical practice. See guidelines at:
    BMC Ear Nose and Throat Disorders 02/2012; 12(1):1. DOI:10.1186/1472-6815-12-1
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Yoga is being increasingly used as an adjuvant therapy for various conditions based on research done in the past many decades. This paper attempts to focus on the scientific basis of some Yoga practices such as Neti and Nada Pranayamas that may help in the prevention and management of sinusitis. This can help us understand the mechanisms through which these Yoga practices can help as an adjuvant therapy in preventing and managing sinusitis. This provides us the confidence to use these therapies as an inexpensive and safe method even in primary health care setting.
Show more