Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update

Abstract

Saline nasal irrigations (SNIs) are often recommended as an additional non-pharmacological treatment for adults with chronic rhinosinusitis (CRS), for which it could even be considered a first-line treatment. However, there is a wide range of different SNI protocols. The aim of this article is to review the published literature regarding all of the potential therapeutic effects of SNIs in adult CRS patients who had not undergone sinus surgery and clarify the role of the various saline nasal solutions and protocols (particularly the volume, frequency and duration of treatment), and describe the nasal devices used. A search was made of the PubMed, Google Scholar and Ovid databases using the key words ‘saline nasal irrigation’ and ‘chronic rhinosinusitis’, or medical subject headings. The search identified 11 studies involving 663 patients. There was no consensus about but substantial agreement concerning the frequency and duration of treatment, the type of device, and the amount of solution to be used when managing CRS. A hypertonic solution with the addition of the natural minerals and oligo-elements found in seawater and some thermal waters may be associated with greater clinical benefit in terms of endoscopic scores and mucociliary clearance than isotonic solutions. Further studies are required to compare the different forms of SNI and define SNI protocols and nasal devices, while considering patient compliance.

Topical Ectoine: A Promising Molecule in the Upper Airways Inflammation—A Systematic Review

“…Medical management of sinonasal and oral inflammatory diseases increasingly involves the use of topical agents, which offer an improved ability to deliver high concentrations of drugs to the UA mucosa avoiding systemic effects. Given the pivotal role that topical therapies play in many sinonasal and oral conditions, considerable interest in the effectiveness, tolerability, and compliance of specific new substances has become evident [16]. Literature data that emerged from our analysis allow us to affirm that topical administration of ectoine can be useful as coadjutant treatment in the acute and chronic inflammatory diseases of UA such as AR, ARS, rhinitis sicca, pharyngitis, and laryngitis.…”

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

“…SNI is a safe way of treatment in the CRS. SNI is usually performed with saline or other solutions and improves the mucosal function of the nasal cavity owing to direct mucosal cleansing [ 11 ]. In addition, SNI enhances ciliary beat frequency by increasing sol layer hydration and propelling gel layer.…”

Effects of houttuynia cordata thunb. on rhinosinusitis by nasal irrigation

“…Low-volume devices such as drops and nebulizers have a limited utility in rhinosinusitis treatment due to their limited extension into the sinus. [ 6 ] Meanwhile, nasal irrigation is a typical, low-cost and well-tolerated method for rhinosinusitis and post-endoscopic sinus surgery; it can directly remove local inflammatory mediators and antigens, [ 7 ] reduce postoperative scab, remove inflammatory mucus, improve mucociliary function and reduce mucosal swelling. [ 6 ] As a mechanical intervention, nasal saline irrigation can clear retained viscous secretions.…”