Nasal irrigation good for patients with chronic sinus: study

Results of a new trial show that patient with chronic sinus congestion to use nasal irrigation a popular nonpharmacologic treatment improved their symptoms, but steam inhalation did not.

"We have found that even a very brief intervention of a video showing patients how to use saline nasal irrigation can improve symptoms, help people feel they do not need to see the doctor to manage the problem, and reduce the amount of over-the-counter medication they need to use," said Paul Little from University of Southampton in Britain.

The findings were published in CMAJ (Canadian Medical Association Journal). To alleviate symptoms of chronic rhinosinusitis, or sinus infection, steam inhalation and nasal irrigation are widely suggested as an alternative to common treatment with antibiotics, which are often not effective and contribute to antibiotic resistance.

The researchers from Britain conducted a randomised controlled trial on the effectiveness of advice from primary care physicians to use nasal irrigation and/or steam inhalation for chronic sinusitis. The study involved



871 patients from 72 primary care practices in England who were randomly assigned to one of four advice strategies: usual care, daily nasal and saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions.

Patients who were instructed to use nasal irrigation showed improvement at three and six months, as measured by the Rhinosinusitis Disability Index. Steam inhalation did not appear to alleviate symptoms of sinusitis. "We found potentially important changes in other outcomes; in particular, fewer participants in the nasal irrigation group than in the no-irrigation group had headaches, used over-the-counter medications and intended to consult a doctor in future episodes," the authors wrote.

"Although there was no significant difference in either physician visits or antibiotic use, as might be expected over only a six-month follow-up period, our findings concerning consultations are important in the longer term, given antibiotic use increases the risk of antimicrobial resistance," the study added.