Rhinosinusitis, commonly known as sinusitis, affects many people worldwide. It is one of the most common complaints reported by patients to doctors. In many cases, this condition resolves itself. However, in some cases, it may lead to chronic symptoms that do not respond to treatment. Both irrigation of the nose with medicated salt water, as well as use of nose spray have been tried in these chronic cases. This study compared the two modalities and found that irrigation of the nose with saline water was a better line of treatment than spray, at four and eight weeks of therapy.
Sinusitis, when it fails to cure itself, may become a chronic problem. Studies have shown that this happens due to local infections of the sinuses and the lining of the nose. Drugs that suppress the inflammation, like steroids, and surgery may help these patients. The commonest mode of treatment is either irrigation of the nose with saline water or using of sprays. Irrigation helps to clear the nose of secretions and crusts and ultimately helps in healing. Nose sprays have also been tried in these conditions and are sometimes recommended due to their better acceptability to the patient. This study was conducted to compare the efficacy of these two methods, since there is no concrete evidence stating which of the two is better.
* For the study, a total of 127 adult patients with chronic sinusitis were included. Of these, 63 received nose sprays and 64 received nasal irrigation with saline.
* Patients with symptoms of nose stuffiness, drying and crusting of the nose, congestion of the nose of thick nasal drippings for two weeks, on at least four or more days per week, were included in the study.
* The therapy was continued for eight weeks before and after the treatment. The participants answered questions regarding their symptoms in a preset questionnaire with scores.
* At end of four and eight weeks of therapy, the group that received irrigation therapy had lower test results, as compared to the group that was treated with spray, showing that the irrigation method had better efficacy.
* Scores were, on an average, low by 4.4 at two weeks, 8.2 points at four weeks, and 6.4 points at eight weeks of therapy, with irrigation therapy.
* At the end of therapy at eight weeks, the symptoms persisted in 40 percent of the group treated with irrigation and 61 percent in those who received the spray treatment.
* The odds of increased frequency of symptoms were lowered by 50 percent in the group treated with irrigation, as compared to the nasal spray users.
The researchers stated that the absence of a control group or a group without any treatment made it difficult to analyze whether these two therapies were better than no therapy at all. Further studies in this regard are warranted. The authors also agree that the irrigation therapy was less acceptable to patients than spray. Twenty one percent of those on irrigation did not complete the study, while 7 percent on the nasal spray dropped out. Another shortcoming was that this study was sponsored by a manufacturer of irrigation devices and nasal saline. This could have affected the results.
This study reveals that irrigation of the nose and nasal sinuses with large volume of saline may be a better way to achieve symptom reduction in chronic cases of sinusitis, when compared to nasal sprays. However, for many patients, irrigation is uncomfortable and sprays are preferable. The authors agree that the “need to learn how to perform nasal irrigation effectively, overcome the fear of water in the nasal cavity, and find the time to perform irrigation regularly can be barriers to this treatment.” They suggest that teaching the patients to perform irrigation of their nose regularly at home could help in incorporating this method of therapy in their daily routine; it could bring greater therapeutic benefits in the long run.
For More Information:
Saline Irrigation Spells Relief for Sinusitis Sufferers
Publication Journal: Journal of Family Practice (online), January 2009
By Mari Egan, MD; John Hickner, MD; The University of Chicago