Saline Nasal Irrigations for Chronic "Sinus" Symptoms

Nasal irrigation previously has been demonstrated to be an effective, safe, and well-tolerated means to treat frequent or chronic rhinosinusitis. The current authors reported results from a randomized controlled trial of 6 months of therapy with 2% saline nasal irrigation vs usual care in the December 2002 issue of the Journal of Family Practice. The authors found that the use of saline was associated with fewer sinus symptoms, improved sinus-related quality of life, and reduced use of antibiotics and nasal sprays. A follow-up study to this trial demonstrated that participants in the original randomized trial continued to use nasal irrigation as a successful modality to treat rhinosinusitis. Given the apparent clinical success of nasal irrigation for frequent or chronic rhinosinusitis, the authors sought to examine qualitative data regarding the everyday benefits and drawbacks of irrigation from study participants. Their results are summarized in the "Study Highlights." Study Highlights Participants from the researchers' primary study were invited to participate in structured 30-minute interviews to explore their experience with nasal irrigation for rhinosinusitis. Patients included in the original study had either 2 episodes of acute sinusitis or 1 episode of chronic sinusitis in the past year. In addition, participants reported a moderate-to-severe overall daily quality-of-life burden associated with rhinosinusitis. Participants randomized to receive nasal irrigation had an educational session that included lessons on rhinosinusitis and individual coaching on the practice of nasal irrigation. 28 of the original 35 subjects who received nasal irrigation agreed to participate in the interviews for the current study. Their clinical data were similar to the original cohort as a whole. 4 main content themes emerged from these interviews: Patients felt empowered in being able to access, monitor, and adjust treatment with nasal irrigation on their own. They were pleased to be less reliant on clinician visits and antibiotics. Patients were enthusiastic regarding the efficacy of nasal irrigation in reducing sinus symptoms and improving their quality of life. Many subjects reported improvement within the first or second use of nasal irrigation. Patients cited fear of having water in the nasal cavity, initial unpleasant sensation of water in the nasal cavity, having to learn how to perform nasal irrigation effectively, the time to perform nasal irrigation, and occasional mild adverse effects as potential barriers to the use of nasal irrigation. Adverse effects included saline drainage and nasal burning, but these events were not strong enough to stop the practice of nasal irrigation. Patients noted that the initial education session, particularly individual coaching on the practice of nasal irrigation, was effective in overcoming many of the barriers to the use of nasal irrigation. In addition, their experience at home with adjusting the schedule, salinity, and temperature of nasal irrigation allowed for effective and well-tolerated treatment. Pearls for Practice Nasal irrigation with saline solution has been demonstrated to improve symptoms of rhinosinusitis, sinus-related quality of life, and the use of other medications for rhinosinusitis. This treatment appears effective over the long term. The current study demonstrates that patients with frequent or chronic rhinosinusitis may have some initial trepidation regarding the use of saline nasal irrigation, but some coaching on how to use irrigation along with self-adjustment of therapy allowed patients to overcome potential barriers to treatment. Patients find the use of nasal irrigation empowering and effective.