Saline irrigation for chronic rhinosinusitis

Abstract

The two studies were very different in terms of included populations, interventions and comparisons and so it is therefore difficult to draw conclusions for practice. The evidence suggests that there is no benefit of a low-volume (5 ml) nebulised saline spray over intranasal steroids. There is some benefit of daily, large-volume (150 ml) saline irrigation with a hypertonic solution when compared with placebo, but the quality of the evidence is low for three months and very low for six months of treatment.

Medical and Surgical Advancements in the Management of Cystic Fibrosis Chronic Rhinosinusitis

“…64,65 In non-CF patients with CRS, a recent Cochrane review concluded that there is some benefit in disease-specific QOL with use of daily, large-volume (150mL), mildly hypertonic (2%) nasal saline irrigation in comparison to placebo. 66 However, recently published data from a multicenter, double-blind, randomized controlled trial found that sinonasal inhalation with hypertonic saline (NaCl 6.0%) applied with vibrating aerosols was not superior to isotonic (NaCl 0.9%) nasal saline irrigation in patients with CF-related CRS. 64 Additionally, hypertonic saline (6 to 7%) is often associated with an increase of adverse reactions due to its irritating properties on sinonasal mucosa, which provokes cough and airway obstruction.…”

Developing a core outcome set for chronic rhinosinusitis: a systematic review of outcomes utilised in the current literature

“…The Cochrane Collaboration has recently updated a few of the published systematic reviews included in this study [6–8, 10, 20] . For completeness, full-text articles of these updated reviews and any trials not previously reviewed were analysed.…”

“…There are a number of Cochrane reviews evaluating the effectiveness of treatments in CRS, but they are limited both by a paucity of high-quality randomised trials, and the heterogeneity of outcomes in those that have been reported which precludes meaningful meta-analysis. In order to overcome this, both the European Position Paper on Rhinosinusitis and Nasal Polyps, and the recently revised Cochrane systematic reviews, recognise the need to define a core outcome set for CRS [1, 6–10]. …”

What role for saline nasal irrigation?

“…The initial Cochrane systematic review reported benefit of SNI for chronic sinusitis, from eight trials and 399 participants 16. The updated Cochrane review on SNI for chronic sinusitis only included two trials (116 adult participants), due to strict inclusion criteria of randomised controlled trials with a follow-up of at least 3 months 9. One study compared once daily large volume (150mL) hypertonic saline (2%) irrigation with usual treatment and showed a 6.3% mean difference (MD) in the 0–100 Disease-Specific Health related quality of life score at 3 months (low quality evidence) and 13.5% improvement at 6 months (very low quality evidence).…”

“…Both the method of irrigation and the tonicity (concentration) of the saline solution may have an impact on its effectiveness,9 and yet, there is no consensus on the superiority of any particular solution or method of delivery. However, a study using radiolabelled solutions showed that large volume nasal douches penetrate better into the sinuses and upper nasal cavity compared with atomised sprays or nebulised small volume of solution 10…”