Article

Nasal irrigation: Opportunities and disadvantages

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Relevance: Despite the widespread use of nasal irrigation in routine medical practice and a significant list of salt solution for nasal irrigation on the pharmaceutical market, contradictions remain in understanding of process essence, when salt solution acts on the mucous membrane of nasal cavity and evaluation of their effectiveness. Aim: analysis of current data of frequency, methods and efficiency of systematic nasal irrigation and effect of salt solution at the mucous membrane of nasal cavity. Results: In review the authors generalized and analyzed recent information about meaning of nasal irrigation for upper respiratory tract disease, about role of nasal mucus at maintaining homeostasis in nasal cavity and initial respiratory tract in general. Describes the data about effect of nasal irrigation on antinfectious protect of mucous membrane of nasal cavity.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Крайне важна местная терапия ОР. Ирригационно-элиминационная терапия в виде промывания полости носа растворами морской воды продемонстрировала свою высокую эффективность и безопасность [12]. В настоящее время в аптеках представлены изотонические и гипертонические растворы морской воды. ...
Article
Nasal decongestants (ND) are representatives of the pharmacological group of α-adrenomimetics and are widely used in clinical practice. These drugs are successfully used as symptomatic therapy of acute rhinosinusitis (AR), as well as as part of the complex therapy of acute otitis during unloading therapy for the auditory tube. The use of ND is necessary before conducting an endoscopic examination of the nasal cavity, for a better assessment of the state of the ostiomeatal complex, the olfactory cleft, as well as differential diagnosis of various forms of rhinitis and dysosmia. ND are indispensable in the prevention of complications of AR, such as acute eustachiitis, exudative otitis media and acute otitis media. Also, these drugs are used in the prevention of the development of aerotitis and ear barotrauma. The most commonly used nasal medications of medium and long duration of action, such as xylometazoline and oxymetazoline. This article presents clinical studies demonstrating the high efficacy and safety of these drugs as part of the treatment of AR. It is shown that oxymetazoline and xylometazoline are well tolerated by patients with a minimum number of adverse events. Modern representatives of ND are such drugs as Otrivin express 0.05% with the aroma of menthol, the main active ingredient of which is oxymetazoline, Otrivin 0.1% Moisturizing formula and Otrivin 0.1% with menthol and eucalyptus, which includes xylometazoline as the main active ingredient. These drugs have confirmed their effectiveness and safety in a large number of clinical studies and can be recommended as local vasoconstrictors.
Article
Irrigation therapy is widely used in clinical practice for the treatment of acute rhinosinusitis. One of the methods of irrigation therapy is the Proetz method. This method has many contraindications and is associated with the development of a number of complications, which are not always taken into account by otorhinolaryngologists. We present a number of observations of complications associated with an uncontrolled pressure decrease in the nasal cavity and paranasal sinuses.
Article
Full-text available
It has long been known, that nasal saline irrigation is a safe and effective method, which is routinely prescribed by otorhinolaryngologists to prevent and to treat a wide range of pathologies. There are a lot of publications on different irrigation techniques and methods. This literature review discusses the key parameters of nasal irrigation, including tonicity, pH, and the additional components, and explains how they affect the effectiveness of the procedure. The vast majority of available publications did not found any possible changes in the effectiveness of solutions with different pH close to neutral meaning. Whereas, the volume of the irrigated solution, increases the efficiency of the irrigation in direct proportion. Thus, the largest distribution area of the solute is noted when washing with a large volume of liquid. Nasal saline irrigation is an effective treatment option for patients with several acute and chronic diseases and for postoperative care after rhinosurgery. Moreover, nasal irrigation might be used as an effective non-specific method for prevention of acute upper respiratory tract infections. Irrigation of the nasal cavity reduces the mucus viscosity and promotes its faster elimination, along with pathogens fixed in it. Additionally, irrigation with isotonic saline solutions increases the hydration of the underlying water base, which enhances the frequency of ciliary beat and reduces the concentration of local inflammatory mediators. COVID-19 pandemic situation due to lack of any specific antiviral drugs dictates the necessity of an effective non-specific preventive option, which could be introduced worldwide. The so-called full volume lavage of the nasal cavity allows for better cleaning of the nasal cavity and effective moisturizing of the mucous membrane. It is the timely cleansing and moisturizing that are most important for maintaining the normal activity of the local protective mechanisms of the upper respiratory tract.
Article
Full-text available
Acute infectious and inflammatory diseases of the upper respiratory tract today belong to the category of the most common pathological conditions. Most often they occur in the form of acute nasopharyngitis, acute rhinosinusitis and acute laryngitis, the clinical of which consists of such symptoms as general weakness, hyperthermia, nasal blockage and nasal discharge, dysosmia, pain and tickling in the throat, cough, dysphonia. The need to select a safe and effective mucoactive therapy justifies the use of the phytopreparation in this pathology, the main active ingredient of which is an extract of ivy leaves. Also in the composition of the drug includes anise oil, peppermint oil, eucalyptus oil and levomenthol. The mechanism of action of is associated with α-hederin contained in ivy leaves. This substance, binding to the beta-adrenoreceptors of the bronchi, causes relaxation of their smooth muscles. In addition, thanks to the saponins contained in the leaves of common ivy, a mucolytic and expectorant effect is achieved. Literature data show that ivy leaf preparations significantly reduce the severity of acute respiratory infections of the upper respiratory tract. Virtually none of the patients had severe side effects. Allergic reactions were recorded in less than 0.5% of cases, with no mention of a severe allergic reaction of the anaphylaxis type. Thus, the drug of plant origin in the form of drops can be successfully used in patients with symptoms of acute respiratory diseases.
