Abstract
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.
Full Text
The Full Text of this article is available as a PDF (165.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adam P., Stiffman M., Blake R. L., Jr A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Arch Fam Med. 1998 Jan-Feb;7(1):39–43. doi: 10.1001/archfami.7.1.39. [DOI] [PubMed] [Google Scholar]
- Anglen J. O., Apostoles S., Christensen G., Gainor B. The efficacy of various irrigation solutions in removing slime-producing Staphylococcus. J Orthop Trauma. 1994 Oct;8(5):390–396. doi: 10.1097/00005131-199410000-00004. [DOI] [PubMed] [Google Scholar]
- Benninger M. S., Anon J., Mabry R. L. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg. 1997 Sep;117(3 Pt 2):S41–S49. doi: 10.1016/S0194-59989770006-8. [DOI] [PubMed] [Google Scholar]
- Daviskas E., Anderson S. D., Gonda I., Eberl S., Meikle S., Seale J. P., Bautovich G. Inhalation of hypertonic saline aerosol enhances mucociliary clearance in asthmatic and healthy subjects. Eur Respir J. 1996 Apr;9(4):725–732. doi: 10.1183/09031936.96.09040725. [DOI] [PubMed] [Google Scholar]
- Fagnan L. J. Acute sinusitis: a cost-effective approach to diagnosis and treatment. Am Fam Physician. 1998 Nov 15;58(8):1795-802, 805-6. [PubMed] [Google Scholar]
- Georgitis J. W. Local hyperthermia and nasal irrigation for perennial allergic rhinitis: effect on symptoms and nasal airflow. Ann Allergy. 1993 Oct;71(4):385–389. [PubMed] [Google Scholar]
- Georgitis J. W. Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators. Chest. 1994 Nov;106(5):1487–1492. doi: 10.1378/chest.106.5.1487. [DOI] [PubMed] [Google Scholar]
- Gysin C., Alothman G. A., Papsin B. C. Sinonasal disease in cystic fibrosis: clinical characteristics, diagnosis, and management. Pediatr Pulmonol. 2000 Dec;30(6):481–489. doi: 10.1002/1099-0496(200012)30:6<481::aid-ppul8>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Heatley D. G., McConnell K. E., Kille T. L., Leverson G. E. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg. 2001 Jul;125(1):44–48. doi: 10.1067/mhn.2001.115909. [DOI] [PubMed] [Google Scholar]
- Homer J. J., England R. J., Wilde A. D., Harwood G. R., Stafford N. D. The effect of pH of douching solutions on mucociliary clearance. Clin Otolaryngol Allied Sci. 1999 Aug;24(4):312–315. doi: 10.1046/j.1365-2273.1999.00265.x. [DOI] [PubMed] [Google Scholar]
- Knops J. L., McCaffrey T. V., Kern E. B. Inflammatory diseases of the sinuses:physiology. Clinical applications. Otolaryngol Clin North Am. 1993 Aug;26(4):517–534. [PubMed] [Google Scholar]
- Low D. E., Desrosiers M., McSherry J., Garber G., Williams J. W., Jr, Remy H., Fenton R. S., Forte V., Balter M., Rotstein C. A practical guide for the diagnosis and treatment of acute sinusitis. CMAJ. 1997 Mar 15;156 (Suppl 6):S1–14. [PubMed] [Google Scholar]
- Mabry R. L. Therapeutic agents in the medical management of sinusitis. Otolaryngol Clin North Am. 1993 Aug;26(4):561–570. [PubMed] [Google Scholar]
- Nuutinen J., Holopainen E., Haahtela T., Ruoppi P., Silvasti M. Balanced physiological saline in the treatment of chronic rhinitis. Rhinology. 1986 Dec;24(4):265–269. [PubMed] [Google Scholar]
- Osguthorpe J. D., Hadley J. A. Rhinosinusitis. Current concepts in evaluation and management. Med Clin North Am. 1999 Jan;83(1):27-41, vii-viii. doi: 10.1016/s0025-7125(05)70085-7. [DOI] [PubMed] [Google Scholar]
- Parsons D. S. Chronic sinusitis: a medical or surgical disease? Otolaryngol Clin North Am. 1996 Feb;29(1):1–9. [PubMed] [Google Scholar]
- Pigret D., Jankowski R. Management of post-ethmoidectomy crust formation: randomized single-blind clinical trial comparing pressurized seawater versus antiseptic/mucolytic saline. Rhinology. 1996 Mar;34(1):38–40. [PubMed] [Google Scholar]
- Rice D. H. Endoscopic sinus surgery. Otolaryngol Clin North Am. 1993 Aug;26(4):613–618. [PubMed] [Google Scholar]
- Schwartz B., Bell D. M., Hughes J. M. Preventing the emergence of antimicrobial resistance. A call for action by clinicians, public health officials, and patients. JAMA. 1997 Sep 17;278(11):944–945. doi: 10.1001/jama.278.11.944. [DOI] [PubMed] [Google Scholar]
- Seppey M., Schweri T., Häusler R. Comparative randomised clinical study of tolerability and efficacy of Rhinomer Force 3 versus a reference product in post-operative care of the nasal fossae after endonasal surgery. ORL J Otorhinolaryngol Relat Spec. 1996 Mar-Apr;58(2):87–92. doi: 10.1159/000276805. [DOI] [PubMed] [Google Scholar]
- Shoseyov D., Bibi H., Shai P., Shoseyov N., Shazberg G., Hurvitz H. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol. 1998 May;101(5):602–605. doi: 10.1016/S0091-6749(98)70166-6. [DOI] [PubMed] [Google Scholar]
- Tomooka L. T., Murphy C., Davidson T. M. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000 Jul;110(7):1189–1193. doi: 10.1097/00005537-200007000-00023. [DOI] [PubMed] [Google Scholar]
- Traissac L., Ohayon-Courtes C., Dufour P., Bordenave L. Le lavage de nez avec Physiomer ... 10 ans après: 1988-1998. Rev Laryngol Otol Rhinol (Bord) 1999;120(2):133–135. [PubMed] [Google Scholar]