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Comparison between the use of saline and seawater for nasal obstruction in children under 2 years of age with acute upper respiratory infection

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Background/aim: The effectiveness of isotonic and hypertonic saline solutions used to open the nasal passage and improve clinical symptoms was compared in children under 2 years of age admitted with the common cold. Materials and methods: The study was performed as a randomized, prospective, and double-blind study. The study included 109 children. The children using saline (0.9%) and seawater (2.3%) as nasal drops (the patient group) and the control group (in which nasal drops were not administered) were compared. Seventy-four patients received nasal drops from package A (seawater) in single days and from package B (physiological saline) in double days. Results: The mean age of the patients was 9.0 ± 3.9 months and the numbers of boys and girls were 65 (59.6%) and 44 (40.4%), respectively. There was no significant difference between Groups A and B in terms of nasal congestion (P > 0.05). However, a significant difference was found between the control group and Groups A and B (P < 0.05). Conclusion: Relief was seen in nasal congestion, weakness, sleep quality, and nutrition with the use of both saline and seawater in children with the common cold. Seawater or saline drops may be added to standard treatment protocols.
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1004
http://journals.tubitak.gov.tr/medical/
Turkish Journal of Medical Sciences
Turk J Med Sci
(2016) 46: 1004-1013
© TÜBİTAK
doi:10.3906/sag-1507-18
Comparison between the use of saline and seawater for nasal obstruction in children
under 2 years of age with acute upper respiratory infection
Tülin KÖKSAL1,*, Mehmet Nevzat ÇİZMECİ2, Davut BOZKAYA2, Mehmet Kenan KANBUROĞLU2,
Şanlıay ŞAHİN1, Tuğba TAŞ2, Çiğdem Nükhet YÜKSEL2, Mustafa Mansur TATLI2
1Department of Pediatrics, Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
2Department of Pediatrics, Faculty of Medicine, Turgut Özal University, Ankara, Turkey
* Correspondence: tulinkoksal6623@gmail.com
1. Introduction
e common cold is an acute and self-limiting viral
infection of the upper respiratory tract. Varying degrees
of sneezing, nasal congestion, rhinorrhea, sore throat,
cough, mild fever, headache, and weakness are seen (1–3).
e treatment of the common cold is supportive. Plenty of
uid intake and opening of the nasal passage with saline or
hypertonic solution are recommended (2).
Paranasal sinus mucosa is a continuation of the
mucosa of the nasal cavity. erefore, the infection of this
region is usually seen as rhinosinusitis. e mucociliary
activity decreases in rhinosinusitis. It has long been argued
that nasal irrigation had a place in the treatment. Nasal
irrigation is used in rhinosinusitis and allergic rhinitis (4).
Mucociliary plaque in the respiratory tract is protective
against infection entering by inhaled air. Reduction in
mucociliary activity causes various respiratory diseases.
According to the accepted hypothesis, it is said that nasal
irrigation increases the mucociliary clearance and reduces
nasal edema and inammatory mediators (5). At the same
time, it is known that irrigation cleans dust and secretions
and makes the mucus more uid; irrigation is performed
with isotonic or hypertonic saline (4).
It is reported that nasal irrigation with saline
solution performs mechanical cleaning by increasing
the mucociliary clearance; in addition to increasing the
mucociliary activity, hypertonic serum reduces edema and
suppresses inammation (6–8).
Besides the benets of hypertonic solutions used for
nasal washes, studies have also reported side eects of
these solutions. It has been stated that hypertonic solutions
cause nasal congestion, rhinorrhea, and pain by increasing
histamine and substance P release. It was reported that the
side eects increased with increasing the concentration of
the nasal wash solution (9,10). In contrast, another study
reported that there was no adverse eect in children with
allergic rhinitis using hypertonic saline (3%) (11).
e studies conducted so far investigated the
eectiveness and the side eects of nasal irrigation in
children with allergic rhinitis or rhinosinusitis. ere
are very few studies in the literature related to the use of
physiological serum in upper respiratory tract infections
Background/aim: e eectiveness of isotonic and hypertonic saline solutions used to open the nasal passage and improve clinical
symptoms was compared in children under 2 years of age admitted with the common cold.
Materials and methods: e study was performed as a randomized, prospective, and double-blind study. e study included 109
children. e children using saline (0.9%) and seawater (2.3%) as nasal drops (the patient group) and the control group (in which nasal
drops were not administered) were compared. Seventy-four patients received nasal drops from package A (seawater) in single days and
from package B (physiological saline) in double days.
Results: e mean age of the patients was 9.0 ± 3.9 months and the numbers of boys and girls were 65 (59.6%) and 44 (40.4%),
respectively. ere was no signicant dierence between Groups A and B in terms of nasal congestion (P > 0.05). However, a signicant
dierence was found between the control group and Groups A and B (P < 0.05).
Conclusion: Relief was seen in nasal congestion, weakness, sleep quality, and nutrition with the use of both saline and seawater in
children with the common cold. Seawater or saline drops may be added to standard treatment protocols.
Key words: Child, common cold, nasal saline, nasal drop, seawater
Received: 03.07.2015 Accepted/Published Online: 13.09.2015 Final Version: 23.06.2016
Research Article
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KÖKSAL et al. / Turk J Med Sci
and inuenza (12,13). It is not known whether the use of
physiological serum or seawater is more eective in viral
upper respiratory tract infection. In the present study, we
aimed to investigate whether there is a dierence between
the use of seawater and saline in terms of the relief of nasal
congestion-associated symptoms in children with acute
upper respiratory tract infections.
2. Materials and methods
In this study 109 children under the age of 2 who were
admitted to Turgut Özal University School of Medicine
general pediatric outpatient clinic between 17 September
2012 and 16 November 2012 and diagnosed with acute
upper respiratory tract infection were evaluated. e
patient group consisted of children using saline (0.9%
isotonic saline) and seawater (2.3% hypertonic saline) as
nasal drops; the control group included children who were
not given nasal drops. e results of both groups were
compared.
e study was planned as a randomized, prospective,
and double-blind study. It was approved by the ethics
committee of Turgut Özal University (B 30 2 FTH 0 20 00
00/1093/2012). e families of the patients participating
in the study were informed and written consent was
obtained. Children with chronic diseases and other serious
infections were excluded from the study.