Article
Full-text available
Background: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Nasal saline irrigation is commonly used to improve patient symptoms. Objectives: To evaluate the effects of saline irrigation in patients with chronic rhinosinusitis. Search methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 9); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 30 October 2015. Selection criteria: Randomised controlled trials (RCTs) with a follow-up period of at least three months comparing saline delivered to the nose by any means (douche, irrigation, drops, spray or nebuliser) with (a) placebo, (b) no treatment or (c) other pharmacological interventions. Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the commonest adverse event - epistaxis. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of local irritation and discomfort. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. Main results: We included two RCTs (116 adult participants). One compared large-volume (150 ml) hypertonic (2%) saline irrigation with usual treatment over a six-month period; the other compared 5 ml nebulised saline twice a day with intranasal corticosteroids, treating participants for three months and evaluating them on completion of treatment and three months later. Large-volume, hypertonic nasal saline versus usual careOne trial included 76 adult participants (52 intervention, 24 control) with or without polyps.Disease-specific HRQL was reported using the Rhinosinusitis Disability Index (RSDI; 0 to 100, 100 = best quality of life). At the end of three months of treatment, patients in the saline group were better than those in the placebo group (mean difference (MD) 6.3 points, 95% confidence interval (CI) 0.89 to 11.71) and at six months there was a greater effect (MD 13.5 points, 95% CI 9.63 to 17.37). We assessed the evidence to be of low quality for the three months follow-up and very low quality for the six months follow-up. Patient-reported disease severity was evaluated using a "single-item sinus symptom severity assessment" but the range of scores is not stated, making it impossible for us to determine the meaning of the data presented.No adverse effects data were collected in the control group but 23% of participants in the saline group experienced side effects including epistaxis. General HRQL was measured using SF-12 (0 to 100, 100 = best quality of life). No difference was found after three months of treatment (low quality evidence) but at six months there was a small difference favouring the saline group, which may not be of clinical significance and has high uncertainty (MD 10.5 points, 95% CI 0.66 to 20.34) (very low quality evidence). Low-volume, nebulised saline versus intranasal corticosteroidsOne trial included 40 adult participants with polyps. Our primary outcome of disease-specific HRQL was not reported. At the end of treatment (three months) the patients who had intranasal corticosteroids had less severe symptoms (MD -13.50, 95% CI -14.44 to -12.56); this corresponds to a large effect size. We assessed the evidence to be of very low quality. Authors' conclusions: The two studies were very different in terms of included populations, interventions and comparisons and so it is therefore difficult to draw conclusions for practice. The evidence suggests that there is no benefit of a low-volume (5 ml) nebulised saline spray over intranasal steroids. There is some benefit of daily, large-volume (150 ml) saline irrigation with a hypertonic solution when compared with placebo, but the quality of the evidence is low for three months and very low for six months of treatment.
Article
Full-text available
Objective To assess the effectiveness of nasal saline irrigation in adult patients with chronic rhinosinusitis.Data SourcesPubMed, EMBASE, the Cochrane Library.Review MethodsA comprehensive search was performed, and 2 authors independently screened publications. The design of selected studies was assessed on directness of evidence and risk of bias.ResultsOf 1596 publications, 1 open-label randomized trial with high directness of evidence and moderate risk of bias was included. In this study, 127 patients were randomly allocated to isotonic nasal saline irrigation or isotonic nasal saline spray, as added to their usual medication. The mean 20-Item Sinonasal Outcome Test (SNOT-20) scores of those treated with nasal irrigation improved more than those allocated to nasal spray. While the authors consider an improvement of 16 or more to be clinically meaningful, the changes from baseline in mean SNOT-20 scores of those treated with irrigation (and the differences with those treated with nasal spray) at 2, 4, and 8 weeks were 12.2 (difference 5.5, [95% confidence interval -0.04 to 11.0]), 16.2 (difference 8.8 [3.2 to 14.4]), and 15.0 (difference 6.5 [0.4 to 12.6]), respectively. Side effects of posttreatment nasal dripping were common but minor and did not lead to discontinuation of treatment.Conclusion and RecommendationIt should be explained to adult patients with chronic rhinosinusitis that there is limited information on the relative effect of nasal saline irrigation and nasal saline spray on subjective symptom improvement, since there is only 1 trial available with a moderate risk of bias showing limited benefit of irrigation over spray.
Article
Full-text available
: Grass pollen grain, an important aeroallergen, can disperse in the environment pollen cytoplasmic granules (PCGs) able to release water-soluble allergens when they are washed out by rainfall. The allergenicity of these washed PCGs is, however, preserved. : The purpose of the study was to assess the allergenic potential of washed and unwashed PCGs, from Phleum pratense pollen grains, in the Brown Norway rat, and to study the IgE reactivity of sera of sensitized rats to water-soluble and water-insoluble extracts of PCGs and pollen grains. : Rats were sensitized and challenged intratracheally with washed or unwashed PCGs or pollen grains. Using water-soluble and -insoluble extracts of pollen grains and/or PCGs, IgE ELISA and immunoblotting were performed with rat sera. Proliferation of bronchial lymph node cells was monitored by [H]-thymidine incorporation in a lymph node assay. Alveolar cells, proteins, and TH1 and TH2 cytokines were quantified in bronchoalveolar lavage fluid. : Rats sensitized with unwashed PCGs showed a predominant humoral response with high serum IgE and reactivity to water-soluble and -insoluble proteins together with low lymph node cell proliferation. Conversely, in rats sensitized to washed PCGs, cellular responses were higher with significant increases in eosinophils, lymphocytes, and TH2 cytokines observed in bronchoalveolar lavage fluid. : Allergic and inflammatory responses were induced by both grass pollen grains and their isolated washed and unwashed PCGs. However, on the basis of humoral and cellular responses, differential patterns were observed. Water-insoluble allergens seem to play a role in the centrally mediated inflammatory response, whereas water-soluble allergens may be involved in the peripheral humoral response.
