Sinus Problems Are Treated Well With Safe, Inexpensive Treatment

The study is the first of its kind to show greater efficacy of saline irrigation treatments versus saline spray for providing short-term relief of chronic nasal symptoms, the authors report. Participants in the study who were treated with irrigation experienced a much greater benefit than those who were treated with saline spray, in terms of both the severity and frequency of their symptoms.

"The irrigation group achieved a clinically significant improvement in quality of life in terms of the severity of their symptoms, whereas the spray group did not," says lead author Melissa A. Pynnonen, M.D., clinical assistant professor in the U-M Department of Otolaryngology. "Strikingly, they also experienced 50 percent lower odds of frequent nasal symptoms compared with the spray group."

The findings, which appear in the new issue of the Archives of Otolaryngology -- Head & Neck Surgery, could be significant for the multitudes of people who suffer from chronic nasal and sinus conditions. In the United States, 36 million people are affected by chronic rhinosinusitis each year, and millions more are affected by other types of allergic and non-allergic rhinitis.

Treatments including antibiotics, antihistamines and anti-inflammatory drugs can be helpful, but for many patients, symptoms persist. "A lot of symptoms still aren't very well treated," Pynnonen says.

Treatment with saline irrigations -- the flushing of nasal passages with a salt water mixture -- often is recommended by otolaryngologists (ear, nose and throat physicians) for a variety of sinus conditions. It has long been used as a treatment following sinus surgery, and more recently is becoming common in non-surgical patients. The authors of this study say their findings suggest that otolaryngologists and primary care physicians should recommend this treatment to their patients more often.

Saline sprays are often used as an alternative to irrigations because spray "is often perceived to be equivalent to and better tolerated than irrigation," the researchers note. But the effectiveness of sprays has not been proven in clinical trials.

Among the 121 adults in this study -- all of whom have chronic nasal and sinus symptoms -- 60 were treated for eight weeks with saline irrigation and 61 were treated with saline spray. The severity of their symptoms was measured with the 20-Item Sino-Nasal Outcome Test, and the frequency of symptoms was measured with a questionnaire.

The irrigation group's average score on the severity test had dropped (improved) by more points than the spray group's average at intervals of two weeks, four weeks and eight weeks (4.4 points out of 100 lower at two weeks, 8.2 points lower at four weeks, and 6.4 points lower at eight weeks).

Frequency of symptoms also improved in both groups, though more for the irrigation group. While 61 percent of the spray group reported having symptoms "often or always" after the eight-week study, just 40 percent of the irrigation group did.

"It's clear from our results that both treatments led to a decrease in frequency and severity of symptoms, but the difference is that the salt water flush led to substantial improvement," Pynnonen says.

Both groups experienced adverse effects, with more reported in the irrigation group. Most were minor, however, and none required that the treatment be stopped. The most commonly reported adverse effect was post-treatment drainage.

"One of the greatest benefits of the nasal irrigation we are using is that it is very cheap and very safe," Pynnonen says.

In addition to Pynnonen, authors of the study were Jeffrey E. Terrell, M.D. and Meredith E. Adams, M.D., of the U-M Department of Otolaryngology; H. Myra Kim, Sc.D., of the Department of Biostatistics and the Center for Statistical Consultation and Research at the U-M School of Public Health; and Shraddha S. Mukerji, M.D., of Texas Children's Hospital.

Financial support was provided by NeilMed Pharmaceuticals, which had no role in design or conduct of the study; collection, management, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript. NeilMed Pharmaceuticals manufactures Sinus Rinse, the saline product.

Reference: Archives of Otolaryngology -- Head & Neck Surgery, Vol. 133, No. 11, Nov. 2007.