ArticleLiterature Review

Nasal saline irrigation for symptoms of chronic rhinosinusitis

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Abstract

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. To evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis. 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. 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. 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. 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. 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.

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... Despite the extensive evidence supporting the use of nasal saline irrigations in pediatric and adult CRS, [26][27][28] there are very few data specific to patients with CF CRS. A total of 4 studies on the use of nasal saline in patients with CF CRS were included, as summarized in Table 4. ...
... Nevertheless, it is important to acknowledge the wide body of literature supporting the use of nasal saline in patients with non-CF CRS. [26][27][28]33 ...
... The use of saline irrigations is better studied in patients with non-CF CRS, in whom there is substantial evidence supporting the use of this treatment. [26][27][28]33 The evidence supports a recommendation of CFTR modulators for the management of CF CRS. Pulmonologists with experience in CF generally prescribe and manage these novel pharmacotherapies. ...
Article
Background Cystic fibrosis (CF) chronic rhinosinusitis (CRS) has emerged as a distinct diagnostic entity, unique from other endotypes of CRS in its presentation, pathophysiology, diagnosis, treatment, and outcomes. As the sinonasal health of this patient population may have broad effects on pulmonary health and quality of life, a comprehensive understanding of the diagnostic and therapeutic approach to CF CRS is essential. Recognizing recent scientific advances and unique treatment modalities specific to this challenging patient population, this review systematically evaluates the scientific literature and provides an evidenced-based review with recommendations (EBRR) for fundamental management principles of CF CRS. Methods A systematic review of the literature was performed. Studies evaluating interventions for the management of CF CRS were included. An iterative review process was implemented in accordance with EBRR guidelines. A treatment recommendation was generated based on an assessment of the benefits, harms and the overall grade of evidence. Results This review evaluated the published literature on five unique topics. Each of the following therapeutic categories was investigated explicitly with regard to treatment outcomes in patients with CF CRS: 1) nasal saline; 2) intranasal corticosteroids (INCS); 3) topical antibiotics; 4) cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy; and 5) endoscopic sinus surgery (ESS). Conclusion Based on the currently available evidence, nasal saline, ESS, and CFTR modulators are recommended in the management of CF CRS when appropriate. INCS and topical antibiotics are options. Clinical judgment and experience are essential in caring for patients with this uniquely challenging disorder. This article is protected by copyright. All rights reserved
... Промывания носа физиологическим раствором широко используются при остром (ОРС) и хрони ческом (ХРС) риносинуситах, аллергическом и вазомоторном ринитах, острых респираторных за болеваниях, а также после операций на околоно совых пазухах (ОНП) [1][2][3][4][5][6][7][8][9][10]. При всей очевидной целесообразности, наличии научной обоснованно сти и доказательной базы до настоящего времени не определены стандартные протоколы процедур, оп тимальный объем жидкости, концентрация и состав раствора, кратность применения и продолжитель ность курса лечения. ...
... Однако и здесь возникают методо логические нюансы, касающиеся оптимального объема и концентрации солевого раствора. В по следние годы были опубликованы результаты ис следований, свидетельствующие о более высокой эффективности промывания полости носа большим объемом (более 200 мл) жидкости [8][9][10]. По воз действию на назальные симптомы промывание большим объемом жидкости оказалось более эф фективным, чем орошение спреем, при оценке на 2, 4 и 8й неделях лечения [8]. ...
... Результаты исследований последних лет позво ляют предположить, что именно при ХРС более эф фективными могут быть промывания гипертониче ским раствором, которые способствуют стимуляции мукоцилиарного транспорта [9,14]. Об этом свиде тельствуют, в частности, результаты недавнего экс периментального исследования на культуре клеток мерцательного эпителия больных полипозным ри носинуситом, которые показали, что цельная мор ская вода в большей степени ускоряет биение рес ничек и регенеративные процессы в слизистой обо лочке, чем разведенная или простой изотонический раствор хлорида натрия [15]. ...
... Sixteen articles (13 RCTs and 3 meta-analyses) assessed adult CRS or mixed adults and children with CRS. 4,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] One RCT was conducted in children. 58 Four RCTs compared the effects of nasal saline with nosaline treatment. ...
... 58 Two meta-analyses did not provide additional data. 47,50 Buffer. One RCT compared buffered saline with nonbuffered saline. ...
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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.
... Hypertonic nasal saline irrigations may improve mucociliary clearance and thereby help to remove thickened secretions and crusting, which accumulate due to the underlying CF pathogenesis [3,15]. Although trials on the application of saline irrigation in CF patients in comparison to antimicrobial treatment are lacking, the treatment is used and recommended based on the benefits demonstrated in non-CF patients treated with hypertonic saline irrigation to remove thickened secretions and crusting [35]. Both the squeeze bottle and neti pot are devices, which provide very good delivery to the paranasal sinuses [15]. ...
... However, more aggressive strategies to treat CF sinusitis patients without symptoms are considered increasingly favorable by clinicians in some centers as evidence points towards surgical management as a good solution for eradicating the bacterial reservoir in the sinuses and thus improving pulmonary therapy outcomes [32,36]. patients in comparison to antimicrobial treatment are lacking, the treatment is used and recommended based on the benefits demonstrated in non-CF patients treated with hypertonic saline irrigation to remove thickened secretions and crusting [35]. Both the squeeze bottle and neti pot are devices, which provide very good delivery to the paranasal sinuses [15]. ...
Article
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Bacterial biofilm-associated chronic sinusitis in cystic fibrosis (CF) patients caused by Pseudomonas aeruginosa infections and the lack of available treatments for such infections constitute a critical aspect of CF disease management. Currently, inhalation therapies to combat P. aeruginosa infections in CF patients are focused mainly on the delivery of antimicrobials to the lower respiratory tract, disregarding the sinuses. However, the sinuses constitute a reservoir for P. aeruginosa growth, leading to re-infection of the lungs, even after clearing an initial lung infection. Eradication of P. aeruginosa from the respiratory tract after a first infection has been shown to delay chronic pulmonary infection with the bacteria for up to two years. The challenges with providing a suitable treatment for bacterial sinusitis include: (i) identifying a suitable antimicrobial compound; (ii) selecting a suitable device to deliver the drug to the sinuses and nasal cavities; and (iii) applying a formulation design, which will mediate delivery of a high dose of the antimicrobial directly to the site of infection. This review highlights currently available inhalable antimicrobial formulations for treatment and management of biofilm infections caused by P. aeruginosa and discusses critical issues related to novel antimicrobial drug formulation design approaches.
... A irrigação da mucosa nasal com solução salina isotónica é uma medida clássica e segura, bastante útil na mobilização das secreções e hidratação da mucosa, como tratamento adjuvante e preventivo das doenças inflamatórias e infeciosas nasossinusais (22) . As irrigações nasais realizadas com grande volume (>200 mL) e baixa pressão positiva são mais eficazes do que as lavagens por pulverização salina para o tratamento dos sintomas da RSC (23) . ...
Article
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A rinossinusite crónica, considerada atualmente um problema de saúde pública, é um grupo heterogéneo de doenças com etiologia multifatorial e caracteriza -se pela presença de sintomas nasossinusais caraterísticos, em associação com evidência clínica ou imagiológica de inflamação. Pode ser subdividida em rinossinusite crónica sem polipose nasal (RSCsPN) e em rinossinusite crónica com polipose nasal (RSCcPN), existindo várias patologias que podem ser consideradas subfenótipos adicionais da rinossinusite crónica. É também importante ter em conta as principais patologias que devem ser consideradas no seu diagnóstico diferencial. O tratamento médico de eleição é dirigido à inflamação nasossinusal, sendo o tratamento cirúrgico necessário nos doentes refratários ao tratamento médico ou com contraindicação à realização do mesmo. Este artigo tem por objetivo rever a informação disponível na literatura sobre a rinossinusite crónica, tendo como ponto de partida um caso clínico de um doente com RSCcPN seguido em consulta de Imunoalergologia.
... При наличии ХРС рекомендуется ирригационная терапия [99,190] (УУР -A, УДД -1). ...
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The problem of timely diagnosis and proper management of patients with cystic fibrosis is crucial not only in our country, but throughout the world. Experts of the Union of Pediatricians of Russia have considered various issues of etiology, pathogenesis, epidemiology, diagnosis, and treatment of this genetic disease in a modern light. Particular attention was paid to screening methods for early diagnosis of cystic fibrosis. The principles of complex therapy were justified, including rational use of antibacterial and mucolytic drugs and enzyme replacement therapy that significantly determine the disease prognosis.
... 45 Nasal irrigations have been shown to be beneficial in a Cochrane review, but proper technique is important to review with patients. 53 Intranasal steroids reduce airway inflammation. 45 Side effects are generally mild and include epistaxis, nasal itching and headache. ...
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Tyler Merrill, Alissa Kanaan University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, Little Rock, AR, USACorrespondence: Tyler Merrill, University of Arkansas for Medical Sciences, Department of Otolaryngology – Head and Neck Surgery, 4301 W. Markham Street, #543, Little Rock, AR, 72205, USA, Tel +1 (501) 686 5140 ; +1 (330) 285 1750, Fax +1 (501) 686 8029, Email tmerrill@uams.eduAbstract: The proportion of the population over 65 years old continues to grow. Chronic rhinosinusitis is common in this population and causes a reduction in quality of life and an increase in health care utilization. Diagnosis of chronic rhinosinusitis with nasal polyps follows the same principles for elderly patients as in the general population, but the elderly population presents some diagnostic challenges worth considering. Presbynasalis, the anatomic and functional changes of the nose and paranasal sinuses associated with aging must be accounted for when caring for these patients. In addition, polypharmacy and other medical issues that can cause similar symptoms must be considered. Medical therapy is generally similar to the general population but with additional concerns given the propensity for geriatric patients to be on multiple medications and to suffer from multiple medical issues. Sinus surgery should be considered following the same indications as in the general population. While some authors have found higher complication rates in endoscopic sinus surgery, others have found higher rates of success. As always, the risks of surgery must be considered with the possible benefits on a patient-to-patient basis.Keywords: sinusitis, nasal polyps, CRSwNP
... Appropriate medical therapy with nasal irrigation with saline and intranasal corticosteroids is the first-line medical treatment both in pediatric and adult CRS with or without NPs [1,82], while antibiotics and systemic steroids are used only in case of exacerbation; there is a lack of supportive evidence for prolonged macrolide therapy in children with CRS [1]. Many studies have demonstrated that topical corticosteroids are a beneficial treatment for adult CRSwNP in terms of symptoms improvement, polyp size reduction, and polyp recurrence prevention after surgery, with rare and minor side effects (the most common are epistaxis and nasal irritation) [83]. ...
