Nasal Irrigation Beneficial for Sinus Symptoms, RCT Shows

Jennifer Garcia

July 22, 2016

Nasal irrigation is more effective than steam inhalation for patients with chronic or recurrent sinus symptoms, according to a new randomized controlled study published online July 18 in the CMAJ.

"Brief advice to use nasal irrigation in routine primary care for chronic or recurrent sinus symptoms was less effective than prior evidence suggested, but it resulted in reduced overall symptom burden, headache, use of over-the-counter medications and the perceived need to consult primary care physicians in future episodes," write the study authors.

Investigators led by Paul Little, MBBS, from the University of Southampton in the United Kingdom, enrolled 871 patients, between 18 and 65 years of age, with a history of chronic or recurrent acute sinus symptoms to determine the effectiveness of nasal irrigation or steam inhalation for control of symptoms. They recruited patients from 72 primary care practices in the United Kingdom and enrolled them between February 11, 2009, and June 30, 2014.

The researchers randomly assigned patients to one of four treatment groups: nasal irrigation once daily, steam inhalation once daily, a combination of the two treatments, or neither of the two treatments (usual care). Additional medications were prescribed at the discretion of the primary care physician.

Patients who were advised to use nasal irrigation noted modest improvements in disability and quality-of-life scores at both 3- and 6-month follow-ups. The authors note, however, that similar improvements were reported among patients in the control group. Patients in the steam inhalation group did not note any improvement; however, given that most of the benefits noted with nasal irrigation were noted in the combined group, a role for steam inhalation therapy cannot be discounted.

In addition, patients in the nasal irrigation group reported fewer headaches, fewer of them used over-the-counter medications, and they were less likely to consult with a physician about their nasal problems in the future when compared with patients in the steam inhalation group.

The researchers note that effectiveness of nasal irrigation in the current study was modest compared with in previous studies, and suggest that the use of more individualized coaching and practice sessions in previous studies ensured proper technique and may have improved outcomes. This, coupled with more follow-up and diary monitoring, may have been why nasal irrigation was previously found to be more effective.

Researchers used the Rhinosinusitis Disability Index, the 20-item Sino-Nasal Outcome Test, and the EuroQol dimension health-related quality-of-life index to evaluate outcomes at baseline, 3, and 6 months. Review of the medical records was performed at 6 months to evaluate for antibiotic use and physician visits.

The authors acknowledge study limitations such as a less than 80% follow-up, possible bias when using self-reporting for the primary outcome, and the inclusion of patients with illness of variable duration and severity.

"This is one of the few studies to address the effectiveness of brief advice to use nasal irrigation or steam inhalation for chronic or recurrent sinus symptoms, and the largest trial in any setting," write Dr Little and colleagues.

"Future research on nasal irrigation should address how much coaching is needed, the role of expectations and its place in relieving symptoms of acute sinusitis," conclude the researchers.

Funding for this study was provided through a grant from the National Institute for Health Research. The authors have disclosed no relevant financial relationships.

CMAJ. Published online July 18, 2016. Full text

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