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Nasal Irrigation
Learn About Nasal Irrigation
A Randomized Controlled Trial
Melissa A. Pynnonen, MD; Shraddha S. Mukerji, MD; H. Myra Kim, ScD; Meredith E. Adams, MD; Jeffrey E. Terrell, MD
OBJECTIVE:
To determine if isotonic sodium chloride (hereinafter "saline") nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays at improving quality of life and decreasing medication use.
Design:
A prospective, randomized controlled trial.
Setting:
Community.
Participants:
A total of 127 adults with chronic nasal and sinus symptoms.
Interventions:
Patients were randomly assigned to irrigation performed with large volume and delivered with low positive pressure (n=64) or spray (n=63) for 8 weeks.
Main Outcome Measures:
Change in symptom severity measured by mean 20-Item Sino-Nasal Outcome Test (SNOT-20) score; change in symptom frequency measured with a global question; and change in medication use.
Results:
A total of 121 patients were evaluable. The irrigation group achieved lower SNOT-20 scores than the spray group at all 3 time points: 4.4 points lower at 2 weeks (P=.02); 8.2 points lower at 4 weeks (P_.001); and 6.4 points lower at 8 weeks (P=.002). When symptom frequency was analyzed, 40% of subjects in the irrigation group reported symptoms "often or always" at 8 weeks compared with 61% in the spray group (absolute risk reduction, 0.2; 95% confidence interval, 0.02-0.38 (P=.01). No significant differences in sinus medication use were seen between groups.
Conclusion:
Nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays for treatment of chronic nasal and sinus symptoms in a community-based population.
Can Fam Physician. 2003 Feb;49:168-73.
Papsin B, McTavish A.
Department of Otolaryngology, Hospital for Sick Children, Toronto, Ont.
OBJECTIVE:
To review clinical evidence on the efficacy of saline nasal irrigation for treatment of sinonasal conditions and to explore its potential benefits.
QUALITY OF EVIDENCE:
Clinical trials, reviews, and treatment guidelines discussing nasal irrigation were obtained through a MEDLINE search from January 1980 to December 2001. Most trials were small and some were not controlled; evidence, therefore, is level II, or fair.
MAIN MESSAGE:
Flushing the nasal cavity with saline solution promotes mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material. The procedure has been used safely for both adults and children, and has no documented serious adverse effects. Patients treated with nasal irrigation rely less on other medications and make fewer visits to physicians. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity.
CONCLUSION:
Nasal irrigation is a simple, inexpensive treatment that relieves the symptoms of a variety of sinus and nasal conditions, reduces use of medical resources, and could help minimize antibiotic resistance.
Publication Types:
- Review
- Review, Tutorial
PMID: 12619739 [PubMed - indexed for MEDLINE]
Laryngoscope. 2002 Aug;112(8 Pt 1):1394-8.
Olson DE, Rasgon BM, Hilsinger RL Jr.
Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California 94611-5963, USA. budelsky@pachell.net
OBJECTIVE:
To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation.
STUDY DESIGN:
Prospective, controlled comparison.
METHODS:
Eight healthy adult volunteers received nasal irrigation with 40 mL of isotonic, nonionic contrast material immediately before having coronal computed tomography to visualize distribution of solution in the paranasal sinuses. For each study subject, three methods of irrigation were used: irrigation using positive-pressure irrigation, irrigation using negative-pressure irrigation, and irrigation using a nebulizer. For each subject, three-dimensional computer reconstructions of the irrigated paranasal sinus airspaces were used to compare contrast solution volume and distribution achieved by the three methods.
RESULTS:
Of the three methods used, two methods, positive-pressure and negative-pressure irrigation, distributed contrast solution widely to ethmoid and maxillary sinuses, but distribution of contrast solution was more uniform using positive-pressure irrigation than using negative-pressure irrigation. The nebulization method distributed contrast solution poorly and resulted in a significantly lower volume of retained contrast solution (P <.05).
CONCLUSION:
Judged solely on the basis of solution distribution in the nasal sinuses, nasal irrigation is effective when either positive-pressure or negative-pressure irrigation is used but is ineffective when a nebulizer is used.
PMID: 12172251 [PubMed - indexed for MEDLINE]
Otolaryngol Head Neck Surg. 2001 Jul;125(1):44-8.
Heatley DG, McConnell KE, Kille TL, Leverson GE.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine, Madison, WI 53792-7375, USA. heatley@surgery.wisc.edu
OBJECTIVE:
To determine the effect of nasal irrigation on sinonasal symptoms.
STUDY DESIGN AND SETTING:
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.
RESULTS:
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.
CONCLUSION:
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.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 11458213 [PubMed - indexed for MEDLINE]
Eur Arch Otorhinolaryngol. 2000 Dec;257(10):537-41.
Bachmann G, Hommel G, Michel O.
Otorhinolaryngological Clinic, Cologne University, Germany. gregor.bachmann@uni-koeln.de
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.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 11195032 [PubMed - indexed for MEDLINE]
Laryngoscope. 2000 Jul;110(7):1189-93.