In this study, 38 of 74 patients admitted to the clinic
received nasal drops from package A (Group A: seawater)
in single days; the other 36 patients received nasal drops
from package B (Group B: physiological saline) in double
days. Cleaning with nasal aspirator or nasal pumps aer
instillation of drops in the nose was suggested for Groups
A and B. No drops or devices were recommended for the
control group (n = 35). While the study was being planned,
the A and B boxes were prepared equally, including 45 vials
in each of them. However, 7 patients from Group A and 9
patients from Group B could not be reached by telephone,
and these patients did not come for check-ups. ese
16 patients, who could not be reached for these reasons,
were excluded from the study, as shown in the study ow
diagram in Table 1.
ree boxes of nasal drops, including 5 vials in each
box, were given to the patients in their rst admission and
3 vials were recommended to be used each day. Enough
drops were given for 5 days. Group A and Group B were
treated exactly the same, and we did not provide any
treatment to the control group. All the groups (A, B, and
control) were examined on days 1 and 7 and rung on days
3 and 5. We planned to recall and examine the patients in
the presence of circumstances necessitating intervention
other than the standard ndings asked in the questionairre.
However, we did not observe a dierent cause other than
the patients’ complaints.
On days 3 and 5 aer the initiation of treatment, the
families were contacted by phone. As it was planned, the
contributions of “TK, MNÇ, DB, MKK, and TT” were in
the conception and design of the study, or the acquisition
of data, or analysis and interpretation of data (call the
patients’ families and/or answer the families’ call). e
telephone numbers of the doctors above were given to the
Assessed for eligibility (n = 125)
Excluded (n = 0)
Not meeting inclusion criteria (n = 0)
Declined to participate (n = 0)
Other reasons (n = 0)
Randomized (n = 125)
Group C (Control)
Allocated to intervention (n = 35)
Received allocated intervention (n = 35)
Did not receive allocated intervention
(Give reasons) (n = 0)
Group B
Allocated to intervention (n = 45)
Received allocated intervention (n = 45)
Did not receive allocated intervention
(Give reasons) (n = 0)
Group A
Allocated to intervention (n = 45)
Received allocated intervention (n = 45)
Did not receive allocated intervention
(Give reasons) (n = 0)
Patients could not be reached by telephone
Lost to follow-up (give reasons) (n = 9)
Patients could not be reached by telephone
Discontinued intervention (give reasons) (n = 0)
Lost to follow-up (give reasons) (n = 0)
Discontinued intervention
(Give reasons) (n = o)
Analysed (n = 35)
Excluded from analysis
(Give reasons) (n = 0)
Analysed (n = 36)
Excluded from analysis
(Give reasons) (n = 0)
Analysed (n = 38)
Excluded from analysis
(Give reasons) (n = 0)
Table 1. Study ow diagram.
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families. If there was no problem, the doctors phoned the
families on days 3 and 5. However, if there was a problem
on days other than these days (3 and 5), the families
called the doctors. e calls by the families only included
questions about the parents’ concerns about their children
and so these calls did not aect the conclusion of the study.
e participants were called in for a check-up on day 7.
If we did not reach the participants by phone the rst
time, we tried again three times at dierent times of the
day. When we were not able to reach them the third time,
we excluded these participants from the study.
As mentioned above, the authors who made the calls
were experienced medical doctors. ey did not know to
which group the patient had been allocated and neither
did the families (double-blind study).
We always asked the same questions in the rst
application, the check-up (day 7), and over the phone
(days 3 and 5), and we have added in the “study form” the
exact wording of the questions.
In the rst application, on the phone (days 3 and 5),
and the check-up (day 7), the families were asked about
several parameters including nasal congestion, rhinorrhea,
nasal bleeding, weakness, sleep patterns, cough, whether
nutrition was aected, and whether there was a history of
usage of nasal pump or aspirator. e answers given were
evaluated as no symptoms: 0, mild symptoms: 1, moderate
symptoms: 2, and severe symptoms: 3.
2.1. Statistical analysis
Descriptive statistics were summarized as counts and
percentages for categorical variables, and as medians,
minimums, and maximums for continuous variables.
Repeated measures were determined by repeated
measures ANOVA, followed by Bonferroni’s post-hoc
test. Chi-square test was applied to compare the data
between the groups. All the data were analyzed using
SPSS for Windows 20 (SPSS Inc, Chicago, IL, USA). P <
0.05 was considered signicant. Sample size estimates
were calculated using G*Power. (Considering an eect
size d of 0.5 andalpha error probability of 0.05, the power
calculated byG*Power (Universität Düsseldorf ) was 78%).
3. Results
e mean age of the patients was 9.0 ± 3.9 months (with a
range of 2–17 months), and the numbers of boys and girls
were 65 (59.6%) and 44 (40.4%), respectively. In Group A
there were 22 boys (57.9%) and 16 girls (42.1%). In Group
B there were 25 boys (69.4%) and 11 girls (30.6%). In the
control group there were 18 boys (51.4%) and 17 girls
(48.6%).
ere was no signicant dierence between Groups A
and B in terms of nasal congestion (P > 0.05). However,
a signicant dierence was found between the control
group and Groups A and B (P < 0.001). As the days passed,
the nasal congestion in Groups A and B lessened, and a
signicant dierence was found when compared with the
control group (Figure 1).