Article
Full-text available
It was previously shown that 50% of irrigation bottles and 40% of irrigation fluids had evidence of bacterial contamination despite cleaning with hot water and soap. Although a novel method of microwave disinfection has recently been proposed to minimize contamination risk, this has not been studied in a real life setting. This study investigates the effectiveness of microwave disinfection for reducing both nasal irrigation bottle and irrigation fluid contamination risk after endoscopic sinus surgery (ESS). Twenty consecutive patients underwent ESS for chronic rhinosinusitis. Patients were given NeilMed Sinus Rinse bottles (NeilMed Pharmaceuticals, Inc., Santa Rosa CA) to use twice daily, with microwave cleaning instructions preoperatively. Bottles were collected and cultured 1 week postoperatively. Sterile saline (5 mL) was mixed into the irrigation bottle and cultured separately. An additional 10 patients were recruited whereby the bottle was cultured at collection and immediately after microwave disinfection was performed in the clinic. For the first cohort of the study, 40% of the bottles and 20% of the irrigation samples had positive cultures 1 week postoperatively. Common bacteria included Acinetobacter, coagulase-negative Staphylococcus, and Gram-negative bacilli. For the second cohort of patients, 20% of the irrigation bottles had positive cultures. However, after supervised microwave disinfection, there was a 0% contamination rate. Despite detailed instructions on microwave disinfection, positive bacterial cultures may still occur after ESS. This risk, however, appears to be significantly reduced when bottles are microwaved under supervision. These findings suggest either a reduced patient compliance to cleaning or a time-dependent recontamination risk after disinfection.
Article
Full-text available
Saline nasal irrigation (SNI) is often recommended as additional nonpharmacologic treatment, having proven its efficacy in acute and chronic rhinosinusitis and for therapy after sinonasal surgery. To date, however, no systematic review or meta-analysis exists showing the influence of SNI on allergic rhinitis (AR). This study aimed to establish the impact of SNI on symptoms of AR in different patient groups. We conducted a systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science databases for literature published from 1994 to 2010 on SNI in AR. Prospective, randomized, controlled trials that assessed the effects of SNI on four different outcome parameters were included. The evaluation focused on primary (symptom score) and secondary parameters (medicine consumption, mucociliary clearance, and quality of life). Three independent reviewers chose 10 originals that satisfied the inclusion criteria (>400 participants total) from 50 relevant trials. SNI performed regularly over a limited period of up to 7 weeks was observed to have a positive effect on all investigated outcome parameters in adults and children with AR. SNI produced a 27.66% improvement in nasal symptoms, a 62.1% reduction in medicine consumption, a 31.19% acceleration of mucociliary clearance time, and a 27.88% improvement in quality of life. SNI using isotonic solution can be recommended as complementary therapy in AR. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient's health or causes unexpected side effects.
Article
Full-text available
Sinonasal saline irrigation has become an accepted practice in the immediate postoperative management of functional endoscopic sinus surgery (FESS) patients. Recent studies have found that valveless delivery systems of sinonasal irrigation are colonized with bacteria. An alternative delivery system uses a one-way valve to reduce saline backflow and may limit bottle contamination. Our sole objective was to determine whether this system in post-FESS patients eliminates microbial bottle contamination. Eight patients undergoing FESS were given one-way valve irrigation bottles to use immediately after surgery. Bottles were collected after 1 week of use and another set of bottles after an additional week. Endoscopic-directed cultures of the middle meatus were performed at the time of surgery. Returned used bottles were swabbed for bacteria and the valve system of the bottle was analyzed under scanning electron microscopy (SEM) for the presence of bacteria. All sinus swabs collected at the time of surgery grew bacteria with Staphylococcus sp. present in all samples. After the 1st week of use, 5/8 bottles grew bacterial cultures and showed bacterial presence on the valves by SEM. After the 2nd week, 4/5 bottles had positive culture results and also showed bacterial presence on the valves by SEM. Despite commercial claims that the use of valves and limit of backflow into the bottle will eliminate contamination, our study showed that one-way valve delivery systems become contaminated with bacteria after 1 week of use. We also showed that the bottle valves themselves harbor bacteria after 1 week of use.