Tomooka LT, Murphy C, Davidson TM.
School of Medicine, University of California San Diego, USA.
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.
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.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 10892694 [PubMed - indexed for MEDLINE]
Rhinology. 1997 Sep;35(3):108-12.
Holmstrom M, Rosen G, Wahlander L.
Department of Otorhinolaryngology, Huddinge University Hospital, Sweden.
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.
PMID: 9403939 [PubMed - indexed for MEDLINE]
Laryngorhinootologie. 1997 Mar;76(3):137-41.
[Article in German]
Keerl R, Weber R, Muller C, Schick B.
Klinik fur HNO-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Kommunikationsstorungen, Stadtisches Klinikum Fulda.
BACKGROUND:
Cleaning of the nose with saline solution after endonasal sinus surgery is very often used for postoperative treatment. But the efficiency and acceptance of this method has not been examined thoroughly until now.
METHODS:
Performance, effectiveness and acceptance of the postoperative treatment was evaluated in a questionnaire. One hundred thirty-four of 180 patients answered.
RESULTS:
One hundred twenty-one patients (66.1%) cleaned their nose with Ems brine; 28.1% of the patients used saline solution. The nasal douche was the cleaning device used by 39.7% of the patients, whereas 53.7% sniffed the solution from their hand. Ninety-five percent found that this kind of treatment was easy to do; 84.7% found it equally pleasant. There was no difference between using Ems brine or NaCl solution nor between using the nasal douche or sniffing out of the hand. Fifty-one point four percent of the patients with an follow-up of 27 to 36 months rinsed their nose up to now; 55.9% resumed nasal irrigation after an interval.
CONCLUSIONS:
Rinsing of the nose after endonasal sinus surgery is judged positively by most of our patients and is integrated well in the daily routine. Although it is most common to sniff saline solution out of the hand, existing research recommends usage of warm Ems brine in combination with the nasal douche.
Publication Types:
- Clinical Trial
PMID: 9213401 [PubMed - indexed for MEDLINE]
Ear Nose Throat J. 1995 Jul;74(7):493.
Berry YJ.
Publication Types:
- Letter
PMID: 7671841 [PubMed - indexed for MEDLINE]
Chest. 1994 Nov;106(5):1487-92.
Georgitis JW.
Department of Pediatrics, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157.
STUDY OBJECTIVE:
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.
DESIGN:
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.
PATIENTS AND PARTICIPANTS:
Thirty symptomatic patients with active perennial allergic rhinitis underwent three treatments at weekly intervals.
MEASUREMENTS AND RESULTS:
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).
CONCLUSIONS:
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.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 7956408 [PubMed - indexed for MEDLINE]
Ann Allergy. 1993 Oct;71(4):385-9.
Georgitis JW.
Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
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.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
- Randomized Controlled Trial
PMID: 8214804 [PubMed - indexed for MEDLINE]
Rhinology. 1987 Dec;25(4):259-64.
Maes JJ, Clement PA.
H. Hartclinic, Eeklo, Belgium.
The authors studied 80 children with sinusitis, all treated with amoxycillin and a decongestive preparation. The authors reached the conclusion that in 30 out of 80 children the third standard X-ray becomes normal without further treatment. In the remaining 50 children the usefulness of irrigation of the maxillary sinus was studied: one group was treated with antroscopy and sinuscopy while the second group did not receive this treatment (control). In both groups control X-rays were performed after three weeks. There was no significant difference between the two groups, which indicates that irrigation does not lead to a better cure. A correlation of 71% was found between X-ray findings and antroscopic findings. As a first treatment antibiotics are recommended.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 2448862 [PubMed - indexed for MEDLINE]
J Biocommun. 1984 Feb;11(1):13-5.
Wilcox MA, Bartner HC.
A teaching model for nasal irrigation is designed to instruct and reassure patients that water pulsed into the nostrils will return out of the nostrils without harm to the individual. Either an electric dental cleanser with a special adapter for the nose or a bulb syringe is used to irrigate. Materials used to produce this model are dental self-curing resins and silicones.
PMID: 6725243 [PubMed - indexed for MEDLINE]
Otolaryngol Clin North Am. 1977 Feb;10(1):71-80.
Jazbi B, Ritter FN.
Sinus disease in children is usually ethmoidal in location. Acute illness is common and responds well to antibiotics. Sometimes the infection causes ipsilateral orbital cellulitis or rarely an orbital abscess. Systemic administration of antibiotics is usually effective in bringing about resolution. Surgery is not often needed. Acute maxillary sinus disease occurs more often in the older child in the second decade of life. It is manifested by pain in the cheek and teeth, nasal obstruction, and discharge. Treatment with antibiotics is usually effective. For chronic illness, irrigations in most cases bring about resolution. However, occasionally Caldwell-Luc surgery may be necessary.
PMID: 854355 [PubMed - indexed for MEDLINE]
J Am Vet Med Assoc. 1956 Jun 15;128(12):577-80.
MEGINNIS PJ.
PMID: 13319194 [PubMed - OLDMEDLINE for Pre1966]
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