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: 1.75). 11/2007; 133(11):1115-20. DOI: 10.1001/archotol.133.11.1115
Source: PubMed

ABSTRACT 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, Jul 30, 2015
  • 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.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Rhinosinusitis is a common, expensive disorder with a significant impact on patients' quality of life. Chronic sinus symptoms are associated with allergic rhinitis, asthma, and nasal polyposis. Saline nasal irrigation is an adjunctive therapy for rhinosinusitis and sinus symptoms. Prior studies suggest that hypertonic saline nasal irrigation (HSNI) may be effective for symptoms associated with allergy, asthma, and nasal polyposis. To assess the degree to which subjects using nasal irrigation for chronic sinus symptoms also reported improvements in symptoms related to allergy, asthma, or nasal polyposis. Qualitative study using in-depth long interviews of 28 participants in a prior qualitative nasal irrigation study. All participants were receiving daily nasal irrigation. Transcripts of interviews were systematically examined. Twelve of 21 subjects with allergic rhinitis spontaneously reported that HSNI improved symptoms. Two of 7 subjects with asthma and 1 of 2 subjects with nasal polyposis reported a positive association between HSNI use and asthma or nasal polyposis symptoms. Transcript content was organized into themes that included: (1) HSNI resulted in improvement of allergic rhinitis and asthma symptoms, and (2) HSNI should be used for symptoms of allergic rhinitis. This hypothesis-generating study offers qualitative evidence that suggests patients with frequent rhinosinusitis and daily sinus symptoms, symptoms of concomitant allergic rhinitis, asthma, or polyposis may improve with HSNI. The parent studies offer strong evidence that HSNI is an effective adjunctive treatment for symptoms of chronic rhinosinusitis. Larger prospective studies are needed in patients with these diagnoses.
    WMJ: official publication of the State Medical Society of Wisconsin 05/2008; 107(2):69-75.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this review is to highlight important articles on upper airway diseases and immunotherapy that appeared in 2007. Advances in rhinitis include the realization that allergic rhinitis might be caused by local nasal IgE sensitization to aeroallergens in the absence of systemic evidence of IgE sensitization. After inhalation, allergens might reach systemic circulation. Epidemiologic studies continue to show that allergic rhinitis impairs school performance and is a risk factor for future asthma. New pathways are being identified in chronic sinusitis, as well as in different types of allergic ocular diseases. New treatments for patients with allergic rhinitis include use of beta-1,3-glucan, a mushroom product that can reduce allergic symptoms by inducing T(H)1 response, and olopatadine nasal spray. Studies on immunotherapy in 2007 suggest that sublingual immunotherapy induces similar immunologic alterations as those induced by subcutaneous immunotherapy, although to a lesser degree. Among allergists in the United States, there is a sizable variation in clinical practice, particularly related to concomitant administration of immunotherapy and beta-blockers, to administration of angiotensin-converting enzyme inhibitors, and to patients with HIV or autoimmune diseases. The combination of omalizumab with allergen subcutaneous immunotherapy can enhance clinical efficacy. Recombinant technology can modify allergen structure to prevent binding to IgE (allergenicity) while enhancing immunogenicity (stimulation of T cells), which might improve the safety and efficacy of immunotherapy.
    The Journal of allergy and clinical immunology 10/2008; 122(3):481-7. DOI:10.1016/j.jaci.2008.06.027 · 11.25 Impact Factor
Show more