Article
Background: Allergic rhinitis is a common condition affecting both adults and children. Patients experience symptoms of nasal obstruction, rhinorrhoea, sneezing and nasal itching, which may affect their quality of life.Nasal irrigation with saline (salty water), also known as nasal douching, washing or lavage, is a procedure that rinses the nasal cavity with isotonic or hypertonic saline solutions. It can be performed with low positive pressure from a spray, pump or squirt bottle, with a nebuliser or with gravity-based pressure in which the person instils saline into one nostril and allows it to drain out of the other. Saline solutions are available over the counter and can be used alone or as an adjunct to other therapies. Objectives: To evaluate the effects of nasal saline irrigation in people with allergic rhinitis. Search methods: The Cochrane ENT Information Specialist searched the ENT Trials Register; CENTRAL; Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 November 2017. Selection criteria: Randomised controlled trials (RCTs) comparing nasal saline irrigation, delivered by any means and with any volume, tonicity and alkalinity, with (a) no nasal saline irrigation or (b) other pharmacological treatments in adults and children with allergic rhinitis. We included studies comparing nasal saline versus no saline, where all participants also received pharmacological treatment (intranasal corticosteroids or oral antihistamines). Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Primary outcomes were patient-reported disease severity and a common adverse effect - epistaxis. Secondary outcomes were disease-specific health-related quality of life (HRQL), individual symptom scores, general HRQL, the adverse effects of local irritation or discomfort, ear symptoms (pain or pressure) and nasal endoscopy scores. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. Main results: We included 14 studies (747 participants). The studies included children (seven studies, 499 participants) and adults (seven studies, 248 participants). No studies reported outcomes beyond three months follow-up. Saline volumes ranged from 'very low' to 'high' volume. Where stated, studies used either hypertonic or isotonic saline solution.Nasal saline versus no saline treatmentAll seven studies (112 adults; 332 children) evaluating this comparison used different scoring systems for patient-reported disease severity, so we pooled the data using the standardised mean difference (SMD). Saline irrigation may improve patient-reported disease severity compared with no saline at up to four weeks (SMD -1.32, 95% confidence interval (CI) -1.84 to -0.81; 407 participants; 6 studies; low quality) and between four weeks and three months (SMD -1.44, 95% CI -2.39 to -0.48; 167 participants; 5 studies; low quality). Although the evidence was low quality the SMD values at both time points are considered large effect sizes. Subgroup analysis showed the improvement in both adults and children. Subgroup analyses for volume and tonicity were inconclusive due to heterogeneity.Two studies reported methods for recording adverse effects and five studies mentioned them. Two studies (240 children) reported no adverse effects (epistaxis or local discomfort) in either group and three only reported no adverse effects in the saline group.One study (48 children) reported disease-specific HRQL using a modified RCQ-36 scale. It was uncertain whether there was a difference between the groups at any of the specified time points (very low quality). No other secondary outcomes were reported.Nasal saline versus no saline with adjuvant use of intranasal steroids or oral antihistamines Three studies (40 adults; 79 children) compared saline with intranasal steroids versus intranasal steroids alone; one study (14 adults) compared saline with oral antihistamines versus oral antihistamines alone. It is uncertain if there is a difference in patient-reported disease severity at up to four weeks (SMD -0.60, 95% CI -1.34 to 0.15; 32 participants; 2 studies; very low quality) or from four weeks to three months (SMD -0.32, 95% CI -0.85 to 0.21; 58 participants; 2 studies; very low quality). Although none of the studies reported methods for recording adverse effects, three mentioned them: one study (40 adults; adjuvant intranasal steroids) reported no adverse effects (epistaxis or local discomfort) in either group; the other two only reported no adverse effects in the saline group.It is uncertain if saline irrigation in addition to pharmacological treatment improved disease-specific HRQL at four weeks to three months, compared with pharmacological treatment alone (SMD -1.26, 95% CI -2.47 to -0.05; 54 participants; 2 studies; very low quality). No other secondary outcomes were reported.Nasal saline versus intranasal steroidsIt is uncertain if there was a difference in patient-reported disease severity between nasal saline and intranasal steroids at up to four weeks (MD 1.06, 95% CI -1.65 to 3.77; 14 participants; 1 study), or between four weeks and three months (SMD 1.26, 95% CI -0.92 to 3.43; 97 participants; 3 studies), or indisease-specific HRQL between four weeks and three months (SMD 0.01, 95% CI -0.73 to 0.75; 83 participants; 2 studies). Only one study reported methods for recording adverse effects although three studies mentioned them. One (21 participants) reported two withdrawals due to adverse effects but did not describe these or state which group. Three studies reported no adverse effects (epistaxis or local discomfort) with saline, although one study reported that 27% of participants experienced local discomfort with steroid use. No other secondary outcomes were reported. Authors' conclusions: Saline irrigation may reduce patient-reported disease severity compared with no saline irrigation at up to three months in both adults and children with allergic rhinitis, with no reported adverse effects. No data were available for any outcomes beyond three months. The overall quality of evidence was low or very low. The included studies were generally small and used a range of different outcome measures to report disease severity scores, with unclear validation. This review did not include direct comparisons of saline types (e.g. different volume, tonicity).Since saline irrigation could provide a cheap, safe and acceptable alternative to intranasal steroids and antihistamines further high-quality, adequately powered research in this area is warranted.
Article
Background Allergic rhinitis (AR) is a significant issue in children. Treatment options include allergen avoidance, pharmacotherapy and immunotherapy. The use of nasal saline douching (NSD) in children has recently gained acceptability. However, there is limited data regarding the acceptability and tolerability of NSD in children with AR. Methods A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of NSD in children aged 4–12 years with AR. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. Results 40 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of NSD include parental and health professionals' preconceptions, and characteristics of the solution. Conclusions Nasal saline douching appears to be effective, being accepted and tolerated in the majority of children (78–100%). NSD has a significant positive impact on the quality of life in children with allergic rhinitis. When used as an adjunctive treatment having mainly a cleansing property, NSD potentiates the effects and may reduce the dose required of AR medications. Among the principal factors that influence the acceptability and tolerability of NSD are the child's age, delivery system and method, and tonicity. Nasal saline douching provides an accessible, low cost, low morbidity, easy to use treatment in children with allergic rhinitis.