Article
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Nasal polyps (NPs) are benign inflammatory masses causing chronic nasal obstruction, usually associated with underlying chronic rhinosinusitis (CRS), which are rarely reported in childhood. The interest in NPs has recently increased due to new therapeutic options, namely biological agents, such as dupilumab, and an update of the European position paper on this topic was released in 2020, providing a detailed classification for these lesions and also discussing diagnostic and therapeutic approaches also in children. In childhood, NPs usually represent red flags for systemic diseases, such as cystic fibrosis and immunodeficiencies. This review outlines the recent data on NPs in childhood, focusing on predisposing factors for CRS as well as on the potential endotypes in this particular age group, for which further studies are required in order to better clarify their pathogenesis and to identify molecular biomarkers that could help achieve more personalized treatments.
... Консервативное лечение ХРС с позиции доказательной медицины включает в себя длительное использование интраназальных глюкокортикостероидов (их терапевтический эффект основан на универсальном противовоспалительном действии), водно-солевые растворы для ирригационной терапии, при обострении ХРС применяются короткие курсы системной и топической антибиотикотерапии [20][21][22][23]. В некоторых случаях в лечении используются длительные курсы терапии низкими дозами антибиотиков группы макролидов [24,25]. ...
Article
Intriduction. Chronic rhinitis and rhinosinusitis noticeably deteriorate the patients’ quality of life and lead to the accompanying upper airway pathology development. The main purpose of treatment of this group of patients is to decrease severity of symptoms and the second one to prevent complications. The optimal therapy will help patients to maintain their lifestyle. Intranasal glucocorticosteroids are first-line drugs to treat acute rhinosinusitis or exacerbations of chronic rhinosinusitis in adults (including the elderly) and adolescents aged 12 years and older as an auxiliary therapeutic agent if treated by antibiotics, and to treat acute rhinosinusitis with mild to moderate symptoms without signs of severe bacterial infection. In the number of trials, mometasone furoate effectiveness in regard to decreasing of prominent symptoms with no side effects development has been shown. Objective: this article reviews available data on the effectiveness of intranasal corticosteroids – mometasone furoate – in the treatment of different forms of chronic inflammatory diseases of the nose and paranasal sinuses. Methods: information for this review was identified through a RISC and MEDLINE databases applying key words. Conclusions: based on the available data, treatment of chronic rhinosinusites and rhinitis should be initiated by conservative therapy. Summarizing information from the available literature we can conclude that treatment by mometasone furoate improve quality of life decreasing clinical symptoms of chronic rhinosinusitis and rhinitis.
... In 2015, a randomised clinical trial demonstrated that hypertonic saline irrigation and gargling for the common cold significantly reduce symptom duration and severity as well as over-the-counter medication use [39]. Furthermore, several Cochrane reviews summarise the evidence for the positive effects of hypertonic saline solution in the management of the symptoms of upper respiratory tract infections [40][41][42]. ...
Article
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Purpose Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis. Methods This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients’ pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients. Results The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported “very good” general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did. Conclusion Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.
... In contrast to the treatment of acute rhinosinusitis, rinsing with saline solution is recommended in the European Position Paper for the treatment of chronic rhinosinusitis (grade of recommendation A), even though for CRS the data situation does not appear to be much better than for acute rhinosinusitis. A Cochrane review article from 2007 [150] considers nasal rinsing as useful for the relief of the symptoms of chronic rhinosinusitis. However, no difference was found between CRS with and without polyps. ...
Article
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Therapeutic decisions in otorhinolaryngology are based on clinical experience, surgical skills, and scientific evidence. Recently, evidence-based therapies have gained increased attention and importance due to their potential to improve the individual patient’s treatment and their potential at the same time to reduce treatment costs. In clinical practice, it is almost impossible to stay ahead of the increasing mass of literature and on the other hand critically assess the presented data. A solid scientific and statistical knowledge as well as a significant amount of spare time are required to detect systematic bias and other errors in study designs, also with respect to assessing whether or not a study should be part of an individual therapeutic decision. Meta-analyses, reviews, and clinical guidelines are, therefore, of increasing importance for evidence-based therapy in clinical practice. This review is an update of the availability of external evidence for the treatment of nasal obstruction and rhinosinusitis. It becomes evident that both groups of diseases differ significantly in the availability of external evidence. Furthermore, it becomes obvious that surgical treatment options are normally based on evidence of significantly lower quality than medical treatment options.
... In the case of the neti pot, safety and efficacy are not in question. Nasal irrigation (with or without the neti pot) is well-established as efficacious treatment for chronic sinusitis with few side effects (Harvey et al., 2007). However, studies also show that nasal irrigation may not be effective for acute colds or flus, and there is not enough evidence to recommend its use in these cases (Achilles & Mösges, 2013;Kassel, 2010). ...
Article
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In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999–2012) about the neti pot, we trace the development of discourses from neti’s first introduction in mainstream news, through the hype following Dr. Oz’s presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot’s complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices’ incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers.
... The selection of appropriate therapy is based on endoscopic evaluation, sinus culture, and the symptoms requiring treatment [21] . To treat CRS, intranasal corti- costeroids [22], systemic corticosteroids [23], systemic antibiotics countering acute exacerbations242526, topical antibiotics [27], intranasal and systemic antifungals [28], antileukotrienes [29, 30], and intranasal saline [31] have been reported in the literature. We found that, in 90 % of countries, nasal steroids were recommended. ...
Article
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Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or “about 50 %”, of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20–35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20–40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.
... In the literature, AMB delivery methods, concentrations, and daily doses varied in studies that used intranasal AMB to treat CRS. 1 Nasal irrigation has become a common adjunctive method for management of CRS. 5 Its benefit may be due to mechanical clearance of mucus, but other potentially beneficial physiologic effects have also been proposed, including improvement in mucus clearance, enhanced ciliary beat activity, removal of antigens, biofilm or inflammatory mediators, and protection of sinonasal mucosa. 6 In our previous study, 1 a total daily dose of 20 mg of AMB, as in the study by Ponikau et al., 3 was used to irrigate the nose with 500 mL of normal saline (NS) solution, but the AMB concentration was only 40 g/mL. Instead of 250 g/mL, Ponikau et al. 3 advocated using 100 mg/mL of AMB solution, which is kept refrigerated and freshly made. ...
Article
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Background Fungus-driven inflammation is proposed to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). Previous studies evaluated the efficacy of intranasal amphotericin B (AMB) in the treatment of patients with CRS, but the results were controversial. The purpose of this study was to evaluate the efficacy of 100 pg/mL of AMB nasal irrigation as postoperative care after functional endoscopic sinus surgery (FESS). Methods Patients with CRS who received FESS for treatment were recruited and randomly assigned to two groups at 1 month after surgery. Patients in the AMB group received 100 pg/mL of AMB nasal irrigation daily for 2 months, and those in the normal saline (NS) group received NS solution nasal irrigation daily for 2 months. Pre-FESS, pre-irrigation, and postirrigation sinonasal symptoms were assessed by questionnaires, and the patients received endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test. Results Seventy-seven patients were enrolled between June 2012 and December 2014. Among the patients who completed the study, 38 received AMB irrigation, and 39 received NS solution irrigation. Although all the patients reported improvement after irrigation, there was no difference in outcome between patients who received AMB and those who received NS solution. Conclusion Our study showed that nasal irrigation with 100 pg/mL of AMB did not confer a greater benefit than that of NS solution nasal irrigation in post-FESS care.
... Irrigation reduces postnasal drainage, removes secretions, rinses away allergens and irritants, and improves mucociliary clearance. 14,57 b) Intranasal corticosteroids Topical aqueous steroid nasal sprays are helpful in all types of CRS and are the cornerstone of maintenan-www.medigraphic.org.mx ce treatment. ...
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.
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Prior to 2005, our existing knowledge of inflammatory patterns in CRS came nearly exclusively from studies with Western patients, and those studies indicated that nasal polyps were “eosinophilic” and characterized by the expression of interleukin (IL)-5 and other type 2 cytokines, whereas CRSsNP resembled a type 1 disease with expression of IFN-gamma [1, 2]. However, less eosinophilic and more neutrophilic inflammation was found in patients with CRSwNP in Asia, when compared with Europe and North America [3]. Chinese patients with CRSwNP demonstrated neutrophil-biased inflammation as compared to their Caucasian counterparts [4]. Approximately 80% of CRSwNP patients in the Western world display a type 2 signature [5, 6], whereas between 20% and 60% display that signature in China, Korea, and Thailand, respectively [3]. By measuring the value of ECP/MPO, Wang et al. [7] found that cases of CRSwNP in regions of Europe, Japan, and Australia showed an eosinophilic dominance (eosinophilic > 50%) rather than a non-eosinophilic dominance (eosinophilic < 50%) such as cases found in Beijing and Chengdu in China. Another study found that <50% of CRSwNP cases in Beijing showed eosinophilic inflammation [8]. The results from different geographic regions indicated that the immunological patterns of CRS were not the same in all ethnic populations [9].