Similarly, there was no signicant dierence between
Groups A and B in terms of weakness, but signicant
dierences were also found between the control group and
Groups A and B (P < 0.05) (Figure 2).
ere was no signicant dierence between Groups A
and B in terms of rhinorrhea, but signicant dierences
were found between the control group and Groups A and
B (P < 0.05) (Figure 3). ere was no signicant dierence
between the control group and Groups A and B in terms of
nasal bleeding (P > 0.05, for each) (Figure 4).
ere was no signicant dierence between Groups
A and B in terms of sleep quality (P > 0.05). However, a
signicant dierence for this variable was found between
the control group and Groups A and B (P < 0.001). Every
day sleep quality was found to be slightly increased in
Groups A and B (Figure 5).
ere was no signicant dierence between Groups A
and B in terms of diet (P > 0.05). A signicant dierence
for this variable was found between the control group and
Groups A and B (P < 0.001). However, changes were not
seen from day 5 (Figure 6).
ere was no signicant dierence between box A and
box B in the usage of nasal pump and nasal aspirator to
clean the nose. However, a signicant dierence for this
variable was found between the control group and Groups
A and B (P < 0.001) (Figure 7).
ere was no signicant dierence between the groups
in terms of cough (P > 0.05) (Figure 8).
Distributions of the parameters in Groups A and B and
the control group at 0, 3, 5, and 7 days are shown in Tables
2, 3, and 4, respectively.
Comparison between the study groups for all variables
(nasal congestion, weakness, etc.) is provided in Table 5.
4. Discussion
Children are mostly aected by nasal congestion in
upper respiratory tract infections. Treatment of acute
upper respiratory tract infections is supportive, including
the intake of food and plenty of uids and opening of
the nasal passage. In upper respiratory tract infections,
nasal secretions become more dense and mucopurulent;
therefore, this situation secondarily aects the mucociliary
transport. When mucus debris is aspirated or rehydrated
with a few drops of saline, it is seen that transport starts
again (14). It has been emphasized in many studies that
nasal irrigation is useful in seasonal allergic rhinitis, acute
sinusitis, and chronic sinusitis (11,15–17). In another
study it was shown that using nasal saline and nasal
corticosteroid together was more eective and economical
than using nasal saline alone or nasal steroid alone (18).
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Figure 1. Nasal congestion in Group A, Group B, and the control group 63 × 45 mm
(300 × 300 DPI).
Figure 2. Weakness in Group A, Group B, and the control group 54 × 47 mm (300
× 300 DPI).
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Figure 3. Rhinorrhea in Group A, Group B, and the control group 54 × 42 mm (300
× 300 DPI).
Figure 4. Nasal bleeding in Group A, Group B, and the control group 54 × 42 mm
(300 × 300 DPI).
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Figure 5. Sleep quality in Group A, Group B, and the control group 54 × 42 mm (300
× 300 DPI).
Figure 6. Diet in Group A, Group B, and the control group 54 × 42 mm (300 × 300
DPI).
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Figure 7. Use of nasal aspirator and nasal pump in Group A, Group B, and the
control group 54 × 42 mm (300 × 300 DPI).
Figure 8. Cough in Group A, Group B, and the control group 54 × 42 mm (300 × 300 DPI).
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Our results were in parallel with these studies and it was
observed that physiological saline and seawater had equal
eciency to relieve nasal congestion; moreover, nasal
congestion was relieved earlier in the treated groups than
in the control (untreated) group. e thickened mucus
was removed from the ambient and the nasal mucosa was
moistened with nasal drops. In addition, more eective
cleaning of the nose with a pump or aspirator and the
reduction of symptoms were signicant.
Šlapak et al. (13) showed that washing the noses of
children between 6 and 10 years of age with acute upper
respiratory tract infection with saline cured the nasal
symptoms and reduced the recurrence of common cold.
In that study, a group of patients were given standard
therapy (antipyretics, nasal decongestants, mucolytics,
and/or systemic antibiotics) and nasal saline wash was not
recommended. In one group, nasal wash with saline was
added to this standard treatment. ose who were enrolled
in the study were followed up for 12 weeks. At the end of
this process, earlier remission of symptoms and recurrence
prevention were found in the group treated with nasal
saline (13). In our study, patients aged 0 to 2 years did
not receive any treatment except isotonic and hypertonic
nasal drops. No nasal drops were recommended for the
control group. Patients were followed for 7 days and the
comparison was made among three groups. e symptoms
of the groups that used nasal drops were lighter and were
relieved sooner. Some researchers have argued that nasal
wash was not eective on the common cold (19).
e uses of buered hypertonic saline and buered
normal saline were compared in children with allergic
rhinitis previously. It was found that buered hypertonic
saline was more advantageous in reducing complaints
compared with normal saline, as it was well tolerated, safe,
Table 2. Distributions of the parameters of Group A (n = 38) at 0, 3, 5, and 7 days.
Days 0357
Parameters n (%) n (%) n (%) n (%)
Nasal congestion 38 (100) 26 (68) 14 (37) 8 (21)
Weak n e s s 28 (74) 21 (55) 14 (37) 9 (24)
Rhinorrhea 30 (79) 26 (68) 20 (53) 15 (39)
Nasal bleeding 1 (3) 0 0 0
Sleep quality* 30 (79) 27 (71) 19 (50) 13 (34)
Diet** 21 (55) 16 (42) 13 (34) 11 (29)
Cough 33 (87) 30 (79) 18 (47) 8 (21)
Nasal pump and aspirator*** 5 (13) 19 (50) 19 (50) 19 (50)
*Deterioration in sleep quality; **Deterioration in appetite;
***Use of nasal pump and aspirator.
Table 3. Distributions of the parameters of Group B (n = 36) at 0, 3, 5, and 7 days.