Article
Objectives: Acute rhinosinusitis (ARS) is a common pediatric problem. Our aim was to determine the efficacy of normal nasal saline irrigation (NSI) with or without amoxicillin in treatment of acute rhinosinusitis (ARS) in children. Methods: It is a prospective randomized, blind placebo-controlled trial. Children with uncomplicated ARS were recruited. One group received (amoxacillin 100mg/kg/day) and 0.9% NSI. The second group received placebo and 0.9% NSI. The primary outcome was the effect of treatment on clinical response. Secondary outcomes included: Rating of Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), middle meatus (MM) bacteriological and cytological cellular responses and adverse effects. Results: Sixty two patients with ARS were eligible for the study. In amoxicillin group (31 patients); clinical cure was observed in 26 (83.9%) in comparison to 22 (71%) patients in NSI without antibiotics group (31 patients) (p=0.22). No differences between both groups in the reported nasal symptom scores and total symptoms scores improvements at day 7 (p=0.09 and 0.65) and day 14 (p=0.29 and 0.14), respectively. The mean total PRQLQ values had no differences between both groups after the 2 weeks of treatment (p=0.06). At day 7, MM neutrophils reduced significantly in amoxicillin group in comparison to placebo group (p=0.004). At day 14, the MM cytological content had no differences between both groups (p=0.07). Normal NSI with placebo has less reported adverse effects than amoxicillin and nasal saline irrigations (p=0.005). Conclusions: NSI can be used alone with the same clinical, bacteriological and cytological cellular changes efficacy and with higher safety profile than amoxicillin after 14 days of treatment in uncomplicated clinically diagnosed ARS in children.
Article
Saline-based irrigation solutions are evidence-based rhinological treatments; however, the formulation of these solutions could theoretically alter the function of innate antimicrobial peptides. The aim of this study was to determine if the antimicrobial activity of normal human nasal secretions in vivo is altered by commercially available large volume irrigation solutions. Minimally manipulated sinonasal secretions were collected from patients with chronic rhinosinusitis (CRS; n = 10) and normal healthy volunteers (n = 20). In a subset of control patients (n = 10) secretions were collected prior to, and at 1 hour, 6 hours, and 24 hours after nasal irrigation with 4 commercial irrigation solutions. Lysozyme and lactoferrin levels were analyzed and the antimicrobial activity of secretions determined using a radial diffusion assay. The antimicrobial activity of nasal secretions was reduced in CRS patients compared to healthy volunteers (p < 0.01), but there was no significant difference in antimicrobial peptide concentrations. Isotonic nasal irrigation reduced lysozyme and lactoferrin levels, which returned to baseline levels by 6 hours; in addition to a sustained decrease in antimicrobial activity before returning to baseline at 24 hours. Low-salt solution stimulated peptide secretion by approximately 40% at 6 hours and 24 hours, but produced a transient decrease in antimicrobial activity, returning to baseline levels by 6 hours. Hypertonic solution initially decreased lysozyme and lactoferrin levels but maintained baseline levels of antimicrobial activity and increased peptide secretion by approximately 30% at 24 hours. The formulation of nasal irrigation solutions significantly affects the measured levels and functionality of sinonasal antimicrobial peptides. © 2015 ARS-AAOA, LLC.
Article
Background: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and decongestant drugs and sometimes antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for URTI symptoms despite a relative lack of evidence for benefit in this clinical setting. This review is an update of the Cochrane review by Kassel et al, which found that saline was probably effective in reducing the severity of some symptoms associated with acute URTIs. Objectives: To assess the effects of saline nasal irrigation for treating the symptoms of acute URTIs. Search methods: We searched CENTRAL (2014, Issue 7), MEDLINE (1966 to July week 5, 2014), EMBASE (1974 to August 2014), CINAHL (1982 to August 2014), AMED (1985 to August 2014) and LILACS (1982 to August 2014). Selection criteria: Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs. Data collection and analysis: Two review authors (DK, BM) independently assessed trial quality with the Cochrane 'Risk of bias' tool and extracted data. We analysed all data using the Cochrane Review Manager software. Due to the large variability of outcome measures only a small number of outcomes could be pooled for statistical analysis. Main results: We identified five RCTs that randomised 544 children (three studies) and 205 adults (exclusively from two studies). They all compared saline irrigation to routine care or other nose sprays, rather than placebo. We included two new trials in this update, which did not contribute data of sufficient size or quality to materially change the original findings. Most trials were small and we judged them to be of low quality, contributing to an unclear risk of bias. Most outcome measures differed greatly between included studies and therefore could not be pooled. Most results showed no difference between nasal saline treatment and control. However, one larger trial, conducted with children, did show a significant reduction in nasal secretion score (mean difference (MD) -0.31, 95% confidence interval (CI) -0.48 to -0.14) and nasal breathing (obstruction) score (MD -0.33, 95% CI -0.47 to -0.19) in the saline group. However, a MD of -0.33 on a four-point symptom scale may have minimal clinical significance. The trial also showed a significant reduction in the use of decongestant medication by the saline group. Minor nasal discomfort and/or irritation was the only side effect reported by a minority of participants. Authors' conclusions: Nasal saline irrigation possibly has benefits for relieving the symptoms of acute URTIs. However, the included trials were generally too small and had a high risk of bias, reducing confidence in the evidence supporting this. Future trials should involve larger numbers of participants and report standardised and clinically meaningful outcome measures.
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
Lysozyme is an innate immune peptide with bactericidal and fungicidal activity (FA). Despite increased expression of lysozyme protein in chronic rhinosinusitis (CRS) sinus mucosa, CRS patients experience repeated bacterial and/or fungal infections. Commercial sinus irrigation solutions are often used to provide symptomatic relief. However, one of the mechanisms of action of lysozyme involves ionic interactions with the microbial cell wall, which may be inhibited by ionic solutions such as commercial sinus irrigation solutions. Determine if the FA of lysozyme is reduced in the presence of solutions with increasing ionic strength and inhibited in the presence of commercial sinus irrigation solutions. Using an in vitro colony-forming unit (CFU) assay, the FA of lysozyme (5 μM) was tested against a fungi commonly isolated from CRS patients, Aspergillus fumigatus, in solutions of increasing ionic strength or commercial sinus irrigation solutions. FA was presented as percent of control. FA of lysozyme against A. fumigatus was 95% in a 21-mM ionic strength solution. However, with increasing ionic strength, FA decreased and was abolished in a 46-mM ionic strength solution. Commercial sinus irrigation solutions abolished the FA of lysozyme against A. fumigatus. The in vitro FA of lysozyme is dependent on the ionic strength of the solution. The use of sinus irrigation solutions should be further evaluated with regard to maintaining functional activity of cationic antimicrobial peptides involved in sinonasal innate immunity.
