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According to a new study in the latest issue of the Archives of Otolaryngology — Head & Neck Surgery, saline irrigation treatments show greater efficacy versus saline spray for providing short-term relief of chronic nasal and sinus symptoms.

In the United States, 29.5 million people 18 years of age and older are affected by sinusitis [1]. Millions more are affected by other types of allergic and non-allergic rhinitis (meaning irritation and inflammation of the mucosal membrane of the nose). Some people can reduce symptom severity using medication, including antihistamines and anti-inflammatory drugs. Antibiotics are frequently prescribed for acute and chronic sinusitis. However, their use far outweighs the predicted incidence of bacterial infection, suggesting that antibiotics are overprescribed for sinus infections. Regardless of the medication used however, for many patients, symptoms persist.

Nasal irrigation - the flooding of the sinus cavity with warm saline solution - can help to reduce sinus congestion and is often recommended by otolaryngologists (ear, nose and throat physicians) for a variety of sinus conditions. The goal of nasal irrigation is to clear excess mucus and foreign debris out of the sinuses, and to moisturize the mucosal membrane. The practice has been subjected to clinical testing and has been found to be safe and beneficial with no apparent side effects (for reviews of clinical evidence, see [2-3]). The practice is simple and inexpensive, and has been shown to decrease the symptoms of a variety of nasal and sinus conditions. As an alternative to irrigation, saline spray is often used because it is thought to be similar to and better tolerated than irrigation. However, the effectiveness of nasal saline spray has not been proven in clinical trials.

A new study from researchers at the University of Michigan Health System concludes that nasal irrigation is more effective that commonly used saline sprays for treating chronic nasal and sinus symptoms. Participants in the study, 127 adults with chronic nasal and sinus symptoms, were randomly assigned to irrigation or spray for 8 weeks. Those using nasal irrigation showed a statistically significant change in symptom severity as early as 2 weeks into the study. After 8 weeks, only 40% of participants in the irrigation group reported frequent (defined as “often or always”) nasal and sinus symptoms compared with 61% in the spray group [4].

Both groups experienced adverse effects. More were reported in the irrigation group. However, most adverse effects were minor and none required that treatment be stopped. The most commonly reported adverse effect was post-irrigation drainage, which occurs when saline in the upper sinuses isn’t expelled and later drains.

The study is the first of it’s kind to show greater efficacy of saline irrigation treatments versus saline spray for providing short-term relief of chronic nasal symptoms. According to lead author Melissa A. Pynnonen, M.D., clinical assistant professor in the University of Michigan Department of Otolaryngology [5]:

The irrigation group achieved a clinically significant improvement in quality of life in terms of the severity of their symptoms, whereas the spray group did not. Strikingly, they also experienced 50 percent lower odds of frequent nasal symptoms compared with the spray group.

An interview-based study assessing the attitudes regarding use of nasal irrigation for frequent rhinosinusitis as well as chronic sinus and nasal symptoms published last year found that [6]:

• Nasal irrigation produced rapid and long-term improvement in the quality of life.
• Users felt empowered.
• Barriers to use included discomfort, time and mild side effects.
• Instruction and at-home use can overcome the fore-mentioned barriers.

The take-home message? If you’re using saline spray to treat chronic sinus symptoms, you will experience a much greater benefit in terms of both symptom severity and frequency with saline nasal irrigation.

Do you use nasal irrigation? Why or why not?

References

1. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2005. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Health Statistics. 2006 Dec.
2. Papsin and McTavish. Saline nasal irrigation: Its role as an adjunct treatment. Can Fam Physician. 2003 Feb;49:168-73.
   View abstract
3. Harvey et al. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006394.
   View abstract
4. Pynnonen et al. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115-20.
   View abstract
5. Sinus problems are treated well with safe, inexpensive treatment, UMHS study finds. Department of Public Relations and Marketing Communications Newsroom. University of Michigan Health System. 2007 Nov 19.
6. Rabago et al. Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study. Ann Fam Med. 2006 Jul-Aug;4(4):295-301.
   View abstract

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The sinuses are hollow spaces located inside the bones in the skull to either side of the nose, behind and in between the eyes, in the forehead and at the back of the nasal cavity. The sinuses are lined with a moist, thin layer of tissue called a mucous membrane, which not only humidifies the air as you breathe it in, but also produces mucus to trap irritants such as dust, pollen and bacteria. The sinuses are lined with microscopic hairs called cilia. The function of cilia is to move mucus to flush the sinuses and nasal passageways of trapped irritants.

Sinus congestion is the blockage of one or more of the nasal passageways as a result of inflammation and swelling of the sinus tissues, secretion of mucus or a deviated septum (meaning obstruction of the nasal passage by the membranous ridge of cartilage in the nose that separates the nasal cavity into the two nostrils). Sinus congestion leads to impaired flow of mucus out of the sinuses. The build up of mucus in the sinuses causes increased pressure. Also, bacteria can become trapped and infect the mucous membrane, a condition termed sinusitis.

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