Days 0357
Parameters n (%) n (%) n (%) n (%)
Nasal congestion 36 (100) 24 (67) 12 (33) 6 (17)
Weak n e s s 29 (81) 24 (67) 15 (42) 8 (22)
Rhinorrhea 25 (69) 20 (56) 15 (42) 13 (36)
Nasal bleeding 2 (6) 1 (3) 0 0
Sleep quality* 31 (86) 30 (89) 18 (50) 6 (17)
Diet** 31 (86) 29 (81) 10 (28) 7 (19)
Cough 25 (69) 26 (72) 21 (58) 14 (39)
Nasal pump and aspirator*** 6 (17) 7 (19) 7 (19) 7 (19)
*Deterioration in sleep quality; **Deterioration in appetite;
***Use of nasal pump and aspirator.
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and cheap (20). Signicant dierence in the reduction of
complaints in our study was not observed between seawater
and physiological saline. e most important dierence
between this study and the previously mentioned one is
the content of the patient groups. Patients with allergic
rhinitis were included in that study and patients with
acute upper respiratory tract infection were included
in our study. Hypertonic solutions may become more
eective by reducing edema due to the predominance
of mucosal edema in allergic rhinitis. e dierence in
the washing eect of the two solutions may not be seen
due to the predominance of increase in secretion in the
pathophysiology of acute upper respiratory tract infection.
Washing with hypertonic saline, particularly in allergic
rhinitis, indicated an increase in the level of leukotriene
C4 (21). Garavello et al. (11) also supported this study
by saying that nasal wash with hypertonic saline relieved
seasonal allergic rhinitis. Ural et al. (4) emphasized in their
study that nasal irrigation was simple, cheap, and eective
in the treatment of sinonasal pathology and reduced the
use of antibiotics. ey reported that hypertonic saline
increased mucociliary clearance in patients with chronic
sinusitis only, but hypertonic irrigation was not superior
to saline irrigation in patients with allergic rhinitis (4). It
was seen in our study that the eects of using seawater and
physiological saline were similar in acute upper respiratory
tract infections.
Changes in cell structure and mucus secretion were
analyzed in nasal epithelial cells caused by pure water,
hypertonic (0.3%), isotonic (0.9%), and hypertonic (3%)
solutions in another in vitro study. As a result, it was
reported that pure water, hypotonic, and hypertonic
solutions increased mucus secretions and damaged the
cells, but isotonic solutions did not cause any change in
the mucous secretion and cell structure (22). In another
study, it was emphasized that hypertonic saline, given as
inhaler, increased mucus secretion (23). It has also been
reported in a review published in 2007 that nasal irrigation
reduced the use of antibiotics and had very few side eects.
ese side eects are nasal itching and nausea. Serious side
Table 4. Distributions of the parameters of Group C (n = 35) at 0, 3, 5, and 7 days.
Days 0357
Parameters n (%) n (%) n (%) n (%)
Nasal congestion 35 (100) 34 (97) 30 (86) 26 (74)
Weak n e s s 34 (97) 31 (89) 27 (77) 26 (74)
Rhinorrhea 35 (100) 35 (100) 35 (100) 33 (94)
Nasal bleeding 1 (3) 0 0 0
Sleep quality* 33 (94) 34 (97) 34 (97) 31 (89)
Diet** 35 (100) 35 (100) 32 (91) 31 (89)
Cough 35 (100) 35 (100) 35 (100) 35 (100)
Nasal pump and aspirator*** 10 (29) 10 (29) 10 (29) 10 (29)
*Deterioration in sleep quality; **Deterioration in appetite; ***Use of nasal pump and aspirator.
Table 5. Comparison between study groups for all variables (nasal congestion, weakness, etc.).
95% Condence interval for dierence
Group Mean dierence ± std. error p Lower bound Upper bound
A* B –0.024 ± 0.114 >0.05 –0.301 0.252
C –0.413 ± 0.115 0.001 –0.692 –0.134
B** A 0.024 ± 0.114 >0.05 –0.252 0.301
C –0.388 ± 0.116 0.003 –0.671 –0.106
C*** A 0.413 ± 0.115 0.001 0.134 0.692
B 0.388 ± 0.116 0.003 0.106 0.671
*Group A (seawater); **Group B (physiological saline); ***Control group. Values in bold are signicant.
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eects have not been reported (24). It has also been shown
in a study conducted by Jee et al. (25) that nasal irrigation
with saline was cheap and had minimal side eects.
In conclusion, we found relief with the use of both
physiological saline and seawater in the following
parameters: nasal congestion, weakness, nutrition, and
sleep quality. Opening the nasal passage with the aid of a
simple device was highly eective in relieving symptoms
regardless of which solution was used. e signicant
dierences found between the control group and Groups A
and B have shown that washing the nose with physiological
saline or seawater in order to clear the nose in acute upper
respiratory tract infections has utility in the improvement
of symptoms. Seawater or saline drops may be added to
standard treatment protocols.
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... 26 In children, 4 RCTs assessed nasal saline vs no-saline treatment. [36][37][38][39] There were no differences between the groups at the duration of 2 days. 36 Symptom reductions (secretion and nasal obstruction) favored the saline at a longer duration (5 days to 3 weeks). ...
... 36 Symptom reductions (secretion and nasal obstruction) favored the saline at a longer duration (5 days to 3 weeks). [37][38][39] A meta-analysis showed benefits on nasal symptom reduction. 41 Minor adverse effects were noted, such as nosebleed and burning sensation. ...
... There was no difference in symptom score reduction and no report of adverse effects in this study. 39 Buffer. There was no comparative study between the buffered and nonbuffered saline. ...
Article
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Objective This review aimed to systematically determine the optimal nasal saline regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov. The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled trials and meta-analyses were included. The effects of nasal saline treatment through various devices, saline tonicities, and buffer statuses were evaluated in patients with allergic and nonallergic rhinitis, acute and chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were effective for treating adults, while low-volume devices (5-59 mL) were effective for children. Isotonic saline was preferred over hypertonic saline due to fewer adverse events. For acute rhinosinusitis, saline irrigation was beneficial in children, but it was an option for adults. Large-volume devices were more effective, especially in the common cold subgroup. For CRS, large-volume devices were effective for adults, but saline drop was the only regimen that had available data in children. Buffered isotonic saline was more tolerable than nonbuffered or hypertonic saline. The data for CRS with cystic fibrosis and nonallergic rhinitis were limited. For postoperative care, buffered isotonic saline delivered by large-volume devices was effective. Conclusion Nasal saline treatment is recommended for treating most sinonasal diseases. Optimal delivery methods for each condition should be considered to achieve therapeutic effects of saline treatment.
