A new study demonstrates that patients with chronic sinusitis may
benefit from use of nasal irrigation using a saline solution. Nasal
irrigation is inexpensive and yet easy to use; however, few studies
exist which examine the efficacy of the procedure.
The authors of the study, "Nasal Irrigation for the Alleviation of
Sinonasal Symptoms," are Diane G. Heatley MD, Glen E. Leverson PhD,
Kari E. McConnell RN, and Tony L. Kille, all from the University of
Wisconsin School of Medicine, Madison, WI. Their findings will be
presented Monday, September 25, 2000, at the American Academy of
Otolaryngology--Head and Neck Surgery Foundation Annual Meeting/Oto
Expo, being held September 24-27, 2000, at the Washington, DC
Convention Center.
Methodology: One hundred and fifty subjects were recruited from the
Madison area via newspaper advertisements. The inclusion requirements
were that patients had to be older than 18 years and at least two
symptoms of chronic sinusitis (nasal congestion, anterior rhinorrhea,
post-nasal drainage, headache, facial pain, halitosis, cough).
Participants were excluded from the study if they had, within a
six-month period, undergone sinonasal surgery or used nasal
irrigation; had profuse nosebleeding more than once a month, or were
latex allergic.
Those eventually enrolled in the study were not under medical care
for their symptoms, and although most had tried conventional therapy
in the past, many no longer used these medications. No medications
were prescribed to the study participants, and they were instructed
to use, during the study period, any medications that they would
normally use for their sinonasal symptoms.
Participants were randomly assigned to one of three treatment groups:
(1) nasal irrigation with bulb syringe; (2) nasal irrigation with a
nasal irrigation pot; and (3) reflexology massage (irrigation
control). Prior to the study, each participant underwent anterior
rhinoscopy to characterize their internal anatomy, character of
secretions, and to rule out a nasal mass.
Groups one and two performed daily hypertonic saline irrigation for
two weeks with one method (bulb syringe or nasal irrigation pot) and
then switched to the other method for the following two weeks.
Irrigation devices were collected and cultured after two weeks of
use. Group three (the control) performed reflexology massage daily
for two weeks. Data was collected prospectively including
pre-treatment Medical Outcomes Study Short Form, pre and
post-treatment Rhinosinusitis Outcomes Measure, daily medication use,
subjective treatment efficacy, and preference of irrigation
method.
Results: Completing the study were 127 subjects (49 males and 78
females), ages 19 to 86 (mean of 49 years). The three groups were
similar regarding gender, smoking habit, allergic rhinitis, previous
sinonasal surgery, and pre-treatment Rhinosinusitis Outcomes Measure
profiles. Improvement was not influenced by the presence of allergic
rhinitis, previous nasal surgery, and age.
Overall, 36 percent of subjects reported decreased use of sinus
medication (decongestants, antihistamines, pain relievers, and nasal
sprays) during the study with no measurable difference between the
three groups.
There was equal preference for the bulb syringe (46 percent) and
nasal irrigation pot (43 percent). The bulb syringe was found more
effective by 36 percent of subjects, nasal irrigation pot by 45
percent.
Smokers were less likely to show improvement. Men (84 percent)
expressed improvement in their condition compared to 68 percent of
women.
Conclusions: The study demonstrated that
daily nasal irrigation with hypertonic
saline offers patients an inexpensive treatment protocol that
improves chronic sinusitis symptoms. During the study, a
number of patients decreased or eliminated medication.The choice of
preferred irrigation protocol was likely linked to the randomization
among patient subjects. It is unclear whether the improvement found
in patients in the reflexology massage group reflects a therapeutic,
placebo, or combination of effects. All the findings highlight the
complex interactions of managing chronic sinusitis symptoms.