Are Saline Irrigations Effective in Relieving Chronic Rhinosinusitis Symptoms?

A Review of the Evidence

Kathy Thornton, RN; Marion Alston, FNP; Herbert Dye III, RN; Suzannah Williamson, FNP

Disclosures

Journal for Nurse Practitioners. 2011;7(8):680-686. 

In This Article

Synthesizing the Evidence

Irrigation of the nose with saline is an inexpensive treatment that is often used alone or with other treatments, but the evidence to support its beneficial use is conflicting.[16,17] The salinity of the solution or delivery device are important considerations for using nasal irrigations.

The evidence on the effects of saline concentration for nasal irrigations is contradictory. Isotonic saline solutions have been reported to be the best physiologic irrigation solutions[18] and decrease sinusitis symptoms,[13,14] while hypotonic and hypertonic saline solutions have been shown to increase mucous secretion and cause cell damage.[18] In contrast, hypertonic Dead Sea salt nasal irrigation was found to reduce CRS symptoms,[10] yet other studies found no difference in the beneficial effects of saline irrigations of different concentrations.[,12] Although nasal irrigation may be an appropriate adjunct for treating CRS symptoms, optimal concentrations are uncertain and vary from 0.9% to 3% saline solutions, which, like pH, and temperature, may vary based on patient preference.[7]

The evidence is not clear as to which delivery method provides the greatest benefit for NSIs. The focus of the research is on the volume and pressure used in the delivery device. The use of large volume irrigations, compared with low positive pressure saline nasal sprays, were found to be more effective for the relief of short-term (8-week) chronic nasal symptoms.[19] However, the use of nasal irrigation by douching, which involves squeezing liquid into the nasal cavity with a bulb syringe, was found to achieve a better distribution within the nasal cavity and sinuses compared to metered nasal spray and nebulizers.[17] A neti pot is a device that uses gravity for nasal irrigation. When comparing the use of a bulb syringe and a neti pot, no difference was found in alleviating CRS symptoms.[16]

Because of the variety of treatments of CRS, especially related to salinity concentration and delivery devices, and conflicting results, it is difficult to draw conclusions to specifically answer the PICO question. The conclusions of the reviewed studies neither support nor refute the efficacy of NSIs and the treatment options of CRS. However, few adverse effects from the use of saline irrigation have been reported, and these were mostly self-limiting, including fullness in the ears, stinging of nasal mucosa, and, very rarely, epistaxis. No serious adverse events have been reported. Although the conclusions of the reviewed studies conflict equally on NSI efficacy and CRS treatment options, the therapy appears to pose no significant health risk and can be a cost-effective alternative to more aggressive or expensive therapies.

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