... Nasal irrigation is mainly used for sinusitis and nasal diseases such as allergic rhinitis [11,12], but is used less often in acute URIs. There are only a few reports utilizing seawater or saline in children with URI and influenza [12,13]. Consequently, whether seawater effectively relieves URI symptoms in adults remains unknown. ...
... Koksal et al [13] reported relief in nasal congestion, rhinorrhea, weakness, sleep quality, diet, and cough after seawater administration in pediatric patients with a common cold. Symptom alleviation was similarly observed in nasal congestion, rhinorrhea, sleep quality, and diet in the present study. ...
... This discrepancy might be related to factors including patient age, work, and social responsibilities. The patients recruited in this study were adults, while Koksal et al [13] assessed individuals below 2 years of age. This suggests that the use of seawater as a nasal drop may be more suitable for young children. ...
Article
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BACKGROUND The purpose of this study was to assess the effects of seawater on nasal congestion and runny nose symptoms in adults with an acute upper respiratory infection (URI). MATERIAL AND METHODS This was a multicenter retrospective cohort trial of patients with acute URI and symptoms of nasal congestion and runny nose. The patients were assigned to 2 groups and were administered regular non-drug supportive treatment or supportive treatment with nasal irrigation with sea salt-derived physiological saline. The primary efficacy endpoint was the effective rate (percentage of patients with ≥30% symptom score reduction from baseline for nasal congestion and runny nose). RESULTS In total, 144 patients were enrolled, including 72 in each group, and 143 patients completed the study. Both groups had similar demographics and vital signs. The effective rates for nasal congestion and runny nose were significantly increased in the seawater group compared with patients in the control group (87.3% vs 59.7% for nasal congestion; 85.9% vs 61.1% for runny nose; both P<0.001). In addition, the 2 groups showed markedly different degrees of patient symptom score improvement in sleep quality and appetite (both P<0.01), but not in cough and fatigue (both P>0.05). There were no adverse events in either group. CONCLUSIONS The sea salt-derived physiological saline nasal spray device satisfactorily improved nasal congestion, runny nose, sleep quality, and appetite in adults with URI, with no adverse effects.
... Regarding other indications, positive effects were described in paediatric patients with viral bronchiolitis [59], bronchiolitis in the intensive care unit [86], acute sinusitis [80], acute upper respiratory tract infections [82,85], chronic tonsilitis [61] and cold and influenza [62]. Moreover, daily nasal irrigation in the paediatric stage (especially in children who cannot blow their noses) is a practice that should be encouraged as a good habit, even without underlying pathologic conditions. ...
... Due to its chemical constituents, such as magnesium, calcium, potassium, bicarbonate and other ions, seawater shows a range of additional chemical effects, from promoting cell repair and reducing inflammation to reducing viscosity of the mucus and increasing ciliary beat frequency. Numerous studies in URT patients, pregnant women, children and elderly individuals show exceptionally good safety profiles for seawater preparations [82,98,108,117]. Side effects are rare, and consist mostly of burning feelings and nasal drainage, with serious adverse events practically non-existent. ...
Article
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The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.
... Nasal lavage with hypertonic saline/seawater was shown to have a favorable effect in the management of sinonasal conditions and symptoms [1,2]. Among different hypertonic solutions, seawater solutions of 2.3% NaCl are frequently used in adult and pediatric populations [3][4][5]. Additional ingredients have been introduced to sinonasal irrigation fluids to improve their action and/or provide additional ancillary benefits. ...
... HSS-Plus nasal spray is highly effective in improving cleaning of the nose, reducing nasal congestion and achieving faster symptom resolution as indicated by high effectiveness scores. HSS-Plus nasal spray has similar properties to 2.3% NaCl hypertonic solutions in terms of ENT symptom management such as improvement of nasal obstruction/comfort and rhinorrhea in children and adults with rhinitis and acute respiratory diseases observed in several clinical studies [3][4][5]. ...
Article
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Limited real-world data exist on the clinical benefits of medical devices for cleansing and decongesting the nasal mucosa. To that end, a user survey study with a hypertonic seawater nasal irrigation solution comprising algal and herbal ingredients (HSS-Plus) was conducted in patients with ENT disorders. One hundred patients who experienced otorhinolaryngological (ENT) symptoms were recruited in private outpatient settings. Patients were advised to perform nasal irrigations with this medical device according to the products' instructions for use over a period of up to two weeks. At the end of the evaluation period, scores of symptom improvement, nasal cleansing, duration of symptoms and total effectiveness, safety and ease of product use were recorded in questionnaires using Visual Analog Scale (VAS) scores. A high score of 8.4/10 was assigned by patients regarding the product's ability to improve nasal cleansing. Enhanced decongestive action (score 8.2/10) and faster symptom improvement (score 8.0/10) was perceived by the product users. Patients were very satisfied with the product giving a high score of 24.7/30 on product's total effectiveness. The medical device had a high safety profile with few minor adverse events noted. These results support adjunctive treatment of HSS-Plus for symptomatic relief in patients with ENT disorders.
... Köksal [60] conducted a randomised controlled trial on 109 children to compare the safety and efficacy of saline (0.9%) and seawater (2.3%) as nasal drops (the patient group) and the control group (no treatment). The authors found a significant improvement between the control group and both intervention groups (p < 0.05). ...
