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Nasal irrigation, rather than steam inhalation, relieves rhinosinusitis symptoms

Pearl Toh
16 Aug 2016

Nasal saline irrigation improved symptoms of rhinosinusitis as well as reduced the need for doctor consultation and use of over-the-counter (OTC) medications, a recent study has shown.

“Based on my experience which is consistent with several published data, patients find symptomatic improvement such as relief of blocked nose, runny nose, facial pains or headaches when using nasal irrigation,” said Dr Dennis Chua, an Otolaryngology (ENT) consultant at the Singapore Medical Specialists Centre Pte Ltd, Singapore, who was unaffiliated with the study.

“I personally find that using nasal irrigation prior to using nasal steroid spray improves its effectiveness as the nasal spray lands directly on the nasal mucosa and not on any mucopus that can be present within the nasal cavity,” Chua said.

The study randomized 871 patients (aged 18-65 years) with chronic or recurrent sinusitis to one of four strategies: daily steam inhalation, daily nasal saline irrigation accompanied with a demonstration video, combined intervention of both strategies, or usual care. They were followed-up at 3 and 6 months after the initial intervention. [CMAJ 2016;doi:10.1503/cmaj.160362]

“We have found that even a very brief intervention of a video showing patients how to use saline nasal irrigation can improve symptoms,” said lead author Dr Paul Little, professor of Primary Care Research at the University of Southampton in Southampton, UK.

Nasal irrigation improved Rhinosinusitis Disability Index (RSDI) scores of patients to a greater extent than those without nasal irrigation (mean difference, -2.51, 95 percent confidence interval [CI], -4.65 to -0.37 at 3 months, and mean difference, -2.41, 95 percent CI, -4.66 to -0.16 at 6 months).  

At 6 months, significantly more patients in the nasal irrigation group maintained a 10-point reduction in RSDI score compared with those without irrigation (44.1 percent vs 36.6 percent).

“Strategy to use nasal irrigation was less effective than prior evidence suggested [ie, a 14-point improvement], but it provided some symptomatic benefit,” said Little and coauthors.

They attributed the difference in effectiveness to the greater amount of follow-up contacts with patients in the previous studies, which could have enhanced treatment effect through adherence.

In addition, the nasal irrigation group was less likely to report headache (p=0.004) and use OTC medications (p=0.051) compared with those without irrigation. The nasal irrigation group was also less likely to visit a doctor for sinus symptoms (mean difference in score on 7-point Likert scale, 0.30, 95 percent CI, 0.08—0.53).

Although the number of respiratory infections was similar in both groups of patients with or without nasal irrigation, the number of days patients felt unwell with sinusitis symptoms was significantly reduced at 6 months in the nasal irrigation group compared with those without the intervention (adjusted relative risk, 0.81, 95 percent CI, 0.68—0.96).

In contrast, steam inhalation did not improve any of the outcomes above except reduced headache.

“Steam inhalation has not been very useful in my experience in relieving nasal symptoms. This could be due to the fact that Singapore already has a very humid climate and steam inhalation may be more useful in temperate climates,” explained Chua. 

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