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The inconsistent findings from early studies in twins suggest that both genetic and environmental factors contribute to the pathogenesis of CRS. The genetic architecture of CRS is complex, and the heritability for CRS has been shown to range from 13% to 53% [1–3]; the highest heritability shown in the triad of aspirin intolerance, nasal polyposis, and asthma [2]. The mutations in cystic fibrosis transmembrane conductance regulator (CFTR) gene [4] and in dynein axonemal heavy chain 5 (DNAH5) gene [5], which have been identified for cystic fibrosis (CF) and primary ciliary dyskinesia (PCD), respectively, exhibit similar features with CRS, and thus provide further evidence for the role of a genetic component in the aetiology of CRS.
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Nasal decongestants can stimulate α-adrenergic receptors, and thereby constrict vascular smooth muscle, conducing to nasal mucosa shrinking in size and thus remission of nasal congestion. It is confirmed that decongestants have no effects on nasal polyp size, only reduce congestion of inferior and middle turbinates [1]. Therefore, decongestants are recommended prior to nasal endoscopy.
Article
Introduction: Chronic rhinosinusitis (CRS) is a disease that can significantly reduce patients' quality of life (QoL). Intranasal steroid therapy is the most commonly used treatment for CRS. There are many evaluation tools dedicated to assessing CRS patients' QoL, but none of them evaluates QoL during local steroid therapy. Mucosal atomization devices (MADs) and nasal saline irrigation (NSI) are effective and safe methods of applying intranasal steroids for CRS patients. Materials and Methods: The sample population for this prospective study comprised 43 CRS patients. Following endoscopic sinus surgery, all participants received intranasal steroids administered via an MAD, followed by NSI for 1.5 months. Each participant completed the SNOT-22 (22-item Sino-Nasal Outcomes Test) score and a new questionnaire, the Complementary Topical Nasal Drug Delivery Questionnaire (the Complementary Questionnaire), at the end of 3 months of intranasal steroid therapy. Results: The patients' responses in both the SNOT-22 score and the Complementary Questionnaire revealed significant differences in their adverse experiences. The patients who received intranasal steroid treatment using NSI experienced more frequently delayed nasal drainage, higher frequency of ear symptoms, and facial pain/pressure, while those whose therapy was administered using an MAD reported complaints such as nasal irritation, nasal dryness, and postnasal drip with unpleasant taste/smell. Conclusion: We used the Complementary Questionnaire as an effective tool for assessment of the QoL of CRS patients. The SNOT-22 score and the Complementary Questionnaire make it possible to select an intranasal applicator tailored to a CRS patient's specific complaints.
Article
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Purpose of Review Chronic pediatric rhinosinusitis is a common entity, with an annual incidence of 4% in the US schoolchildren’s population. The predominant contributing factor in younger children is adenoid pathology and in older children, allergic rhinitis. Recent research on sinus microbiome, biofilm, inflammatory response, and therapeutic alternatives is providing new insights in this prevalent disease. Recent Findings Adenoid size does not correlate with the severity of the disease suggesting that it is due to the biofilms observed in both adenoiditis and hypertrophic adenoids. There is new consensus among the experts on the definition and clinical diagnosis of pediatric chronic rhinosinusitis (PCRS). In PCRS, inflammation is mediated by helper T lymphocyte type 2 with limited glandular hyperplasia or fibrosis observed histologically. Both innate and adaptive immunity contribute to the heterogeneous inflammatory pathogenesis of PCRS that is driven by genetic, environmental, and microbiome factors. Medical treatment includes nasal hygiene, anti-inflammatory, and antibiotic therapy. When medical treatment fails, adenoidectomy is the surgical treatment of choice in children less than 6 years old, adenoidectomy plus possible endoscopic endonasal surgery (EES) between ages 6 and 12, and EES for children 12 and older. Balloon sinuplasty has been reported to be effective between 70 and 80% in older children. Summary This review focuses on the most recent PCRS consensus statements, novel research in histopathology and microbiome, and the evolving medical and surgical therapeutic options for this challenging disease.
Article
The article highlights that rhinitis is the most common disease, it is divided into 3 main phenotypes: infectious (IR), allergic (AR) and non-infectious non-allergic (NAR). There are also combined forms.IR is a viral disease. Its clinical picture is described, the frequent failure of patients to consult a doctor for this disease is noted, which contributes to the development of complications and its chronization.The authors described the characteristic features of the AR clinic with “oral Allergy syndrome“.It is noted that NAR is a heterogeneous disease, which is divided into at least 6 subphenotypes: drug, taste, hormonal, atrophic, idiopathic and rhinitis of older people. The authors analyze the reasons for their occurrence. There is also a professional form of rhinitis.All these phenotypes are United by the symptom of difficult nasal breathing, which also occurs in chronic rhinosinusitis and “empty nose“ syndrome.Other causes of nasal breathing disorders are also mentioned.In the treatment of patients with almost any of the rhinitis phenotypes, the main ones are irrigation-elimination therapy and the appointment of topical decongestants (TD). An important role is played by avoiding the causes that activate the course of rhinitis, and educating the population to properly organize the individual treatment process.Topical vasoconstrictor drugs are the leading topical remedies that eliminate nasal breathing difficulties. They are sold in our country in the usual access and if used incorrectly can cause the development of medical rhinitis and many serious consequences. The methods of correct administration of the drug in the form of drops and spray, as well as its age-related dosages, are disclosed
Article
Behandlungen nach naturheilkundlichen Prinzipien erfreuen sich zunehmender Beliebtheit — aber erfüllt Naturheilkunde auch die Standards der modernen Medizin? Was sagen die Leitlinien und Cochrane Reviews zu Naturheilverfahren bei Infektionen der oberen Atemwege?
Article
Chronic rhinosinusitis (CRS) is an inflammatory sinonasal condition with multiple etiologic factors that is associated with a vast economic cost. Treatment is most frequently pharmacologic and has centered on agents that ameliorate inflammation, decrease bacterial or pathogen load, and facilitate egress of mucus or purulence from the sinonasal cavity. Nasal saline irrigations, topical nasal steroids, certain antibiotics, and systemic steroids have shown some efficacy in the management of CRS. Recently, biologic therapeutics that target specific inflammatory pathways associated with subsets of CRS have been developed and evaluated. Early data evaluating these biologic treatments suggest a potential role in treating a subset of CRS with refractory, poorly controlled disease. Additional studies are necessary to identify which patients would benefit most from biologic therapies and to assess the cost of these therapies compared with the benefit they provide. This review describes the pathophysiology of CRS and summarizes both established and novel biologic pharmacologic treatments.
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This is the protocol for a review. The full review was published in 2016, and full text is available here: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011995.pub2/full A PDF copy is available here: https://www.researchgate.net/publication/301660887_Saline_irrigation_for_chronic_rhinosinusitis
Article
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Latar belakang. Keunggulan semprot hidung salin isotonik air laut pada anak balita dengan common cold masih kontroversi, dan studi pada anak balita masih sedikit. Tujuan. Membandingkan respons klinis dan efek samping semprot hidung salin (air laut) dan tetes hidung salin pada pasien dengan common cold, melalui a) penurunan skor gejala hidung, b) penurunan skor suhu tubuh, c) lama sakit, dan d) efek samping (epistaksis). Metode. Suatu opened-label randomized clinical trial, dilaksanakan di Puskesmas Kecamatan Kalideres dengan subjek anak berusia 12-60 bulan. Subjek diberikan semprot hidung salin air laut dan sirup parasetamol (kelompok eksperimen) atau tetes hidung salin dan parasetamol (kelompok eksperimen) atau hanya parasetamol (kontrol) berdasarkan alokasi random. Semprot hidung salin (air laut) diberikan 3 kali sehari 1 semprot tiap lubang hidung selama 7 hari, tetes hidung salin diberikan 3 kali sehari 2 tetes tiap lubang hidung selama 7 hari, dan parasetamol sirup diberikan 10 mg/kgbb tiap 4 jam bila suhu tubuh ≥38ºC. Penilaian skor gejala hidung, skor suhu tubuh, dilakukan sebelum dimulai pengobatan sampai dengan hari ke delapan. Lama sakit dan efek samping obat dinilai dari awal pengobatan sampai sembuh Hasil. Didapat 68 subjek yang memenuhi kriteria inklusi dirandomisasi menjadi kelompok eksperimen (semprot hidung salin air laut dan tetes hidung salin) atau kontrol. Pada hari kedelapan pengobatan, tidak terdapat perbedaan bermakna pada penurunan skor gejala hidung (p=0,976), skor suhu tubuh (p=0,884), dan lama sakit (p=0,805) antara ketiga kelompok penelitian. Tidak didapatkan efek samping berupa epistaksis. Kesimpulan. Pada anak balita dengan common cold yang diberikan semprot hidung salin (air laut) dibandingkan dengan tetes hidung salin dan kontrol tidak terdapat perbedaan bermakna pada respons klinis dan efek samping.
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With changes in the health care system imminent, office-based procedures offer multiple benefits, including a decrease in health care costs to the patient and the healthcare system. Office procedures can provide successful results with high patient satisfaction ratings. This chapter discusses patient and disease selection in managing different frontal sinus problems in the office including sinusitis, nasal polyposis, mucoceles, and stenosis. The principles and technique for anesthesia and different office technologies including the microdebrider and balloon dilation are discussed. Surveillance and post-surgical medical management of frontal sinus disease is also reviewed. This chapter is meant for all otolaryngologists who want to understand the principles for office-based management of the frontal sinus. It is also meant for novice or seasoned physicians who wish to improve their office-based skills in frontal sinus procedures.
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Frontal rhinosinusitis is the most challenging to treat given its dependence on the health of other sinuses and need for demanding surgery.