Article
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Objective To identify the causes and treatments of nasal obstruction in the paediatric population. Methods A systematic search of Medline and Embase was conducted to identify the relevant articles. A detailed inclusion and exclusion criterion was developed and implemented to screen the abstracts. Full texts of the selected studies were then assessed to establish their inclusion or exclusion in our review. All relevant data were extracted, and the results were summarised narratively. Results Fifty-nine studies met out inclusion-exclusion criteria and were included in this systematic review. All of these primary research studies were categorised into causes and treatments. Cleft lip and palate was the most reported cause of nasal obstruction among congenital causes. However, among the acquired causes, allergic rhinitis was the most reported. Twenty-one of 39 studies described treatments for allergic rhinitis, including perennial rhinitis, 9 for adenoid hypertrophy, 2 for the common cold, 5 for septal deviation, and 2 for chronic rhinosinusitis. Conclusion This systematic review provides good evidence regarding the causes and treatments of nasal obstruction. Allergic rhinitis is the most common cause of acquired nasal obstruction, and cetirizine, fexofenadine, fluticasone furoate nasal spray, and mometasone furoate monohydrate nasal are the commonly used treatments to alleviate the symptoms.
... A second study of children <2 years (mean age 9.0 ± 3.9 months) found significant improvement in the two treatment groups of isotonic and sea-salt nasal saline irrigation when compared to the control group in nasal congestion, rhinorrhea, weakness, nutrition, sleep quality and diet (p<0.05) (48) . There was no significant difference in cough symptoms between the three groups (p>0.05). ...
Article
Full-text available
This paper provides a brief historical background of saline nasal irrigation (SNI), main modes of SARS-COV-2 transmission and entry, and anti-infective properties of saline. It reviews the protective evidence associated with SNI and gargling against viral upper respiratory tract infection (URTI). SARS-CoV-2 presents as an URTI transmitted mainly via respiratory droplets and aerosols to the oro-nasal mucosa and indirectly after touching these entry sites from contaminated fomites. It can potentially be transmitted from the conjunctival mucosa to the nasal mucosa or from resuspension and inhalation from the facial area around the nose. SNI has antiviral, anti-inflammatory and mucociliary restorative properties. Numerous randomized controlled trials have reported that SNI, with and without gargling, prevents and treats viral URTI. Based on biological rationale and anecdotal evidence we suggest a protocol: Soap and Water to the Hands and Face-Eye Rinse Nasal Irrigation and Gargling with Saline (SWHF-ERNIGS) may limit the transmission SARS-CoV-2, and prevent and treat COVID-19 infection. Clinical considerations of the protocol are presented. The protocol is safe, straightforward and can be easily performed by healthcare workers and the general public; it uses readily available salt, water and soap. Formal studies of effectiveness and application of the protocol are warranted.
... 29 In children <2 years treated with saline/ sea water drops (three times a day for 5 days), there was a significant reduction in URTI symptoms reported when compared with untreated children. 30 However, a Cochrane review concluded that no definitive conclusions could be drawn as the available studies were small and had major methodological limitations: baseline symptom score was calculated over 7 days (not at the point of entry) and groups had different characteristics at baseline. 31 We recently completed the Edinburgh and Lothians' Viral Intervention Study (ELVIS), an open label pilot randomised controlled trial (RCT) of HS nasal irrigation and gargling (HSNIG) in 66 adults with an URTI ( www. ...
Article
Full-text available
Introduction: Edinburgh and Lothians' Viral Intervention Study Kids is a parallel, open-label, randomised controlled trial of hypertonic saline (HS) nose drops (~2.6% sodium chloride) vs standard care in children <7 years of age with symptoms of an upper respiratory tract infection (URTI). Methods and analysis: Children are recruited prior to URTI or within 48 hours of developing URTI symptoms by advertising in areas such as local schools/nurseries, health centres/hospitals, recreational facilities, public events, workplaces, local/social media. Willing parents/guardians, of children <7 years of age will be asked to contact the research team at their local site. Children will be randomised to either a control arm (standard symptomatic care), or intervention arm (three drops/nostril of HS, at least four times a day, until 24 hours after asymptomatic or a maximum of 28 days). All participants are requested to provide a nasal swab at the start of the study (intervention arm: before HS drops) and then daily for four more days. Parent/guardian complete a validated daily diary, an end of illness diary, a satisfaction questionnaire and a wheeze questionnaire (day 28). The parent/guardian of a child in the intervention arm is taught to prepare HS nose drops. Parent/guardian of children asymptomatic at recruitment are requested to inform the research team within 48 hours of their child developing an URTI and follow the instructions already provided. The day 28 questionnaire determines if the child experienced a wheeze following illness. Participation in the study ends on day 28. Ethics and dissemination: The study has been approved by the West of Scotland Research Ethics Service (18/WS/0080). It is cosponsored by Academic and Clinical Central Office for Research and Development-a partnership between the University of Edinburgh and National Health Service Lothian Health Board. The findings will be disseminated through peer-reviewed publications, conference presentations and via the study website. Trial registration number: NCT03463694.
... At 100 GHz the ac-conductivity of pure water is 100 S/m at 20 C [24][25][26], whereas regular sea water is 75 S/m at 89 GHz [27]. As sea water is hypertonic [28] the ac-conductivity of pure water is a better base line for modeling. Although sweat contains ions, in our model we used values one order of magnitude more than water. ...
Article
The helical nature of human sweat ducts, combined with the morphological and dielectric properties of skin, suggests electromagnetic activity in the sub-THz frequency band. A detailed electromagnetic simulation model of the skin, with embedded sweat ducts, was created. The model includes realistic dielectric properties based on the measured water content of each layer of skin, derived from Raman Spectroscopy. The model was verified by comparing it to measurements of the reflection coefficient of the palms of 13 volunteers in the frequency band 350-410 GHz. They were subjected to a measurement protocol intended to induce mental stress, thereby also activating the sweat glands. The Galvanic Skin Response was concurrently measured. Using the simulation model the optimal ac-conductivity for each measurement was found. The range of variation for all subjects was found to be from 100 S/m to a maximum value of 6000 S/m with averages of 1000 S/m. These are one order of magnitude increase from the accepted values for water at these frequencies (~100 s/m at 100 GHz). Considering the known biochemical mechanism for inducing perspiration, we conclude that these ac-conductivity levels are probably valid, even though the real time measurements of sweat ac-conductivity levels inside the duct are inaccessible. This article is protected by copyright. All rights reserved.