Article
This review examines the literature regarding nasal saline irrigation in the management of sinonasal disease. We explore the various properties of nasal irrigation solutions and their effects on nasal symptoms. English-language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through December 2011. Randomized, controlled trials (RCTs), prospective controlled and comparative studies, and observational studies reporting on the indications, efficacy, and safety of nasal saline irrigation. Nasal saline irrigation has often been used as both a solo and an adjunctive treatment in sinonasal diseases, including allergic rhinitis and chronic rhinosinusitis. Nasal saline irrigation has contributed to a reduction of inflammation as well as relief of nasal symptoms. Identifying the optimal technique is hampered by the fact that studies have employed various delivery devices and saline compositions, which subsequently have demonstrated different effects on mucus clearance, ciliary beat activity, and inflammatory mediators. Overall, the data appear to demonstrate some small clinical benefit to nasal saline irrigation. Nasal saline irrigation is well tolerated, with minimal side effects. Further definitive studies are needed to optimize efficacy.
Article
This study aimed to assess the clinical relevance of contamination of nasal irrigation bottles in patients with recalcitrant chronic rhinosinusitis (CRS). Secondary investigations to identify the presence of bacterial biofilms on the inner surface of the bottles and to assess different sterilization methods were also undertaken. Prospective, observational. Eleven patients with recalcitrant CRS who were already using nasal irrigation as part of their treatment regimen were examined every 2 weeks for a period of 6 weeks. At each visit, a culture sample was taken from their irrigation bottle and middle meatus, and they were given a new irrigation bottle. Irrigation bottles from six patients were analyzed with scanning electron microscopy (SEM) to detect biofilm formation. Finally, new bottles were inoculated with different strains of Staphylococcus aureus and then cleaned with different methods. The bottles were cultured immediately after cleaning and 48 hours later. Overall, 42 of 43 (97%) bottles collected demonstrated bacterial growth. Concurrent sinonasal and bottle infection with S. aureus was seen in 51% of patients during the study. Bacterial biofilms were demonstrated on the inner surface of four of the six irrigation bottles tested. Treatment with Milton's solution (1% NaOCl plus 19% NaCl) and microwaving were found to be effective methods for sterilizing the bottles both initially after the cleaning and 48 hours later. Patients who irrigate their nose and sinuses commonly contaminate their irrigation bottle, most often with S. aureus, which can be in the biofilm form. Simple cleaning methods could reduce contamination of the bottles. Laryngoscope, 2010
Article
Endoscopic sinus surgery is an accepted treatment for medically recalcitrant chronic rhinosinusitis. Effective saline douching may improve long-term outcomes of chronic rhinosinusitis but is often impaired by postoperative ostial stenosis. The aim of this study is to determine a critical ostial size at which douching solution reliably enters the sinus cavities. Prospective study of consecutive patient cohort. Seventeen preoperative or well-healed postoperative endoscopic sinus surgery patients were irrigated with 5 mL blue food coloring mixed with 200 mL buffered saline from a squeeze bottle. The degree of sinus penetration, sinus ostial patency, and ostial size were endoscopically determined. Sinuses penetrated by blue dye had a significantly larger minimal ostial dimension (7.31 mm; 95% confidence interval 5.54-9.08) than those that had no blue dye penetration (1.26 mm; 95% confidence interval 0.86-1.66) as determined by Student t test. Chi-square analysis showed that operated sinuses were more likely to be penetrated than nonoperated sinuses (P = .0016) and obstructed sinuses (P = .0325). Logistic regression showed a 95% probability of penetration when the minimum ostial dimension is 3.95 mm or greater. Unoperated sinuses or cases with gross sinus ostial obstruction will not be reliably penetrated by sinus irrigant. A 3.95-mm ostial diameter seems to be the minimum size to guarantee penetration in paranasal sinuses to maximize the potential for topical sinus treatment.
Article
Nasal douching is recommended for the treatment of a variety of diseases of the nose and paranasal sinuses. Nasal douching with saline solution has proven to be effective in chronic rhinosinusitis and after sinus surgery and is recommended by different otolaryngologic societies. A systematic review of the literature was performed to determine whether nasal douching is effective in the treatment of acute rhinosinusitis and in preventing recurrent upper respiratory tract infections. We also reviewed whether nasal douching has adverse eff ects and can lead to recurrent upper respiratory tract infections if performed regularly over a longer period of time. Nasal douching with saline solution has a limited effect in adults with acute rhinosinusitis (level of evidence Ia). It is effective in children with acute rhinosinusitis in addition to the standard medication (level of evidence Ib) and can prevent recurrent infections (level of evidence IIb). It is assumed that nasal douching improves the function of the mucous membranes. There is currently no evidence that daily nasal douching with isotonic saline solution over a longer period of time has an adverse effect on the individual health or leads to a higher rate of infections. Nasal douching with saline solutions can be recommended for adults with acute rhinosinusitis (grade of recommendation A), in addition to the standard medication in children with acute rhinosinusitis (grade of recommendation A) and to prevent recurrent infections (grade of recommendation B).