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Es folgen 15 Fragen zum Themengebiet Nase und Nasennebenhöhlen. Beispiele sind:Was stellen Rhinoviren mit der Nasenschleimhaut an?Was versteht man unter dem Lund-Mackay CT-Score?Sind Nasenduschen Keimschleudern?
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Chronic rhinosinusitis treatment is a relevant problem, for there is no universal therapy regimen for this disease. It is necessary to consider mucoactive drugs in addition to antibiotics, topical steroids, and irrigation therapy. Material and methods. A prospective comparative epidemiological study of the clinical outcomes of three treatment regimens for chronic rhinosinusitis was conducted in 317 patients with an exacerbation of moderate uncomplicated chronic rhinosinusitis without polyps. They were all treated according to three regimens: antibiotic therapy; monotherapy with Sinuforte nasal spray; combined therapy with an antibiotic and Sinuforte. Results. Addition of Sinuforte mucoactive spray to standard antibiotic therapy could reduce the number and frequency of chronic sinusitis recurrences by 4 times. When Sinuforte nasal spray was used as monotherapy, the regression of rhinosinusitis symptoms was comparable and, in terms of some indicators, more marked than when antibiotic monotherapy without a mucolytic was performed. Conclusion. Thus, incorporation of the mucoactive drug Sinuforte into a therapy regimen can improve the efficiency of treatment for mild and moderate uncomplicated chronic rhinosinusitis without polyps. Sinuforte may be used as monotherapy if a follow-up is conducted, which allows the need for antibiotic therapy to be reduced.
Article
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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
Background: The efficacy of decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Methods: Selection criteria: Randomized controlled trials (RCTs) and quasi-RCTs that evaluated children <18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough, were included. Trials involving children with chronic sinusitis and allergic rhinitis were excluded. Data analysis: Two review authors independently assessed each study for inclusion. Results: Of the 662 studies identified through the electronic and manual searches, none met all of the inclusion criteria. Conclusions: There is no evidence to determine whether the use of antihistamines, decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
Chapter
Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the nasal passageways and sinuses lasting over 12 weeks. CRS is treated with multiple medical therapies in children and adults. Topical nasal corticosteroids are recommended for CRS with and without nasal polyps by multiple rhinosinusitis guidelines and evidence-based meta-analyses. The safety profile of nasal corticosteroids is excellent. The majority of studies show no adrenal suppression. Further, no growth suppression is seen in children using low dosages and side effects are generally mild. Nasal saline irrigation has also led to an improvement in symptom scores and quality of life measures using isotonic and hypertonic saline solutions. A Cochrane review states that medical management of CRS is as effective as surgical therapy based on available data. This highlights the important role of specialists in allergy/immunology and otolaryngology that have expertise in the treatment of CRS. Additional high-level evidence is urgently needed to best define optimal treatment strategies and which subgroups of CRS may respond best to the various medical treatments.
Chapter
Rather than a single disease, chronic rhinosinusitis (CRS) should be thought of as a syndrome resulting from variety of disease processes and underlying etiologies. Accordingly there is no one single medical management for all patients. However, medical management is the cornerstone of the management of the majority of uncomplicated CRS, and surgery is largely an adjunct to the overall management of the syndrome when medical therapy does not control the disease process. Accordingly, it is important to carefully evaluate the patient for the underlying factors involved in the disease process and to tailor the medical therapy appropriately, based on both patient symptomatology and also endoscopic examination. In addition to briefly reviewing some of the underlying predisposing causes of CRS, this chapter will focus on both the potential topical and systemic managements of this disorder and present the evidence for efficacy of these therapies based upon previously published studies.
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Optimal medical management of chronic rhinosinusitis (CRS) is predicated on suspected or proven contributors. Historically, reported medical treatment options have included oral, topical, and intravenous anti-infective agents, oral and topical anti-inflammatories, treatment of comorbid allergic disease, and perioperative debridement. This chapter is a summary of selected medical treatment regimen with a presentation of available evidence. The use of oral antibiotics not exceeding three weeks has been shown to be beneficial in CRS exacerbations. Macrolides and doxycycline have been reported to have anti-inflammatory properties in addition to their antibacterial properties. Although widely practiced among sinus surgeons, original research on postoperative antibiotics produced mixed results and depends on surgeon preference. There is no proven role for intravenous antibiotics, topical antifungals, and oral antifungals in any phase of noninvasive CRS management. Topical steroids are beneficial as mainstay medical treatment in preoperative and postoperative care. There is some evidence supporting short perioperative course of oral steroids, but there is no strong evidence available to suggest doses higher than 30 mg 5–7 days preoperatively. Patients with allergic contributors may benefit from a wide variety of agents including oral and topical antihistamines and postoperative immunotherapy. In addition, patients with aspirin-exacerbated airway disease (AERD) who receive postoperative aspirin desensitization have better outcomes than cohorts who do not receive aspirin desensitization. There is great promise in the use of anti-IgE antibody omalizumab in the treatment of CRS patients with nasal polyposis and asthma. This should be considered in the treatment of applicable patients if available.
Chapter
Saline irrigation has long been a recommended therapy for the treatment of sinonasal symptoms, including both rhinitis and chronic rhinosinusitis. Only recently has high-level evidence become available to confirm its efficacy both as an adjunct and a stand-alone therapy. Its excellent safety profile and tolerability make it a successful therapy in the long term when primed by effective surgery and high-volume devices; the addition of topical medications has further demonstrated an ability to confer significant symptomatic relief to sufferers of sinonasal disease. This chapter updates the reader on the delivery device, position, tonicity, role of surgery, and effect on the microenvironment, combined with the most up-to-date available evidence confirming its utility in the setting of CRS.
Chapter
This is the protocol for a review and there is no abstract. The objectives are as follows: To perform a systematic review with meta-analysis to assess the efficacy of nasal saline delivered by drops, sprays, nebulizers and irrigations as a treatment for patients with allergic rhinitis.
Article
Background: Saline nasal irrigation is effective in the treatment of sinonasal disorders, including chronic rhinosinusitis (CRS). Despite bacterial contamination in rinse bottles and reports of infections from contaminated irrigation water, tap water is still used by ∼50% of irrigation users, raising a potential public health concern. This study aimed to determine whether bacteria from the water supply used in sinus irrigations colonizes the paranasal sinuses. Methods: Samples were taken from the: (1) water used for irrigation, (2) faucet or container the water originated from, (3) rinse bottle, and (4) postoperative ethmoid cavity from 13 subjects with CRS. Microbiota were characterized using quantitative polymerase chain reaction (qPCR) and 16S ribosomal RNA (rRNA) gene sequencing. The Morisita-Horn beta-diversity index (M-H) was used to assess similarity in microbiota between samples, and genomic analysis was performed to assess clonality of cultured bacteria. Results: Of 13 subjects, 6 used distilled water, 6 used tap water, and 1 used well water in this institutional review board (IRB)-approved observational study. Well-water had markedly more bacteria than tap or distilled water. There was a trend toward tap having more bacteria than distilled water. The sinus samples were notably dissimilar to the bottle, faucet, and irrigant (M-H 0.15, 0.09, and 0.18, respectively). There was no difference in postoperative microbiotas between distilled and tap water users. Conclusion: The current study suggests that irrigation plays little role in establishing the sinus microbiome. Although rinsing with tap water may never be formally recommended, these data are useful to counsel patients who prefer to do so in non-endemic areas if the municipal water supply is appropriately treated.
Article
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Opinion statement One type of non-allergic, non-infectious rhinitis (NIR), representing the heterogeneous group is drug-induced rhinitis (DIR), which can be arranged into four and more subtypes related to pharmaceutical treatment (local inflammatory type, neurogenic type, idiopathic type, and rhinitis medicamentosa, a distinct phenotype caused by excessive use of intranasal decongestant sprays). DIR management implicates pharmacological and a non-pharmacological components only after the proposal to terminate and withdraw the causative medication; these components include factors inducing the disease and patients’ education. A patient’s individual sub-phenotype should be considered for management classification. Nowadays, intranasal glucocorticosteroids are considered to be the most reliable means available for DIR treatment. Intranasal antihistamines antagonizing H1 receptors are used for treating nasal congestion, but their effect is much weaker than that of intranasal corticosteroids. In particular occasions, oral decongestants can be applied, and oral corticosteroids are last-resort treatment for symptoms resistant to all other therapeutic intervention, but their use is limited to the short term. Notwithstanding that there are no obvious data proving the benefit, nasal irrigation with isotonic or hypertonic saline is the auxiliary treatment usually applied in almost all rhinitis phenotypes. Rarely applied treatments include nasal cromolyn, sedatives/hypnotics, diode laser inferior turbinate reduction, and surgical referral for submucosal resection of the inferior turbinate bones, which may be indicated only in cases of extensive medical treatment failure. In this review article, we present a literature review on prevalence, mechanisms, mediators, treatment options, safety, and efficacy issues of drugs and QoL of the patients with DIR.
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Background: Management of rhinosinusitis during pregnancy requires special considerations. Objectives: 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. Methods: The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Results: Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. Conclusions: The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
Article
Background: Effective mucus lavage and delivery of topical pharmaceuticals are central to successful management of chronic rhinosinusitis (CRS). The frontal sinus remains difficult to penetrate with topical therapies. This study evaluates the benefit of Draf III frontal dissection compared to traditional Draf IIa for distribution of topical therapies. Methods: Fresh human cadaver heads were dissected sequentially with Draf IIa frontal sinusotomy and then Draf III procedures. Each cavity was irrigated with pediatric (120 mL) and adult (240 mL) irrigation bottles with 1/1000 10% fluorescein-labeled free water in 2 fixed positions (vertex and Frankfort horizontal). An endoscope at a fixed position within the frontal sinus recorded frontal sinus and frontal recess penetration. The images then underwent blinded evaluation of fluid distribution scored as 0 to 4 (nasal cavity only, frontal recess, medial one-half, lateral one-half, and lavage). Ordinal distribution score was analyzed with Kendall's tau-b. Results: Eight specimens (age 76 ± 11.2 years; 50% female) were assessed. Draf III was superior to Draf IIa in ability to achieve frontal sinus distribution of irrigation (90.6% vs 50.1%, p < 0.001). Vertex head position improved distribution (90.6% vs 50.1%, p < 0.001), was synergistic with Draf III (100% with 87.5% lavage, p < 0.001), but was unable to overcome Draf IIa (81.2% with 25% lavage, p < 0.001). Irrigation volume trended toward improved distribution with larger volume irrigations. Conclusion: Successful treatment of sinonasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning.