Article
Antibacterial therapy in acute rhinosinusitis (ARS) is prescribed 4–9 times more often than recommended, while no >5 % of patients require such treatment. The main motive for the irrational antibiotic prescription is the presence of mucopurulent discharge and nasal congestion in combination with hyperthermia. The study objective was to determine the efficacy of hypertonic seawater solution in the technology of delayed antibiotic prescription in patients with ARS. Methods In a multicenter, randomized, open-label, comparative study, 100 children were randomized. 100 children with ARS aged 6–11 years, who received Aqua Maris Extra Strong irrigation therapy in addition to standard therapy or received standard therapy, completed the study. Evaluation criteria decreased intensity of nasal congestion, rhinorrhea, postnasal drip, headache and facial pain, assessed by the physician using a 4-point scale at each visit compared to Visit 1, dynamics of self-scored symptoms using a 10-point visual analogue scale, frequency of antipyretic and antibiotic prescription. Results The use of hypertonic seawater solution in patients with ARS provides a clinically significant reduction in the severity of core or key symptoms: rhinorrhea, nasal congestion, postnasal drip and headache, assessed by the physician at V2 (p < 0.05). There are significant differences in the dynamics of these symptoms according to the patient's self-assessment from treatment Day 2 (p < 0.05). The use of irrigation therapy with Aqua Maris Extra Strong in the technology of delayed antibiotic prescription in patients with ARS allows to reduce the prescription of antibacterial drugs. No on-treatment side effects were observed in any patient. Conclusion Hypertonic seawater solution Aqua Maris Extra Strong is a safe and effective medicinal product for the symptomatic treatment of acute rhinosinusitis in children aged 6–11 years/ It provides a significant therapeutic effect when prescribed in addition to standard therapy and helps to reduce the need for antibiotics.
Article
This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.
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Background: The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Treatment strategies often include the use of topical saline from once to more than four times a day. Considerable patient effort is often involved. Any additional benefit has been difficult to discern from other treatments. Objectives: To evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis. Search methods: Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2006), MEDLINE (1950 to 2006) and EMBASE (1974 to 2006). The date of the last search was November 2006. Selection criteria: Randomised controlled trials in which saline was evaluated in comparison with either no treatment, a placebo, as an adjunct to other treatments or against treatments. The comparison of hypertonic versus isotonic solutions was also compared. Data collection and analysis: Trials were graded for methodological quality using the Cochrane approach (modification of Chalmers 1990). Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis. A narrative overview of the remaining results is presented. Main results: Eight trials were identified that satisfied the inclusion criteria. Three studies compared topical saline against no treatment, one against placebo, one as an adjunct to and one against an intranasal steroid spray. Two studies compared different hypertonic solutions against isotonic saline. There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology 'placebo'. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear. Authors' conclusions: Saline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Objectives/hypothesis: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study design: A prospective controlled clinical study. Methods: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. Results: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. Conclusions: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease.
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Nasal irrigation has been used as an adjunctive therapy of allergic rhinitis (AR). Available evidence suggested that buffered hypertonic saline (BHS) is superior to buffer normal saline (BNS) for relief nasal symptoms. To evaluate the effectiveness of BHS nasal irrigation in the management of children with symptomatic AR. This was a randomized, prospective, double-blind placebo-controlled study. The present study was a randomized prospective double-blind placebo-controlled study. Eighty-one children with symptomatic AR who had a total nasal symptom score (TNSS)≥4 were included in this study. Each participant was randomly treated with either normal saline (NSS) or BHS by a blinded investigator. Nasal saccharine clearance time (SCT) and TNSS were measured before and 10 min after nasal irrigation. Quality of life (QoL) was assessed using the questionnaire for Thai allergic rhinoconjunctivitis patients (Rcq-36). The 7-point Likert scale for satisfaction was also performed. All participants were assigned to perform nasal irrigation twice daily for the period of 4 weeks. During this period, they recorded TNSS, side effects and antihistamine use on daily diary card. A physical examination and subjective evaluation were performed at 2nd and 4th week visits, and daily diary cards were collected. Patients with BHS were significantly improved in SCT (39.2% versus 15.5%, P=0.009) and TNSS (82.7% versus 69.3%, P=0.006) compared to the NSS group. However, at 2nd and 4th week both groups had improvement in TNSS and QoL compared to baseline visit. There was a significant improvement in mean QoL score in BHS group at 2nd week visit compared to NSS group (P=0.04) but not at the 4th week. Nasal congestion but not TNSS was significantly improved in the BHS group (P=0.04). Moreover, a decreased use of oral antihistamine was observed in BHS group (P=0.04). There were few complaints reported, and side effects were seen equally in both groups. Nasal irrigation with BHS causes an improvement in SCT, TNSS and QoL compare to NS in children with symptomatic AR.
Article
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Saline nasal irrigation is an adjunctive therapy for upper respiratory conditions that bathes the nasal cavity with spray or liquid saline. Nasal irrigation with liquid saline is used to manage symptoms associated with chronic rhinosinusitis. Less conclusive evidence supports the use of spray and liquid saline nasal irrigation to manage symptoms of mild to moderate allergic rhinitis and acute upper respiratory tract infections. Consensus guidelines recommend saline nasal irrigation as a treatment for a variety of other conditions, including rhinitis of pregnancy and acute rhinosinusitis. Saline nasal irrigation appears safe, with no reported serious adverse events. Minor adverse effects can be avoided with technique modification and salinity adjustment.