Article
Acute upper respiratory tract infections (URTIs) are infections of the upper airways that can cause symptoms for up to four weeks. Acute URTIs include colds, influenza and infections of the throat, nose or sinuses. The symptoms are often treated with painkillers and decongestants. Sometimes antibiotics are prescribed, although most acute URTIs are caused by viruses. Nasal saline sprays or irrigation have been used to treat symptoms of chronic airway infections, and sometimes for acute infections. This review is limited by the differences in the characteristics of the included studies, including study populations and outcome measures. However, it found little research to support the use of nasal saline for acute URTIs. Included studies showed limited benefit for symptoms relief with nasal saline irrigation in adults. Nasal saline is safe and may reduce time off work but may cause minor adverse effects such as dry nose or irritation in less than half of users. Future studies are needed to establish the use of nasal saline irrigation as a way of reducing acute URTI symptoms safely while keeping people at work and reducing antibiotic use.
Article
Saline nasal irrigation has become an important aspect of post-operative care following endoscopic sinus surgery. The objective of this study was to identify the risks of contamination of both the nasal irrigation bottle and fluid following endoscopic sinus surgery. This was a prospective study of consecutive patients undergoing endoscopic sinus surgery for chronic sinusitis. All patients were given nasal irrigation bottles with detailed cleaning instructions preoperatively. Nasal irrigation bottles were collected and cultured at 1 and 2 weeks postoperatively. During the same visit, 5-ml of sterile normal saline was mixed into the irrigation bottle and then cultured separately. A total of 20 patients agreed to participate in the study. At 1 week postoperatively, 50% of the bottles had positive cultures with 40% of the irrigation samples testing positive for bacteria. At two weeks, the contamination in the irrigation bottle and fluid decreased to 26.7% and 20%, respectively. The most common bacteria cultured was Pseudomonas aeruginosa. There were no cases of postoperative infection. Despite detailed cleaning instructions, there is a relatively high risk of bacterial contamination in nasal irrigation bottles and fluid following endoscopic sinus surgery. Although these risks did not translate into higher infection rates postsurgery, it may be important for physicians to emphasize regular cleaning techniques to minimize a potential source of bacterial contaminant exposure.
Article
Nasal irrigation is widely used in treating sinonasal diseases. Not only does it remove static secretions and promote mucociliary clearance, but, in chronic rhinosinusitis, nasal flush is also a potential route for topical drug administration into paranasal sinuses. A clinical study was conducted to investigate how well nasal irrigation could reach paranasal sinuses with the ostiomeatal units blocked in chronic rhinosinusitis. This study was performed to (1) assess the ability of a nasal douche and spray to deliver a solution into the paranasal sinuses in chronic rhinosinusitis and (2) compare the performance of the two techniques. Fourteen patients, with bilateral chronic rhinosinusitis, underwent nasal irrigation with 140 mg/mL of iodinated contrast solution by 40 mL of douching using an irrigation syringe in one side, and 10 mL of spraying in the other side. A computed tomography scan was undertaken for each patient to determine the volume and the distribution of staining in the nose and paranasal sinuses. Only two patients had any staining, with a small amount present in a total of three maxillary sinuses (0.10 mL, 0.04 mL, and 0.13 mL). The mean volumes of paranasal sinus staining by nasal douche and nasal spray were 0.0093 and 0.01 mL, respectively. We found that the two techniques had a similar performance. Both of them delivered only a small amount of the solution, if any, into the sinuses (with a mean difference of -0.0007 mL; 95% CI, -0.02-0.02 mL; p = 0.94). Nasal douche and spray is not effective in delivering a nasal irrigation solution into paranasal sinuses in chronic rhinosinusitis.
Article
Local nasal hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various rhinitis disorders such as the common cold and allergic rhinitis. Inhaled heated vapor treatments and simple saline solution nasal irrigation were investigated for their effect on inflammatory mediator production in nasal secretions. Three treatments were given for nasal irrigation: heated water particles (large particle water vapor) at 43 degrees C, heated molecular water vapor (molecular water vapor) at 41 degrees C, and simple saline solution nasal irrigation. Nasal washes were done before each treatment (baseline), immediately after treatments, and at 30 min, 2, 4, and 6 h. Histamine, prostaglandin D2, and leukotriene C4 (LTC4) concentrations were measured in nasal secretions and compared with baseline values. Thirty symptomatic patients with active perennial allergic rhinitis underwent three treatments at weekly intervals. Nasal histamine concentrations fell substantially with the nasal irrigation (p < 0.01 immediately posttreatment and at 30 min; p < 0.05 at 2, 4, and 6 h). Large particle vapor also reduced histamine concentrations for up to 4 h posttreatment compared with baseline values (p < 0.05). Alternatively, molecular water vapor did not alter nasal histamine concentrations. Surprisingly, the three treatments did not alter prostaglandin D2 concentrations over the 6 h. Leukotriene C4 concentrations fell briefly after the large particle treatment but did not with the molecular water vapor. With saline solution irrigation, LTC4 concentrations in nasal secretions were lower than baseline at 30 min to 4 h after a treatment (p < 0.05). This study demonstrated the usefulness of large particle vapor treatment and saline solution irrigation in reducing inflammatory mediators in nasal secretions and indirectly supports the clinical efficacy of these treatments for chronic rhinitis.
