Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review

Abstract

Objective This review aimed to systematically determine the optimal nasal saline regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov. The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled trials and meta-analyses were included. The effects of nasal saline treatment through various devices, saline tonicities, and buffer statuses were evaluated in patients with allergic and nonallergic rhinitis, acute and chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were effective for treating adults, while low-volume devices (5-59 mL) were effective for children. Isotonic saline was preferred over hypertonic saline due to fewer adverse events. For acute rhinosinusitis, saline irrigation was beneficial in children, but it was an option for adults. Large-volume devices were more effective, especially in the common cold subgroup. For CRS, large-volume devices were effective for adults, but saline drop was the only regimen that had available data in children. Buffered isotonic saline was more tolerable than nonbuffered or hypertonic saline. The data for CRS with cystic fibrosis and nonallergic rhinitis were limited. For postoperative care, buffered isotonic saline delivered by large-volume devices was effective. Conclusion Nasal saline treatment is recommended for treating most sinonasal diseases. Optimal delivery methods for each condition should be considered to achieve therapeutic effects of saline treatment.

Pencegahan Rinosinusitis Akut Dengan Melakukan Cuci Hidung Menggunakan Larutan Salin Isotonis

“…Sistem cuci hidung bervolume besar diperlukan untuk mencapai rongga-rongga sinus paranasal (3,9,24,33,34) . Chitsuthipakorn (35) menelaah alat cuci hidung yang optimal untuk mengobati penyakit hidung dan sinus paranasal. Beliau menyarankan cuci hidung dengan larutan salin pada rinosinusitis akut yang terjadi pada dewasa dan anak yang berdurasi lebih dari 5 hari.…”

“…Misalnya otalgia, telinga terasa penuh, dan epistaksis anterior, dapat terjadi pada orang dewasa. (35,43) Satdhabudha (44) mengobservasi efek samping jarang terjadi pada sekelompok anak mencuci hidung dengan botol tekan dibandingkan yang menggunakan spuit.…”

Key issues of acute rhinosinusitis

“…Элиминационно-ирригационная терапия, основанная на использовании изотонических солевых растворов для промывания полости носа и околоносовых пазух, рекомендуется как для поствирусного, так и острого бактериального риносинусита. Она считается особенно эффективной при остром гнойном риносинусите, осуществляется объемным промыванием полости носа [6,7,[53][54][55]. Деконгестанты, наносимые на слизистую оболочку носа, проявляют клиническую эффективность в острой фазе заболевания.…”

Targeting Epithelium Dysfunction and Impaired Nasal Biofilms to Treat Immunological, Functional, and Structural Abnormalities of Chronic Rhinosinusitis

“…High-volume irrigations seem more effective than low-volume saline sprays and nebulizers [133]. Although overall, saline irrigation appears to help treat CRS, there is contradictory evidence regarding the superiority of either hypertonic or isotonic solution for nasal douching on symptoms and mucociliary clearance [134,135].…”