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To investigate the impact of nasal irrigation with isotonic or hypertonic sodium chloride solution on mucociliary clearance time in patients with allergic rhinitis, acute sinusitis and chronic sinusitis. Mucociliary clearance time was measured using the saccharine clearance test on 132 adults before and after 10 days' application of intranasal isotonic or hypertonic saline. Patient numbers were as follows: controls, 45; allergic rhinitis, 21; acute sinusitis, 24; and chronic sinusitis, 42. The results before and after irrigation were compared using the Wilcoxon t-test. Before application of saline solutions, mucociliary clearance times in the three patient treatment groups were found to be significantly delayed, compared with the control group. Irrigation with hypertonic saline restored impaired mucociliary clearance in chronic sinusitis patients (p < 0.05), while isotonic saline improved mucociliary clearance times significantly in allergic rhinitis and acute sinusitis patients (p < 0.05). Nasal irrigation with isotonic or hypertonic saline can improve mucociliary clearance time in various nasal pathologies. However, these solutions should be selectively prescribed rather than used based on anecdotal evidence. Further studies should be conducted to develop a protocol for standardised use of saline solution irrigation in various nasal pathologies.
Article
To evaluate the effect of nasal saline irrigation in the treatment of allergic rhinitis (AR) in children and to assess whether nasal saline irrigation could be used as a complementary therapy for AR in children in combination with the intranasal corticosteroids (INS). In total, 61 children with AR were divided into three groups: the nasal irrigation, intranasal corticosteroid, and combined treatment groups. Symptoms and signs of AR and eosinophils (EOS) in the nasal secretions were evaluated after 4 weeks, 8 weeks, and 12 weeks of treatment. In AR children treated with nasal irrigation and a decreased the INS dose, a significant improvement in symptoms and signs and a significant decrease in the mean EOS count in nasal secretions were observed at week 12. Nasal saline irrigation with physiological seawater is well tolerated and benefits the patients with AR, and can thus be considered a good adjunctive treatment option to maintain the effectiveness of the INS at a lower dose, thus resulting in reduced side effects and a decreased economic burden.
Article
The common cold, or upper respiratory tract infection, is one of the leading reasons for physician visits. Generally caused by viruses, the common cold is treated symptomatically. Antibiotics are not effective in children or adults. In children, there is a potential for harm and no benefits with over-the-counter cough and cold medications; therefore, they should not be used in children younger than four years. Other commonly used medications, such as inhaled corticosteroids, oral prednisolone, and Echinacea, also are ineffective in children. Products that improve symptoms in children include vapor rub, zinc sulfate, Pelargonium sidoides (geranium) extract, and buckwheat honey. Prophylactic probiotics, zinc sulfate, nasal saline irrigation, and the herbal preparation Chizukit reduce the incidence of colds in children. For adults, antihistamines, intranasal corticosteroids, codeine, nasal saline irrigation, Echinacea angustifolia preparations, and steam inhalation are ineffective at relieving cold symptoms. Pseudoephedrine, phenylephrine, inhaled ipratropium, and zinc (acetate or gluconate) modestly reduce the severity and duration of symptoms for adults. Nonsteroidal anti-inflammatory drugs and some herbal preparations, including Echinacea purpurea, improve symptoms in adults. Prophylactic use of garlic may decrease the frequency of colds in adults, but has no effect on duration of symptoms. Hand hygiene reduces the spread of viruses that cause cold illnesses. Prophylactic vitamin C modestly reduces cold symptom duration in adults and children.
Article
To determine the compliance with and tolerance of nasal saline irrigation in children. Phone survey. Tertiary pediatric hospital. Children diagnosed with nasal congestion and rhinorrhea from sinusitis, chronic rhinitis or allergic rhinitis were identified. Children who were prescribed a therapeutic course of nasal saline, who were instructed how to administer the treatment and who were available for follow up were included. Parents were contacted by phone and asked to complete a questionnaire regarding their child's experience with nasal saline irrigation. 61 Children met inclusion criteria. 73% of parents initially thought that nasal saline irrigation would be helpful, but only 28% thought that their children would tolerate the treatment. 93% of children made an attempt to use nasal saline irrigation and 86% were able to tolerate the treatment. 84% of parents whose children attempted nasal saline irrigation noted an improvement in their child's nasal symptoms. 77% of children that attempted nasal saline irrigation continue to use this treatment for symptom relief. 93% reported an improvement in their child's overall health that they attributed to this treatment. Perhaps the biggest barrier to routine recommendation of nasal saline irrigation in children is the assumption by both parents and physicians that children will not tolerate it. However, this study demonstrates that the majority of children, regardless of age, were judged by their parents to tolerate nasal saline irrigation.
Article
Background: Nasal irrigation has been used as adjunctive therapy for sinonasal disease but is under-researched in children. The study aim was to evaluate the effectiveness of nasal irrigation with normal saline in the management of acute sinusitis in atopic children. Methods: We enrolled 60 atopic children with acute sinusitis, of whom 29 received nasal irrigation with normal saline and 31 did not receive nasal irrigation. All participants underwent a nasal peak expiratory flow rate (nPEFR) test, a nasal smear examination, and radiography (Water's projection) and were requested to complete a Pediatric Rhinoconjunctivitis Quality-of-Life Questionnaire (PRQLQ) during the baseline visit. All participants were requested to record symptoms in a daily diary and were followed up at 1-week intervals. A physical examination, nasal smear, and nPEFR were performed at each visit, and all daily diaries were collected. At the final visit (after 3 weeks), the symptom diaries were reviewed and participants were requested to complete the PRQLQ again. nPEFR, radiography, and a nasal smear were also repeated. Results: There were significant improvements in mean PRQLQ and nPEFR values (p < 0.05) for the irrigation compared to the non-irrigation group. There was no significant difference in radiographic findings between the groups (p > 0.05). The irrigation group recorded significant improvements in eye congestion, rhinorrhea, nasal itching, sneezing, and cough symptoms compared with the non-irrigation group. Conclusion: Nasal irrigation is an effective adjunctive treatment for acute sinusitis in atopic children.