Article
Sinusitis is defined as an inflammation of the mucosal lining of the paranasal sinuses and can be caused by various factors including allergy, environmental irritants, and infection by viruses, bacteria, or fungi. It is also commonly referred to as rhinosinusitis, because there is almost always coexisting inflammation in the nasal mucosa. Sinusitis can be classified based on duration of symptoms into acute, subacute, and chronic. Acute sinusitis lasts up to 4 weeks and is usually caused by a viral or bacterial infection. Chronic sinusitis lasts more than 12 weeks and may result from a wide range of allergic and nonallergic causes. Subacute sinusitis lasts 4 to 12 weeks and usually represents a transition between acute and chronic sinusitis. Other patterns include recurrent acute sinusitis, defined as the occurrence of four or more episodes of acute sinusitis within 1 year, each lasting at least 7 days; and acute exacerbation of chronic sinusitis, defined as the presence of signs and symptoms of chronic sinusitis that worsen but return to baseline after treatment. Sinusitis can also be categorized according to the mode of infection and underlying conditions, such as nosocomial sinusitis associated with nasotracheal intubation, odontogenic sinusitis, and sinusitis in severely immunocompromised hosts. From a clinical and management standpoint, the most important goal is to distinguish a bacterial infection from viral or allergic causes in acute sinusitis and to identify structural or fungal causes in chronic sinusitis. Distinguishing bacterial infection is critical for appropriate antimicrobial therapy, whereas structural or fungal causes may necessitate surgical intervention for diagnosis and treatment.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of leukotriene receptor antagonist therapy in the treatment of rhinosinusitis, with the subgroup of allergic rhinitis expected to account for the bulk of, if not all, studies.
Article
CRS is a highly prevalent disease often recalcitrant to therapy. The presence of polypoid disease complicates management and worsens prognosis. CRS in any form is a source of frustration to both patient and provider and presents a tremendous economic burden to the health care system. Research into pathogenesis and the disease process has led to an evolving system for diagnosis. Medical therapy with antibiotics and intranasal steroids are the basis for first-line management, though there is a high rate of treatment failure. Surgery offers promise of relief to those that fail medical management. However, proper patient selection, counseling, and follow-up are essential for a favorable surgical outcome.
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions aimed at preventing the onset of WRR and WRRS in occupational settings. We will combine findings of rhinitis and rhinosinusitis in this review due to their similarity in definition, presentation and reported effects, but we will separate the two entities if possible in our subgroup analysis.
Article
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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.
Article
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To ascertain whether a daily nasal spray with physiological saline could prevent symptoms of common cold in a population of otherwise healthy adults. This was study involving 10 weeks of daily use of a nasal saline spray and 10 weeks of only recording symptoms. Young adults eligible for military service at an army barrack in Boden, Sweden were invited to participate in the study and 108 healthy conscripts aged approximately 20 years agreed to do so. Data were recorded by the participants in a diary at home. In the diary the participants noted symptoms such as rhinitis, blocked nose, cough, fever and sore throat (pharyngeal pain). They also recorded inability to perform their duties due to the symptoms, and any medication or antibiotics necessitated by upper respiratory tract infection. A total of 69 subjects completed the 20-week diary period. For 60 of them, compliance during the spray period exceeded 60% and their data were used in the statistical calculations. During the spray period the number of days with nasal secretion and/or blocked nose (mean 6.4 days) was significantly (p=0.027) lower than that during the observation period (mean 11 days). Furthermore, the participants had a mean of 0.7 episodes of upper respiratory tract infection during the spray period, compared with 1.0 episodes during the observation period (p=0.05). A daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.
Article
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In a prospective, randomized, controlled, double-blind trial we compared the effectiveness of endonasal irrigations with Ems salt solution to that with sodium chloride solution in the treatment of adult patients with chronic paranasal sinus disease. Subjects (n = 40) were randomly allocated to treatment either with isotonic Ems salt solution or with isotonic sodium chloride solution. The treatment consisted of endonasal irrigation twice daily and additional nasal spray as required. Nasal endoscopy, plain radiography of the paranasal sinuses, olfactometry, anterior rhinomanometry, and a saccharin-clearance test were carried out on days 1 and 7. Patients recorded rating scales of general discomfort, nasal airway obstruction, agreeableness of the irrigation, duration of improved nasal resistance after each irrigation, and the amount of additional nasal spray in a diary. Nasal air flow was not improved significantly. Subjective complaints, endonasal endoscopy, and radiography results revealed a significant improvement in both groups (P = 0.0001). In comparison, the two groups were not significantly different in outcome. Endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis, and a significant difference between Ems salt and sodium chloride was not observed.
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To test whether daily hypertonic saline nasal irrigation improves sinus symptoms and quality of life and decreases medication use in adult subjects with a history of sinusitis. Randomized controlled trial. Experimental subjects used nasal irrigation daily for 6 months. Seventy-six subjects from primary care (n=70) and otolaryngology (n=6) clinics with histories of frequent sinusitis were randomized to experimental (n=52) and control (n=24) groups. Primary outcome measures included the Medical Outcomes Survey Short Form (SF-12), the Rhinosinusitis Disability Index (RSDI), and a Single-Item Sinus-Symptom Severity Assessment (SIA); all 3 were completed at baseline, 1.5, 3, and 6 months. Secondary outcomes included daily assessment of compliance and biweekly assessment of symptoms and medication use. At 6 months, subjects reported on side effects, satisfaction with nasal irrigation, and the percentage of change in their sinus-related quality of life. No significant baseline differences existed between the 2 groups. Sixty-nine subjects (90.8%) completed the study. Compliance averaged 87%. Experimental group RSDI scores improved from 58.4 -/+ 2.0 to 72.8 -/+ 2.2 (P < or =.05) compared with those of the control group (from 59.6 -/+ 3.0 to 60.4 -/+ 1.1); experimental group SIA scores improved from 3.9 -/+ 0.1 to 2.4 -/+ 0.1 (P < or =.05) compared with those of the control group (from 4.08 -/+ 0.15 to 4.07 -/+ 0.27). The number needed to treat to achieve 10% improvement on RSDI at 6 months was 2.0. Experimental subjects reported fewer 2-week periods with sinus-related symptoms (P <.05), used less antibiotics (P <.05), and used less nasal spray (P =.06). On the exit questionnaire 93% of experimental subjects reported overall improvement of sinus-related quality of life, and none reported worsening (P <.001); on average, experimental subjects reported 57 -/+ 4.5% improvement. Side effects were minor and infrequent. Satisfaction was high. We found no statistically significant improvement on the SF-12. Daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis. Primary care physicians can feel comfortable recommending this therapy.
Article
To determine whether nasal respiratory function can be improved by regular nasal irrigation with isotonic Emser salt solution in chronic, nonallergenic rhinosinusitis and whether a potential improvement results from the irrigation effect alone or has to be ascribed to additional salts, minerals, and trace elements, 38 patients participated in a double-blind study from October 1995 to April 1996 involving two nasal irrigation procedures with isotonic Emser salt solution or tap water (control group) per day. Regular examinations carried out over a period of 8 weeks recorded the evaluation of the patients with regard to symptoms, tolerance, and sensation of irrigation as well as nasal endoscopy, rhinomanometry, exfoliative cytology, and saccharine clearance. The study was discontinued prematurely due to a high incidence of otitis media; opening of the codes revealed that the patients affected were all in the control group. A pronounced improvement of mucosa status with reduction of reddening, swelling, secretion, and hindrance of nasal respiration was seen in both groups during the first 2 weeks, somewhat more markedly in the verum group. After 1 week of irrigation treatments, both groups showed accelerated saccarine clearance - significant only for isotonic Emser salt solution - and a rhinomanometrically measured increase in flow rate with Emser salt solution. No significant differences were seen between the two groups during the 8-week study period in the replies regarding improvement of symptoms, tolerance, whether the treatment was pleasant, and exfoliative cytology. However, initial symptom improvement and tolerance of isotonic Emser salt irrigation were rated much higher than irrigation with tap water, with a steady state status reached after 2 weeks. The patients excluded due to otitis media were only evaluated until their exclusion as per study protocol, which may have rendered the evaluation of tap water irrigation more favorable. Based on these results, a second modified study will compare iso-osmotic Emser salt solution with 0.9% NaCl solution.
Article
Substantial numbers of clinical trials continue to be reported only in summary reports that present insufficient methodological details to permit informed judgments about the likely validity of the conclusions. Using a cohort of 176 controlled trials reported in summary form, we tested the hypotheses that they would be more likely to be followed by full reports if, on the basis of the information provided in the summary report, (1) the trial was judged to be methodologically sound, (2) the results favored the test treatment, and (3) the sample size was relatively large. The results of univariate and multivariate analyses provided support for only the third of these hypotheses. Investigators, as well as those who fund and sanction the conduct of clinical research, should make greater efforts to ensure that clinical trials are reported properly. (JAMA. 1990;263:1401-1405)
Article
Some patients with allergic rhinitis have oral allergic reactions to fresh fruits and vegetables. This phenomenon has been termed "oral allergy syndrome" and is proposed to be due to cross-reacting allergens in the food and dust. Prick skin test titration was performed before the treatment. Fifthy patients suffering from perennial allergic rhinitis were treated in a randomized, double-blind, parallel group study comparing sulphurea water (Group A) and placebo (normal) water (Group B): all the patients were skin prick positive to either dust (Dermatophagoides farinae e pteronyssinus) and peach. Sulphurea water has shown to be effective in the treatment of the Oral allergy syndrome.
