Saline Irrigation Can Solve Chronic Rhinosinusitis

MIAMI BEACH – Before you refer one of your pediatric patients with chronic rhinosinusitis to surgery, consider a trial of once-daily intranasal irrigation with isotonic saline, a pediatric otolaryngologist recommended, based on personal experience and results of a study with 40 children.

Participants in the 6-week study – children aged a mean 6 years – complied with the irrigation and experienced significant improvements in quality of life scores within 3 weeks. Prior to treatment, these children have "significant nasal stuffiness, and no matter how hard they blow their nose, nothing comes out," Dr. Julie L. Wei said.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis," Dr. Wei said. "Young children tolerate and like irrigation."

In the prospective, double-blind study, 19 children with chronic rhinosinusitis were randomized to daily irrigation with 80 mL saline only and 21 were randomized to 80 mL saline plus gentamicin. Congestion and cough were the most common presenting symptoms. The average duration of symptoms exceeded 8 weeks.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis."

With no significant difference in clinical improvement between the two groups at 3 and 6 weeks follow-up, results suggest that saline alone is efficacious, Dr. Wei said at the Triological Society Combined Sections Meeting.

"I had learned to use saline with gentamicin in it to irrigate adults, so I started to use it in children. I knew the [amount of] gentamicin in the saline was minuscule, and I wanted to prove to myself that saline would be just as efficacious," said Dr. Wei, who is on the otolaryngology–head and neck surgery faculty at the University of Kansas/KU Medical Center in Kansas City.

Symptom resolution post irrigation correlated with positive changes in Lund-MacKay scoring of before and after CT scans. All domains of the Sinus and Nasal Quality of Life Survey (SN5) significantly improved in both groups from baseline to 3 weeks, with continued improvements observed until 6 weeks. Full study results were published in September 2011 (Laryngoscope 2011;121:1989-2000).

One patient required functional endoscopic sinus surgery because of persistent symptoms. Four families reported otalgia during the study.

More than 90% of the children were compliant with the 6-week regimen and nasal irrigation was "absolutely safe," Dr. Wei said at the meeting, which was cosponsored by the Triological Society and the American College of Surgeons. In addition, children and families only require about 2 minutes of instruction in the technique.

Dr. Wei said that she had no relevant financial disclosures.

MIAMI BEACH – Before you refer one of your pediatric patients with chronic rhinosinusitis to surgery, consider a trial of once-daily intranasal irrigation with isotonic saline, a pediatric otolaryngologist recommended, based on personal experience and results of a study with 40 children.

Participants in the 6-week study – children aged a mean 6 years – complied with the irrigation and experienced significant improvements in quality of life scores within 3 weeks. Prior to treatment, these children have "significant nasal stuffiness, and no matter how hard they blow their nose, nothing comes out," Dr. Julie L. Wei said.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis," Dr. Wei said. "Young children tolerate and like irrigation."

In the prospective, double-blind study, 19 children with chronic rhinosinusitis were randomized to daily irrigation with 80 mL saline only and 21 were randomized to 80 mL saline plus gentamicin. Congestion and cough were the most common presenting symptoms. The average duration of symptoms exceeded 8 weeks.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis."

With no significant difference in clinical improvement between the two groups at 3 and 6 weeks follow-up, results suggest that saline alone is efficacious, Dr. Wei said at the Triological Society Combined Sections Meeting.

"I had learned to use saline with gentamicin in it to irrigate adults, so I started to use it in children. I knew the [amount of] gentamicin in the saline was minuscule, and I wanted to prove to myself that saline would be just as efficacious," said Dr. Wei, who is on the otolaryngology–head and neck surgery faculty at the University of Kansas/KU Medical Center in Kansas City.

Symptom resolution post irrigation correlated with positive changes in Lund-MacKay scoring of before and after CT scans. All domains of the Sinus and Nasal Quality of Life Survey (SN5) significantly improved in both groups from baseline to 3 weeks, with continued improvements observed until 6 weeks. Full study results were published in September 2011 (Laryngoscope 2011;121:1989-2000).

One patient required functional endoscopic sinus surgery because of persistent symptoms. Four families reported otalgia during the study.

More than 90% of the children were compliant with the 6-week regimen and nasal irrigation was "absolutely safe," Dr. Wei said at the meeting, which was cosponsored by the Triological Society and the American College of Surgeons. In addition, children and families only require about 2 minutes of instruction in the technique.

Dr. Wei said that she had no relevant financial disclosures.

MIAMI BEACH – Before you refer one of your pediatric patients with chronic rhinosinusitis to surgery, consider a trial of once-daily intranasal irrigation with isotonic saline, a pediatric otolaryngologist recommended, based on personal experience and results of a study with 40 children.

Participants in the 6-week study – children aged a mean 6 years – complied with the irrigation and experienced significant improvements in quality of life scores within 3 weeks. Prior to treatment, these children have "significant nasal stuffiness, and no matter how hard they blow their nose, nothing comes out," Dr. Julie L. Wei said.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis," Dr. Wei said. "Young children tolerate and like irrigation."

In the prospective, double-blind study, 19 children with chronic rhinosinusitis were randomized to daily irrigation with 80 mL saline only and 21 were randomized to 80 mL saline plus gentamicin. Congestion and cough were the most common presenting symptoms. The average duration of symptoms exceeded 8 weeks.

"Nasal irrigation is effective as first-line and possibly the only treatment for chronic rhinosinusitis."

With no significant difference in clinical improvement between the two groups at 3 and 6 weeks follow-up, results suggest that saline alone is efficacious, Dr. Wei said at the Triological Society Combined Sections Meeting.

"I had learned to use saline with gentamicin in it to irrigate adults, so I started to use it in children. I knew the [amount of] gentamicin in the saline was minuscule, and I wanted to prove to myself that saline would be just as efficacious," said Dr. Wei, who is on the otolaryngology–head and neck surgery faculty at the University of Kansas/KU Medical Center in Kansas City.

Symptom resolution post irrigation correlated with positive changes in Lund-MacKay scoring of before and after CT scans. All domains of the Sinus and Nasal Quality of Life Survey (SN5) significantly improved in both groups from baseline to 3 weeks, with continued improvements observed until 6 weeks. Full study results were published in September 2011 (Laryngoscope 2011;121:1989-2000).

One patient required functional endoscopic sinus surgery because of persistent symptoms. Four families reported otalgia during the study.

More than 90% of the children were compliant with the 6-week regimen and nasal irrigation was "absolutely safe," Dr. Wei said at the meeting, which was cosponsored by the Triological Society and the American College of Surgeons. In addition, children and families only require about 2 minutes of instruction in the technique.

Dr. Wei said that she had no relevant financial disclosures.