In the Journals

Nasal irrigation outperforms steam inhalation for chronic sinus symptoms

The use of nasal irrigation for chronic or recurrent sinus symptoms may reduce discomfort, headache, over-the-counter medication use and the need to consult a general practitioner for future symptoms, according to recent study findings.

Rhinosinusitis probably affects more than 25 million Americans and 2.5 million Canadians,” Paul Little, MBBS, professor of primary care research at the University of Southampton, and colleagues wrote. “Quality of life of patients with chronic or recurrent sinusitis has been reported to be similar to congestive heart disease and chronic pulmonary disease. Antibiotics are prescribed for nearly all patients with sinusitis, but the evidence is modest, and an international priority is to contain antibiotic resistance.”

The researchers conducted a randomized controlled trial over a 5-year period that included 871 adult patients in the United Kingdom who had recurrent or chronic sinusitis. The investigators sought to determine the efficacy of advice given by PCPs from 72 practices on how to use nasal irrigation and/or steam inhalation for chronic sinusitis. Patients were randomly assigned one of four strategies: usual care (n = 210), daily nasal and saline irrigation instruction supported by a demonstration video (n = 219), daily steam inhalation (n = 232), and combination treatment with both interventions (n = 210). Patients were assessed at baseline and at 3 months and 6 months after completion by using the Rhinosinusitis Disability Index (RSDI).

Seventy-seven percent of the patients reported RSDI scores at 3 months. Patients assigned nasal irrigation showed a greater mean difference in RSDI score at 3 months than those who did not use nasal irrigation (–2.51, 95% CI; –4.65 to –0.37). At 6 months, more patients experienced significantly improved RSDI scores with nasal irrigation (44.1% vs. 36.6%) than without irrigation. Fewer nasal irrigation patients (59.4% vs. 68%) used over-the-counter medications or planned to see a physician for future bouts. Outside of headache improvement, patients assigned steam inhalation showed no significant improvements, and rates of adverse effects were similar for both interventions.

“Apart from being associated with fewer headaches, the strategy of advising patients to use steam inhalation was ineffective in our study, a finding that matches the limited impact in acute coryzal illness or in acute respiratory tract infections more generally,” Little and colleagues wrote. “However, advice to use nasal irrigation was beneficial mostly in the combined treatment group, which suggests a possible role for steam inhalation in supporting nasal irrigation.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.

The use of nasal irrigation for chronic or recurrent sinus symptoms may reduce discomfort, headache, over-the-counter medication use and the need to consult a general practitioner for future symptoms, according to recent study findings.

Rhinosinusitis probably affects more than 25 million Americans and 2.5 million Canadians,” Paul Little, MBBS, professor of primary care research at the University of Southampton, and colleagues wrote. “Quality of life of patients with chronic or recurrent sinusitis has been reported to be similar to congestive heart disease and chronic pulmonary disease. Antibiotics are prescribed for nearly all patients with sinusitis, but the evidence is modest, and an international priority is to contain antibiotic resistance.”

The researchers conducted a randomized controlled trial over a 5-year period that included 871 adult patients in the United Kingdom who had recurrent or chronic sinusitis. The investigators sought to determine the efficacy of advice given by PCPs from 72 practices on how to use nasal irrigation and/or steam inhalation for chronic sinusitis. Patients were randomly assigned one of four strategies: usual care (n = 210), daily nasal and saline irrigation instruction supported by a demonstration video (n = 219), daily steam inhalation (n = 232), and combination treatment with both interventions (n = 210). Patients were assessed at baseline and at 3 months and 6 months after completion by using the Rhinosinusitis Disability Index (RSDI).

Seventy-seven percent of the patients reported RSDI scores at 3 months. Patients assigned nasal irrigation showed a greater mean difference in RSDI score at 3 months than those who did not use nasal irrigation (–2.51, 95% CI; –4.65 to –0.37). At 6 months, more patients experienced significantly improved RSDI scores with nasal irrigation (44.1% vs. 36.6%) than without irrigation. Fewer nasal irrigation patients (59.4% vs. 68%) used over-the-counter medications or planned to see a physician for future bouts. Outside of headache improvement, patients assigned steam inhalation showed no significant improvements, and rates of adverse effects were similar for both interventions.

“Apart from being associated with fewer headaches, the strategy of advising patients to use steam inhalation was ineffective in our study, a finding that matches the limited impact in acute coryzal illness or in acute respiratory tract infections more generally,” Little and colleagues wrote. “However, advice to use nasal irrigation was beneficial mostly in the combined treatment group, which suggests a possible role for steam inhalation in supporting nasal irrigation.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.