Article
The aim of the present study is to quantify the alterations of clinical and instrumental parameters after a crenotherapic cycle with bicarbonate-sulphate-carbonic waters in cararrhal disease of upper respiratory ways (rhino-sinutsitis, rhino-pharyngitis, rhino-otitis). The study was carried on 50 patients enrolled at the Thermae, affected by rhino-pharyngo-tubaric disease (Group A); as control group were enrolled 50 patients affected by chronic and sub-acute disorders of upper respiratory tract (Group B). The patients of the two groups showed similar clinical and demographic patterns. Each subject of Group A underwent a 12 days crenotherapic cycle with aerosol and inhalations and each patient of group B underwent, for the same period, a treatment with microfine nasal washing with isotonic saline solution. Measurements have been done before and after therapy: 1) symptomatologic subjective score; 2) "objective Score" evaluated by the physician; 3) nasal mucociliary transport time (tTMC); 4) nasal patency evaluated by Active Anterior Rhinomanometry; 5) liminar tonal audiometry; 6) timpanometry. In the B group (placebo) for each pattern any statistical variation has been found. On the other hand in the A group we noticed a statistical significant difference of each pattern with the exception of tympanometric and audiometric ones. Our study demonstrates the beneficent effects of the bicarbonatesulphate-alkaline-carbonic waters and introduce it as a valid therapeutic choice in the treatment of upper respiratory ways diseases.
Article
The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication, “Rhinosinusitis: Establishing definitions for clinical research and patient care” and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.
Article
Hintergrund: Die adäquate Nachsorge nach Nasennebenhöhleneingriffen basiert auf der schonenden Absaugung von Borken, der regelmäßigen Befeuchtung der Schleimhäute und der Salbenapplikation. Die Effektivität und die Compliance zweier unterschiedlicher Spülmethoden werden gegenüber gestellt. Methode: In einer prospektiven Untersuchung wurden in einem interindividuellen Parallelgruppendesign 50 Patienten mit Polyposis nasi einer endonasal-endoskopischen Nasennebenhöhlenoperation unterzogen. 24 randomisierte Patienten benützten postoperativ isotones NaCl-Nasenspray, 20 Patienten führten die traditionelle Hohlhandspülung durch. Als Wirksamkeitvariable wird die Veränderung von videoskopisch erfassten endonasalen Befunden (unterer Nasengang, mittlerer Nasengang, Kieferhöhlenostium, Siebbein) an 2 unterschiedlichen Untersuchungszeitpunkten ermittelt. Zusätzlich wurde mittels Patiententagebuch die Compliance geprüft. Ergebnisse: Eine signifikante Befundverbesserung zeigte sich im Bereich des Siebbeins bei Verwendung des Nasensprays, die klinischen Befunde der übrigen anatomischen Regionen verhielten sich bei beiden Applikationsformen im Wesentlichen gleich. Die größere Akzeptanz ergab sich bei den Benutzern des Nasensprays. Schlussfolgerung: Die Behandlung mittels Nasenspray scheint der Behandlung mittels Hohlhandspülung in Bezug auf Befeuchtung und Wundkonditionierung sowie Handhabung und hygienischen Ansprüchen überlegen.
Introduction Many otolaryngologists use nasal saline irrigations and sprays for patients with chronic rhinitis and rhinosinusitis as a mainstay to treat and irrigate purulent secretions from the nasal cavity. The Dead Sea is the world’s most saline lake. Its 30% salt composition has proportionately more calcium, magnesium, bromine, and potassium, and less sodium sulfate and carbonate than any other ocean. The dominant cation, magnesium, has been effective in the treatment of inflammatory cutaneous lesions, inhibits histamine effects, and stabilizes eosinophils. This article examines the value of a nasal irrigating solution and spray from the Dead Sea. Purpose To determine the effectiveness of Dead Sea salt solution (Oasis nasal spray/irrigation; Master Solutions, Tulsa, OK) on the symptomatic treatment of purulent rhinitis and rhinosinusitis by measuring the quality of life and sinus-specific symptoms. Methods A total of 31 patients were selected because of refractive purulent rhinosinusitis that persisted after medical or surgical treatment. A relatively new irrigating solution and nasal wash containing Dead Sea salt as their major components (Oasis) were used as an irrigation in the morning, and spray midday and evening. The Medical Outcomes Short Form 36 (SF-36) and Chronic Sinusitis Survey were used to measure quality of life. Of the 31 patients, 26 returned the survey instruments. Data were analyzed using STATISTICA (StatSoft, Inc, Tulsa, OK). Results The means before treatment were 20.08 for chronic sinusitis and 75.88 for quality of life, and after treatment significantly reduced to 13.37 and 45.65, respectively. Conclusions Dead Sea Salt is an effective irrigation and spray in the treatment of purulent rhinosinusitis, improving quality of life and rhinosinusitis symptoms. It may have its effectiveness because of the different cation composition from normal or hypertonic saline.
Article
Zusammenfassung Um zu klären, ob sich die nasale respiratorische Funktion bei chronischer nichtallergischer Rhinosinusitis durch eine regelmässige Nasenspülbehandlung mit isotoner Emser-Salz-Lösung verbessern lässt und ob eine mögliche Verbesserung alleine auf den Spüleffekt oder auf zusätzliche Salze, Mineralien und Spurenelemente zurückzuführen ist, unterzogen sich 38 Patienten von Oktober 1995 bis April 1996 im Rahmen einer Doppelblindstudie einer 2mal täglich durchgeführten Nasenspülung mit isotoner Emser-Salz-Lösung oder Leitungswasser (Kontrollgruppe). Anlässlich regelmässiger Untersuchungen während 8 Wochen wurden die Patienten hinsichtlich Beschwerden, Verträglichkeit und Empfinden der Spülbehandlung sowie Nasenendoskopie, Rhinomanometrie, Exfoliativzytologie und Saccharinclearance beurteilt. Die Studie wurde wegen gehäufter Otitis-media-Inzidenz vorzeitig abgebrochen; die Dechiffrierung ergab, dass es sich hierbei nur um Patienten der Kontrollgruppe handelte. Bei beiden Gruppen, etwas ausgeprägter in der Verumgruppe, kam es innerhalb der ersten 2 Wochen zu einer deutlichen Besserung der Schleimhautverhältnisse mit Rückbildung von Rötung, Schwellung, Sekretion und Nasenatmungsbehinderung. Nach lwöchiger Spülbehandlung zeigte sich bei beiden Gruppen eine Beschleunigung der Saccharinclearance, signifikant nur für isotone Emser-Salz-Lösung, sowie rhinomanometrisch nach isotoner Emser-Salz-Lösung ein Flow-Anstieg. Die Angaben zu Beschwerdelinderung und Verträglichkeit sowie in bezug darauf, ob die Behandlung angenehm sei, und die Exfoliativzytologie ergaben über den 8 Wochen dauernden Untersuchungszeitraum keine signifikanten Unterschiede zwischen beiden Gruppen. Jedoch wurden initiale Beschwerdelinderung und Verträglichkeit einer isotonen Emser-Salz-Lösung deutlich besser eingestuft als die Spülung mit Leitungswasser; nach 2 Wochen kam es zu einem Steady state. Durch das Studienprotokoll bedingt wurden die wegen Otitis media ausgeschlossenen Patienten nur bis zum Studienaus-schluss ausgewertet, so dass die Leitungswasserspülung möglicherweise positiver beurteilt wurde. Aufgrund der Ergebnisse folgt eine zweite modifizierte Studie mit isoosmotischer Emser-Salz-Lösung versus 0,9&percnt;iger NaCl-Lösung.
Article
The effects of a special balanced physiological saline on nasal symptoms of 93 patients with chronic rhinitis were studied. The main diagnoses of the patients were allergic rhinitis, atrophic rhinitis and ozaena, rhinitis sicca, chronic sinusitis, nasal polyposis and postoperative condition after nasal surgery. The tested solution was administered by a simple metered dose pump. 85 (91%) of the patients reported beneficial effects of the tested solution on nasal symptoms. In addition, 22 (71%) of those patients who used continuous anti-allergic medication, mainly intranasal steroids, reported that the tested solution improved the efficacy of their ordinary drug. So the tested solution proved to be beneficial in humidifying atrophic or otherwise dry mucosa, douching crusty nose and as adjuvant therapy in the treatment of allergic rhinitis.
This paper describes a new instrument for nasal irrigation, the nasal irrigator tip which is designed to attach to a water pik dental device. The instrument has the following advantages: Exact pressure can be obtained each time by a dial setting. It is aesthetically acceptable to patients. It is faster and less expensive to use than other methods. A pulsating stream assures better removal of crusts and pus. Pulsation improves the suction effect to the sinus. Another advantage is that children will use it.
Article
Although chronic sinusitis is an increasingly common diagnosis in the United States, the health burden of this disorder relative to the general population and to other chronic diseases has not been previously evaluated. One hundred fifty-eight patients with chronic sinusitis and no prior surgery underwent cross-sectional evaluation by use of the Medical Outcome Study Short-form 36-Item Health Survey. These patients were all referred for otolaryngologic care, and more than 80% subsequently underwent sinus surgery. Mean scores were compared from the eight subscales of general health assessment with similarly derived data for the United States general population. Significant differences (p < 0.05) were seen in several domains, including bodily pain, general health, vitality, and social functioning. Comparisons with other chronic diseases revealed significantly lower scores (p < 0.05) in measures of bodily pain and social functioning for sinusitis patients than in patients with congestive heart failure, angina, chronic obstructive pulmonary disease, and back pain. These findings suggest that the national health impact of chronic sinusitis is far greater than is currently appreciated.
