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Saline irrigation more effective than spray for nasal symptoms

US researchers evaluated 121 adults with chronic nasal and sinus symptoms (stuffiness, congestion, or thick/ discolored nasal discharge) ongoing for over 6 months. Patients were randomized to isotonic saline via spray or as a large volume nasal irrigation instilled into the nostril, similar to the traditional neti pot procedure. After twice daily treatments for 2 months, along with their usual treatments, patients were evaluated using a previously validated instrument, the 20-item Sino-Nasal Outcome Test (SNOT-20) score. (Apparently, cardiologists and oncologists are not the only specialists who can invent clever acronyms.) SNOT scores improved approximately twice as much on average in the irrigation group, showing significant changes at both 4 and 8 weeks.

Clinical Question:

Is nasal washing more effective than saline spray at decreasing symptoms in patients with chronic nasal or sinus symptoms?

Bottom Line:

Nasal irrigation (nasal washing) using a stream of normal saline, is more effective in decreasing general nasal or sinus symptoms than saline spray. The saline can be made at home, purchased as a kit, or adminstered using a neti pot. Direct your patients to an online source of video (eg, www.youtube.com) to see how it is administered. (LOE = 1b)

Reference:

Pynnonen MA, Mukerji SS, Kim HM, Adams ME, Terrell JE. Nasal saline for chronic sinonasal symptoms. Arch Otolaryngol Head Neck Surg 2007;133 (11):1115-1120. [Medline abstract]

Study Design: Randomized controlled trial (nonblinded)

Funding: Industry

Allocation: Concealed

Setting: Outpatient (specialty)

Synopsis:

These US researchers evaluated 121 adults with chronic nasal and sinus symptoms using community advertisements. The patients were men and women (average age = 46 years) who reported symptoms of stuffiness, congestion, or thick or discolored nasal discharge. Most reported symptoms "often" or "always" for more than 6 months. Patients were excluded if they had recent sinus surgery or respiratory infection. The patients were randomized, using concealed allocation, to be treated with isotonic nasal saline as a spray or as a large volume nasal irrigation flowed into a nostril and drained out of the mouth. The patients were asked to use the treatment twice daily for 2 months along with their usual treatments. Symptoms were evaluated using a previously validated instrument, the -- I'm not making this up -- SNOT-20 measure of symptom severity, including the physical problems, functional limitations, and emotional consequences of sinusitis. From an initial average score of 35.5 to 37.6 of a possible 100 at baseline, SNOT scores dropped approximately twice as much, on average, in the irrigation group. The changes were significantly different at 4 weeks (-7.4 vs 16.2; P = .002) and at 8 weeks (8.5 vs 15.0; P = .04) of treatment. A decrease of 16 points is considered to be clinically relevant. By the end of 8 weeks, 61% of patients using the spray reported that symptoms were present "often" or "always" as compared with 40% in the irrigation group (P = .02). Hypertonic saline irrigation also has been shown to be effective for sinusitis (J Fam Pract 2002; 51:1049-55).

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