Article
In this study we reinvestigated the kinetics of allergen release from birch pollen (Betula verrucosa) and timothy grass pollen (Phleum pratense) using different protein extraction procedures, immunoblotting with specific antibodies and immune electron microscopy. Pollen allergens such as the major birch pollen allergen, Bet v I, the major timothy grass pollen allergens, Phl p I and Phl p V, group-II/III allergens from timothy grass and profilins were released rapidly and in large amounts from hydrated pollen. Within a few minutes pollen allergens could be detected in aqueous supernatants prepared from birch and grass pollen with serum IgE or specific antibodies. In parallel the allergen content in the pollen pellet fractions decreased. A nonallergenic protein such as heat shock protein 70 can be extracted in sufficient amounts only with harsh extraction procedures. Immune electron microscopy of dry and rehydrated birch pollens showed that after short hydration, the major birch pollen allergen, Bet v I, migrated into the exine and to the surface of intact pollen grains, whereas profilin, against which a lower percentage of patients is sensitized, was retained in the pollen grain. Comparing the amino acid composition and hydrophilicity of the tested allergens with a nonallergenic protein such as heat shock protein 70, no significant difference was noted. In agreement with earlier observations we conclude that the allergenic properties of proteins are rather linked to the amount and speed of solubility from airborne particles than to intrinsic properties.
Article
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.
Article
Mucociliary transport is an important defense mechanism of the respiratory tract. Nonetheless, the factors determining mucociliary transport are only partially understood. Ciliary beat frequency is assumed to be one of the main parameters, although the experimental evidence remains inconclusive. Comparing influences on mucociliary transport to influences on ciliary beat frequency. The present study measures the effects on mucociliary transport of two ciliary beat frequency-inhibiting compounds (0.1% xylometazoline and 0.9% NaCl) and a ciliary beat frequency enhancer (0.1% salbutamol). The measurements were performed by a technetium-99m nebulizing scintigraphic method. The experiments were carried out in 15 healthy young volunteers. The 0.1% xylometazoline appeared to slow ciliary transport, although the decrease was not significant (P = .44). The 0.9% NaCl did reduce mucociliary transport significantly (P = .033). The 0.1% salbutamol resulted in a highly significant increase of mucociliary transport (P = .009). Xylometazoline brings about drastic changes in the nasal cavity, both anatomically and physiologically. Any comparison of mucociliary transport before and after using this vasoconstrictive agent must take this effect into account. The present study demonstrates a significant similarity in the effects of NaCl and salbutamol on ciliary beat frequency in vitro and on mucociliary transport in vivo. The evidence from our experiments suggests that ciliary beat frequency is a determining factor in the mucociliary transport rate in the nose.
Article
The mechanisms by which eosinophilic inflammation damages the epithelium and contributes to recurrent acute exacerbations in chronic rhinosinusitis (CRS) have not been fully elucidated. We tested the hypotheses that eosinophils deposit toxic major basic protein (MBP) in the mucus and that MBP reaches concentrations able to damage the sinonasal epithelium. Tissue specimens with mucus attached to the tissue were carefully collected from 22 patients with CRS and examined by using immunofluorescence staining for MBP. This immunofluorescence was digitally analyzed to determine the area covered by MBP and the intensity of the staining (estimating MBP concentration). Levels of MBP in extracts from nasal mucus were quantitated by means of RIA. Heterogeneous eosinophilia was evident within tissue and mucus specimens. All tissue specimens showed intact eosinophils, but diffuse extracellular MBP deposition, as a marker of eosinophil degranulation, was rare. In contrast, all mucus specimens showed diffuse MBP throughout and abundant diffuse extracellular MBP deposition within clusters of eosinophils. Digitized analyses of MBP immunofluorescence revealed increased area coverage (P < .0001) in mucus compared with that seen in tissue. Estimated concentrations of MBP within the clusters suggested toxic levels. MBP concentrations in mucus extract reached 11.7 microg/mL; MBP was not detectable in healthy control subjects. In patients with CRS, eosinophils form clusters in the mucus where they release MBP, which is diffusely deposited on the epithelium, a process not observed in the tissue. Estimated MBP levels far exceed those needed to damage epithelium from the luminal side and could predispose patients with CRS to secondary bacterial infections.
Bolezni verhnih vozduhonosnyh putej
  • M Shmidt
Acute rhinosinusitis in outpatient practice
  • E V Nosulya
  • I A Kim
Носуля Е.В., Ким И.А. Острый риносинусит в амбулаторной практике. Consilium Medicum. 2005;4:300-305. [Nosulya EV, Kim IA. Acute rhinosinusitis in outpatient practice. Consilium Medicum. 2005;4:300-305. (In Russ.)].
Irrigation therapy: relevance and effectiveness
  • E V Nosulya
  • A K Vinnikov
  • I A Kim
Ирригационная терапия верхних дыхательных путей. М.: Медицина
  • А И Кюлев
Кюлев А.И. Ирригационная терапия верхних дыхательных путей. М.: Медицина; 1987. [Kyulev AI. Irrigacionnaya terapiya verxnix dy'xatel'ny'x putej. M.: Medicina; 1987. (In Russ.)].
Лечебно-диагностическая тактика при остром синусите. Вестник оториноларингологии
  • А И Крюков
  • А А Сединкин
  • Т А Алексанян
Крюков А.И., Сединкин А.А., Алексанян Т.А. Лечебно-диагностическая тактика при остром синусите. Вестник оториноларингологии. 2002;5:51-56. [Kryukov AI, Sedinkin AA, Aleksanyan TA. Therapeutic and diagnostic policy in acute sinusitis. Vestnik otorinolaringologii. 2002;5:51-56. (In Russ.)].
Ирригационная терапия: актуальность и эффективность
  • Е В Носуля
  • А К Винников
  • И А Ким
  • E V Nosulya
  • A K Vinnikov
  • I A Kim
Носуля Е.В., Винников А.К., Ким И.А. Ирригационная терапия: актуальность и эффективность. РМЖ. 2011;8:490-493. [Nosulya EV, Vinnikov AK, Kim IA. Irrigation therapy: relevance and effectiveness. RMZh. 2011;8:490-493. (In Russ.)].