Article
Sinus catheters were inserted in 44 children (mean age 8.5 years) suffering from acute and chronic purulent polysinusitis. In 33 outpatients sinus catheterization was combined with nasal irrigation providing a persistent therapeutic effect on the inflammation focus. In view of good treatment results both methods are offered for inpatient and outpatient pediatric practice of treating sinusitis.
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
Sinusitis can be defined as inflammation of the paranasal sinus mucosa. However, the definition of chronic sinusitis is not yet fully established. As chronic sinusitis occurs both on an infectious and non-infectious basis there are many symptoms, local as well as general, from the upper respiratory tract. It is generally agreed that the time aspect of the disease is important. Long-term symptoms, i.e. more than 3 months, and objective findings of mucosal inflammation are criteria for chronic sinusitis. In clinical practice it is also important to realize that mucosal changes usually persist for at least 8 weeks after the treatment of an acute infection. Interest has lately been focused on local sinusal inflammation, especially on the inflammatory cells whose immunoactive products seem to keep inflammation ongoing even after the infection is cured. It is not clear to which extent the mucosal damage, with granulation tissue, polyp formation and fibrosis, is reversible. In chronic sinusitis, the ostial function is disturbed, especially in patients with nasal polyposis. This function must be re-established, but it is still uncertain whether obstruction in the osteomeatal complex is primary or secondary to other factors. Further research into local immunological factors and analysis of the development of special local tissue pathology in sinusitis is necessary in order to be able to establish exactly why acute sinusitis does not resolve but turns into a chronic inflammatory disease.
Article
Local hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various nasal disorders such as the common cold and allergic rhinitis. With technical advances in vapor generation, water can be heated to a range of 41 degrees C to 43 degrees C with variation in particle size. The effect of inhaled heated vapor treatments was studied in patients with perennial rhinitis for changes in nasal airflow and patient perception of symptoms. Thirty symptomatic patients underwent three treatments at weekly intervals: (1) a large particle heated water vapor at 43 degrees C for 20 minutes with a particle size of 4 to 8 microns, (2) a molecular water vapor at 41 degrees C for 20 minutes which is a vapor phase, and (3) nasal irrigation. Nasal airflow increased after both vapor treatments at four and six hours (P < .05) whereas airflow decreased after simple nasal irrigation treatment. Rhinitis symptoms improved after vapor treatments but not with nasal irrigation. Patients preferred the molecular water vapor treatment over the large particle vapor treatment and nasal irrigation by 2:1 margin. This study demonstrated the usefulness of heated vapor treatments in improving rhinitis symptoms and nasal airflow.
Article
Twenty-eight patients undergoing rhinologic surgery were enrolled in a clinical study to compare two post-operative cleansing preparations. Patients were asked to wash their nasal fossae for 1 month, either with Rhinomer, a cleansing preparation of isotonic, sterile, undiluted sea water, presented in slightly pressurised bottle with neither CFC nor preservative, or with Prorhinel, a marketed solution containing an antiseptic agent. Patients were randomly allocated to treatment beginning 2 days after surgery. Nasal status was assessed by symptoms (blocking nose, rhinorrhoea, sneezing, itching and impaired smell) and rhinologic endoscopy (colour of the nasal mucosa, swelling of the mucosa, secretions, presence of crusts or pus). Patients attended control visits on days 9, 15 and 30 following surgery. They were asked to record symptom intensity and use of a rescue medication (Vibrocil, dimetindene 0.25 mg and phenylephrine 2.5 mg/ml) on a diary card. Twenty-six of 28 patients were eligible for efficacy analysis, 14 in the Rhinomer group and 12 in the Prorhinel group, In both groups, intensity of complaints decreased markedly over the study period. No severe adverse drug reactions were reported in either treatment. Evoked complaint frequency was comparable between groups, but patient's and physician's opinion on tolerability was significantly different between treatments, in favour of Rhinomer. In addition, the test preparation was found to be easier to use than Prorhinel. The weekly average frequency of use of the rescue medication was not significantly different between treatments. When both patients and physicians were asked about treatment efficacy, they expressed an opinion significantly more favourable to Rhinomer than to the reference drug. In this study, Rhinomer has shown efficacious results that justify its use in washing of the nasal cavities following endonasal surgery.
Article
This study compared the efficacy of mechanical nasal lavages with pressurized seawater versus nasal irrigations with saline plus benzododecinium (antiseptic) plus oleosorbate (mucolytic). Twenty patients agreed to participate in a randomized, single-blind clinical trial. All patients underwent endoscopic endonasal ethmoidectomy for nasal polyps. The packing was removed after 48 h and patients were asked to start the same day nasal lavages three times a day. Clinical evaluations were performed: (1) by weighing residual nasal crusts and secretions after 21 +/- 2 days; and (2) by using visual analogue scales to daily record symptom scores. Data are presented as mean +/- SEM. T-test statistics for two independent groups were applied. The mean residual crust and secretion weights were 1,756 +/- 688 mg and 1,033 +/- 422 mg in the pressurized seawater group, 932 +/- 414 mg and 1,222 +/- 435 mg in the antiseptic-mucolytic saline group. No statistical differences were found. Sample size calculations showed that 100 subjects in each group would be necessary to confirm a 700-mg reduction in residual crusts in the antiseptic/mucolytic saline group (power = 0.80; two-sided type-I error = 0.05). Daily symptom score curves were similar in both groups and allowed us to give a description of post-operative complaints. The role of antiseptic, mucolytic and mechanical lavages in preventing post-ethmoidectomy crust formation is discussed.
Article
Endonasal irrigation with saline solution is a widely used constituent of mucosal care after sinus surgery. This procedure could explain a repeatedly observed phenomenon: contamination of the endonasal mucosa by facultative skin pathogens from the palm during paranasal sinus irrigation. For this reason the effect of nasal rinses with saline solution on the endonasal bacterial flora was investigated (use of so-called nasal douche [Siemens & Co., Bad Ems] compared to rinsing by hand). In 36 patients (23 m., 13 f., 36 +/- 19.5 years of age) with chronic sinusitis, a total of 288 swabs was collected before, during, and after surgery. The collected specimens were transferred to a Port-A-Cul transport medium and processed within four hours. Two hundred sixty-six cultures of 325 bacterial strains were aerobic (82%), while 59 were anaerobic (18%). Staphylococcus aureus (33%) and representatives of the Enterobacteriaceae family (31%) were the most common enriched germs. The number of times that enterobacteriaceae could be isolated was significantly (p < 0.05) lower (13%) when a nasal douche was used than when irrigation was done using the palm (38%). An irrigation technique-related effect was found on neither the spectrum of the pathagonic organisms nor the wound healing process. The frequent isolation of enterobacteria in nasal swabs of individuals rinsing by hand constitutes the difference between irrigation by nasal douche and by hand in the postoperative care of the endonasal mucosa. These pathogens can sustain the paranasal sinus system.
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
A new modification of sinus-catheter RMNK-5 is proposed enabling simultaneous irrigation of the nasal cavity and evacuation of the discharge from the paranasal sinuses. Details of the technique are provided. A positive effect consisting in attenuation of the inflammation, prolongation of the remission improvement of life quality is illustrated in the analysis of 6 cases.
Article
Background: Ephedrine nasal wash (0.25% to 1%) was once used in the treatment of sinusitis and other nasal and paranasal symptoms, but there are no reported controlled trials in allergic rhinitis. Methods: In a blinded study, 118 patients with perennial allergic rhinitis were randomly divided into two groups of 65 and 53 patients, respectively, and administered either a placebo or a 1% ephedrine-saline nasal wash once every 48 hours for a period of 4 weeks. These groups were then crossed over after a 4-week interval, and their weekly symptom scores and peak nasal inspiratory flow rates were monitored. Results: Use of ephedrine-saline nasal wash resulted in significant improvement in symptom scores and peak nasal inspiratory flow rates as compared with placebo (p < or = 0.001). A statistically significant difference between the two groups began in the second week. The effects of treatment lasted for more than 2 weeks after the study, without notable side effects, in most patients. Conclusion: A 1% ephedrine-saline nasal wash is an inexpensive and effective treatment for allergic rhinitis.
Article
Sinus irrigation is the traditional treatment for chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) restores aeration and allows secretions to be removed from an infected sinus. This study compares the efficacy of sinus irrigation with that of sinus irrigation followed by FESS in 89 patients. We measured the effects by way of sinus radiographs, nasendoscopic findings, and patient complaints. When we analyzed the data in terms of intent to treat, we found significantly favorable results for sinus irrigation followed by FESS at the end point, though only for loss of smell and purulent rhinitis. Treatment consisting of sinus irrigation alone prevented surgery in 58% of all patients for 1 year. Both treatment methods were combined with a 10-day course of loracarbef, which might have contributed to the outcome. We conclude that a good option for treatment of chronic maxillary sinusitis seems to be sinus irrigation in combination with a broad-spectrum antibiotic followed by FESS.
Article
Nasal complaints and impaired nasal physiology are common in various occupational environments. Saline lavage has been recommended as treatment but has not yet been sufficiently evaluated. In this cross-sectional study of 45 wood industry workers, a significant decrease in nasal symptoms (such as obstruction, posterior secretions, itching, irritation and sneezing) was seen after a 3-week treatment with Rhinomer, which contains de-ionized, sterilized, isotonic seawater. Nasal peak expiratory flow (NPEF), especially in workers with nasal complaints, and nasal mucociliary clearance also improved significantly. The treatment, according to participants, was simple to perform and there were only a few side effects.
