Saline irrigation spells relief for sinusitis sufferers

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Saline irrigation spells relief for sinusitis sufferers

J Fam Pract. 2009 January;58(1):29-32

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References

1. Pynnonen MA, Mukerji SS, Kim HM, et al. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg. 2007;133:11115-1120.

2. Gliklich RE, Metson R. Economic implications of chronic sinusitis. Otolaryngol Head Neck Surg. 1998;118(3 Pt 1):344-349.

3. International Rhinosinusitis Advisory Board. Infectious rhinosinusitis in adults classification, etiology and management. Ear Nose Throat J. 1997;76(12 suppl):s5-s22.

4. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):s1-s7.

5. Sharp HJ, Denman D, Puumala S, et al. Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002. Arch Otolaryngol Head Neck Surg. 2007;133:260-265.

6. Subramanian HN, Schechtman KB, Hamilos DL. A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis. Am J Rhinol. 2002;16:303-312.

7. Druce HM. Adjuncts to medical management of sinusitis. Otolaryngol Head Neck Surg. 1990;103(5 Pt 2):880-883.

8. Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;110:1189-1193.

9. Heatley DG, McConnell KE, Kille TL, et al. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg. 2001;125:44-48.

10. Rabago D, Zgierska A, Mundt M, et al. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract. 2002;51:1049-1055.

11. Taccariello M, Parikh A, Darby Y, et al. Nasal douching as a valuable adjunct in the management of chronic rhinosinusitis. Rhinology. 1999;37:29-32.

12. Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;(3):CD006394.-

13. Keojampa BK, Nguyen MH, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004;131:679-682.

14. Piccirillo JF, Merritt MG, Jr, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg. 2002;126:41-47.

15. Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg. 2007;137:815-821.

16. Rabago D, Barrett B, Marchand L, et al. Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study. Ann Fam Med. 2006;4:295-301.

17. University of Wisconsin Department of Family Medicine. Nasal Irrigation Instructions. Available at: http://www.fammed.wisc.edu/files/webfm-uploads/documents/research/nasalirrigationinstructions.pdf. Accessed December 1, 2008.

CHALLENGES TO IMPLEMENTATION: Tx may “scare away” some patients

Despite its effectiveness in reducing rhinosinusitis symptoms, performing large-volume, low-pressure nasal saline irrigation is not intuitive—and may sound downright scary to some patients. The need to learn how to perform nasal irrigation effectively, overcome the fear of water in the nasal cavity, and find the time to perform irrigation regularly can be barriers to this treatment.

A little bit of coaching can go a long way

A study by Rabago et al¹⁶ found that coached practice and patient education are effective tools in mastery of the technique ( PATIENT HANDOUT ).^10,17 The researchers also found that several home strategies—incorporating nasal irrigation into the daily hygiene routine, placing the materials in a convenient location, and using warm water—facilitate regular use.

There is evidence, too, that patients who successfully use large-volume, low-pressure saline irrigation gain more than symptom relief. Rabago et al also found that effective use of this technique was associated with a sense of empowerment, and led to improved self-management skills, as well as a rapid, and long-term, improvement in quality of life.¹⁶

PATIENT HANDOUT

Saline nasal irrigation Your step-by-step guide

STEP 1: GATHER THE SUPPLIES

- Salt (kosher, canning, or pickling salt)
- Baking soda
- Nasal irrigation pot (available at most pharmacies)
- Measuring spoons
- Container with lid

OR

- An irrigation kit that includes the device and premixed saline packets

STEP 2: PREPARE THE SOLUTION

- Put 1 tsp salt and ½ tsp baking soda into the container.
- Add 1 pint of lukewarm tap water.
- Mix contents.
- Fill the nasal pot.

STEP 3: POSITION YOUR HEAD

- Lean over the sink; rotate your head to one side.
- Insert the spout of the irrigation device into the uppermost nostril.
- Breathe through your mouth.
- Raise the handle of the nasal pot so the solution flows into the upper nostril; in a few moments, the solution will begin to drain from the lower nostril.
- Continue until the pot is empty, then exhale gently through both nostrils and gently blow your nose.
- Refill the nasal pot, turn your head to the opposite side, and repeat with the other nostril.
- Do this twice a day or as directed.

STEP 4: CLEAN AND PUT AWAY THE EQUIPMENT

- Wash the nasal pot daily with warm water and dish detergent; rinse thoroughly.
- Store unused saline solution in the sealed container; it can be kept at room temperature and reused for 2 days.

Adapted from: University of Wisconsin Department of Family Medicine.¹⁷