Squeeze Bottle versus Saline Spray after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Pilot Multicentre Trial

Macdonald, Kristian I.; Wright, Erin D.; Sowerby, Leigh J.; Rotenberg, Brian; Chin, Christopher J.; Rudmik, Luke; Sommer, Doron D.; Nayan, Smriti; Desrosiers, Martin; Tewfik, Marc A.; Valdés, Constanza J.; Massoud, Emad; Thomas, Drew; Kilty, Shaun; Vescan, Allan; Mechor, Bradford; Lavigne, François; Fandiño, Marcela; Javer, Amin R.; Witterick, Ian J.

doi:10.2500/ajra.2015.29.4125

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…However, the effect had diminished at 12 weeks postoperatively 28 . The other (86 patients) found no significant difference between groups 29 …”

Section: Discussionmentioning

confidence: 82%

“…28 The other (86 patients) found no significant difference between groups. 29 Furthermore, one randomized control study compared corticoste- found that douching was significantly more effective in penetrating the maxillary sinus (P = .036) and frontal recess (P = .003). 32 We found that the high-volume devices were most effective in Although randomized controlled trials have yielded conflicting results, we found that high-volume devices yielded higher symptom scores from patients with all types of rhinosinusitis and resulted in minimal side effects.…”

Section: Discussionmentioning

confidence: 99%

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A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients

Piromchai

Puvatanond

Kirtsreesakul

et al. 2020

Laryngoscope Investig Oto

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Background: Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. Methods: We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. Results: Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. Conclusions: Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices.

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“…However, the effect had diminished at 12 weeks postoperatively 28 . The other (86 patients) found no significant difference between groups 29 …”

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients

Piromchai

Puvatanond

Kirtsreesakul

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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“…Previous randomized studies have evaluated the use of saline in the endoscopic sinus surgery population; however, data are scarce in the EEA population. 6 Furthermore, a survey study examined practice patterns of CPAP use in various endoscopic and nonendoscopic nasal surgeries and found that although the majority of surgeons stop CPAP use for 1 to 2 weeks postoperatively, some do not, with seemingly few complications. 7 A recent survey study likewise found highly variable practice patterns among respondents with respect to skull base surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Continuous Positive Airway Pressure Use and Nasal Saline Rinses After Endonasal Endoscopic Skull Base Surgery in Patients With Obstructive Sleep Apnea: A Practice Pattern Survey

Choi

Reddy

Weitzel

et al. 2018

Am J Rhinol�Allergy

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Background Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA. Methods A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. Results Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients’ CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon’s choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001). Conclusion Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.

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“…4 Saline nasal treatment increases hydration in the sol layer and enhances mucociliary function. 4 For greater clearance, nasal irrigation with large volume and high pressure saline is effective on mechanical removal of postoperative clotted blood, debris, and crust, 5,6 and the risk of postoperative adhesions is minimized and ostiomeatal patency is promoted. When thick eosinophilic mucin is effectively removed, chronic inflammation can be brought under control.…”

Section: Introductionmentioning

confidence: 99%

Does Heating up Saline for Nasal Irrigation Improve Mucociliary Function in Chronic Rhinosinusitis?

Nimsakul

Ruxrungtham

Chusakul

et al. 2018

Am J Rhinol�Allergy

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Background Mucociliary function is affected by temperature. Exposure to cold air may impair ciliary beat frequency. While saline nasal irrigation improves in ciliary beat activity, there is no evidence supporting the use of heated saline irrigation in treating patients with chronic rhinosinusitis. Objective To compare the effects of heated saline to room-temperature saline nasal irrigation on mucociliary clearance in chronic rhinosinusitis patients. Methods Adult patients with chronic rhinosinusitis were randomized into two groups receiving either heated saline or room-temperature saline nasal irrigation. Healthy subjects were included as control. Saccharin transit time was measured before and after nasal irrigation. Nasal patency was assessed by peak nasal inspiratory flow, anterior rhinomanometry, acoustic rhinometry, nasal obstruction score, and breathe-comfort score. Any adverse events were reported. Results Twenty-three patients with chronic rhinosinusitis and nine healthy subjects were enrolled. Saccharin transit time was decreased after nasal irrigation in both heated saline subgroup (baseline 12.3 ± 4.5 min vs. postirrigation 8.4 ± 4.9 min, p = 0.05) and room-temperature subgroup (baseline 12.8 ± 5.0 min vs. postirrigation 8.9 ± 4.2 min, p = 0.01). The saccharin transit time improvement was not different between heated saline (3.8 ± 6.2 min) and room-temperature saline (3.8 ± 4.0 min), p = 0.13. Postheated saline irrigation saccharin transit time of chronic rhinosinusitis patients (8.4 ± 4.9 min) was not different to healthy subjects (9.2 ± 3.7 min), p = 0.69. Nasal patency was not different between groups. There was no adverse event reported. Conclusion Nasal saline irrigation is beneficial to patients with chronic rhinosinusitis on mucociliary improvement. Warming saline is not necessary and adds no additional benefit to room-temperature saline irrigation.

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Squeeze Bottle versus Saline Spray after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Pilot Multicentre Trial

Cited by 15 publications

References 21 publications

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients

Postoperative Continuous Positive Airway Pressure Use and Nasal Saline Rinses After Endonasal Endoscopic Skull Base Surgery in Patients With Obstructive Sleep Apnea: A Practice Pattern Survey

Does Heating up Saline for Nasal Irrigation Improve Mucociliary Function in Chronic Rhinosinusitis?

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