Article
Rhinitis sicca is a widespread disease, caused by a variety of factors. There are many different treatments, but none is more reliable than the other. In a prospective study we examined 12 patients before and after a ten-day course of nasal irrigation with Rhinomer Force 1 regarding their symptoms, the mucociliary clearance measured with the saccharin test according to Andersen and tolerance of therapy. Improvement of nose breathing (57%), sensation of mucous running in the pharynx (42%), feeling of a dry nose (42%, significant p = 0.0313). The overall improvement was significant (67%, p = 0.054). Mucociliary transport analysed for each side of the nose (24 sides) resulted in 38% improvement (up 10 min in average), 12% same result, 50% worsening (down 12 min in average). The acceptance was reported as very good in 91% of the study group. Depending on the symptoms, a high to significant amount of improvement is documented after therapy with isotonic salt water solution. In our study the measurement of the mucociliary transport does not correlate with subjective symptoms. It does not appear to be an adequate tool for diagnosing rhinitis sicca or evaluating the success of treatment.
Article
Chronic sinusitis (CS) is a common disease in children, especially those with allergies, that is caused by impaired drainage from the sinuses. Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency. We performed a randomized double blind study to compare the effect of nasal wash with hypertonic saline (HS) (3.5%) versus normal saline (NS) (0.9%) on CS. Thirty patients with CS aged 3 to 16 years were studied. They were randomly divided into two treatment groups matched by age and severity of the disease. Each individual was treated with either HS or NS for 4 weeks. All patients were evaluated by two clinical scores (cough and nasal secretions/postnasal drip [PND]) and by a radiology score at the beginning of the study and after 4 weeks. The HS group improved significantly in all scores (average +/- SD): cough score, from 3.6 +/- 0.51 to 1.6 +/- 0.74; nasal secretion/PND score, from 2.86 +/- 0.35 to 1.6 +/- 0.74; and radiology score, from 8.06 +/- 1.28 to 2.66 +/- 1.04. The NS treatment group showed significant improvement only in the PND score (from 2.66 +/- 0.49 to 1.53 +/- 0.83) but no significant change in both the cough score (from 3.53 +/- 0.52 to 3.33 +/- 0.49) and the radiology score (from 8.13 +/- 1.25 to 7.86 +/- 0.91). Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups. HS nasal wash is an efficient treatment of CS.
Article
Based on data collected from a national sample of office-based physicians, statistics are presented on the provision and utilization of ambulatory medical care services in physicians' offices during 1991. Ambulatory medical care services are described in terms of patient characteristics, physician practice characteristics, and visit characteristics.
Article
The effect of nasal douching in 40 patients with chronic rhinosinusitis was tested, and two different preparations compared: 19 receiving traditional alkaline nasal douche and 21 receiving a sterile sea water spray, in addition to their regular treatment. Douching per se improved endoscopic appearances (p = .009), and quality of life scores (p = .008). These measures did not change in a control group (n = 22) who received standard treatment for chronic rhinosinusitis, but no douche. There were significant differences between the two douching preparations in that the alkaline nasal douche improved endoscopic appearances but not quality of life, whereas the opposite was true for the spray.
The authors present the story of Physiomer. It began in 1988 in Goemar's 'Laboratory of the Sea', with an original idea of making a product manufactured from sea water and transforming it into an isotonic solution, while preserving all the elements of natural sea water, specially the trace elements and the alkaline PH. Scientific analysis has shown that the chemical composition of the product is true to the original, and that it has a positive action on cellular growth in respiratory tract mucosa in experimental culture, and it is very well tolerated. Clinical tests using nasal washings have confirmed beneficial action on the nasal and sinus mucosa in medical disease and after surgery. Tests have been carried out on 410 cases, 344 of which were treated with Physiomer, and on 199 cases after surgery on the nose or sinuses. Physiomer nasal washings have proved their value. It now remains for all the potential qualities of sea water to be demonstrated, using other preparations or other combinations.
Article
Serum levels of IgE to pollen allergens increase in allergic patients during the pollen season. Nasal tissues appear to play a critical role in this rise because levels of IgE to these allergens may be inhibited by intranasal steroids administered during the season. 1,2 Sodium chloride nasal irrigation is an old home remedy used for rhinitis relief with a presumably rather simple action: nasal cleansing and secretion removal. Here we have assessed for the first time the effect of nasal irrigation on the seasonal IgE increase in grass-allergic patients.
Article
Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.
Article
To determine the effect of nasal irrigation on sinonasal symptoms. A total of 150 adult subjects with chronic sinusitis symptoms were recruited from the community and assigned to 1 of 3 treatment groups: nasal irrigation with bulb syringe, nasal irrigation with nasal irrigation pot, or control treatment with reflexology massage. Groups 1 and 2 performed daily hypertonic saline irrigation with 1 device for 2 weeks and then with the other device for 2 weeks. Group 3 performed reflexology massage daily for 2 weeks. Prospective data collected included pretreatment Medical Outcomes Study Short Form, pretreatment and posttreatment Rhinosinusitis Outcomes Measure, daily medication use, subjective treatment efficacy, and preference of irrigation method. There was a significant and equivalent improvement in Rhinosinusitis Outcomes Measure 31 score after 2 weeks of intervention in each treatment group; 35% of subjects reported decreased use of sinus medication. Daily nasal irrigation using either a bulb syringe, nasal irrigation pot, and daily reflexology massage were equally efficacious and resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects. Medication usage was decreased in approximately one third of participants regardless of intervention.
Article
Irrigation with isotonic saline is one of the most frequently used solutions after nasal surgery. However, the effect of saline solutions on mucociliary clearance is not well known. In a previous study, it was found that isotonic saline solution had a negative effect on ciliary beat frequency but Ringer-Locke solution had no effect in vitro. In this study we compared the effects of Ringer-Lactate solution and isotonic saline solution on mucociliary transport time before, and after, nasal septal surgery in patients with nasal septal deviation. We found that patients who used Ringer-Lactate solution as irrigation after surgery had a significantly better mucociliary transport time than the patients using isotonic saline solution (p < 0.05). In conclusion, it is better to use Ringer-Lactate solution instead of 0.9 per cent saline solution for nasal irrigation.
Article
To evaluate whether there was any difference in efficacy when nasal mucosa dryness was treated with pure sesame oil (Nozoil) compared with isotonic sodium chloride solution (ISCS). In a randomized, crossover study, 79 subjects with nasal mucosa dryness were enrolled. Half the subjects received pure sesame oil for 14 days followed by ISCS for 14 days, and the other half received ISCS for 14 days followed by pure sesame oil for 14 days. During the test period from March 13 to May 30, 2000, the outdoor absolute humidity was low. Nasal mucosa dryness, stuffiness, and crusts were scored every evening with a visual analog scale. The County Hospital, Skellefteå, Sweden. Nasal mucosa dryness improved significantly when pure sesame oil was used compared with ISCS (P<.001). The improvement in nasal stuffiness was also better with pure sesame oil (P<.001) as was improvement in nasal crusts (P<.001). Eight of 10 subjects reported that their nasal symptoms had improved with pure sesame oil compared with 3 of 10 for ISCS (P<.001). Adverse events were few and temporary. When nasal mucosa dryness due to a dry winter climate was treated, pure sesame oil was shown statistically to be significantly more effective than ISCS.
Article
To investigate the clinical effect of Rhinitis Spray (RS) in treating chronic rhinitis. Eighty patients with chronic rhinitis were divided into three groups, and treated with RS, ephedrine and normal saline respectively. The short-term effective rate in the three groups was 89.3%, 66.7% and 8.0% respectively. RS was effective in alleviating symptoms, increasing IgG level in nasal discharge, improving ventilation of nasal cavity and transfer function of cilia of nasal mucosa obviously. The therapeutic effect of RS in treating chronic rhinitis is good.
Article
The aim of this study was to test the effects of the iodine bromide water of the thermal baths of Salsomaggiore on patients suffering from specific nonseasonal rhinitis (Dermatophagoides Farinae and Dermatophagoides Pteronyssinus). The patients, 80 in all, were divided in two groups (group A and group B). All of the patients underwent rhinoscopic examination, anterior rhinomanometry, prick test, rast screening, total IgE assay together with that of the other immunoglobulins (IgA, IgM, IgG), mucociliary clearance evaluation and were asked to evaluate their degree of nasal obstruction, before and after 30 days of treatment. Group A carried out the experiment by applying endonasal Acqua Sal spray seven times a day for 30 days; group B used oily drops for the same time and with the same frequency. At the end of the trial period, the patients in group A showed a 100% improvement in their subjective perception of their symptomatology, in comparison with a 33% improvement in the control group. A characteristic decrease in the IgE and increase in the IgA was observed in the serum of the patients who had been treated with Acqua Sal spray. Iodine bromide water has a general and local anti-inflammatory effect, which is also due to the activation of the corticosurrenal system (with a relative increase in cortisol). The cleansing action of hypertonic water in the nasal cavities must also be cited, as it minimizes contact between the mucosa and allergens.
Article
Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study. Ten children were randomized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season, which had lasted 6 weeks. Ten patients were allocated to receive no nasal irrigation and were used as controls. A mean daily rhinitis score based on the presence of nasal itching, rhinorrea, nasal obstruction and sneezing was calculated for each week of the pollen season. Moreover, patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated. In patients allocated to nasal irrigation, the mean daily rhinitis score was reduced during 5 weeks of the study period. This reduction was statistically significantly different in the 3th, 4th and 5th week of therapy. Moreover, a decreased consumption of oral antihistamines was observed in these patients. This effect became evident after the second week of treatment and resulted in statistically significant differences during the 3th, 4th and 6th week. This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective.
Article
Nasal decontamination may be indicated when the anterior nasal passages are contaminated with highly radioactive material or radioactive material with either irritating or toxic properties. Nasal irrigation (wash, rinse, douche, lavage) is an established technique used for other conditions and can be applied in these cases. This paper discusses the rationale and use of nasal irrigation and how to perform the technique.