Nasal Saline May Be Effective for Chronic Rhinosinusitis

July 20, 2007 — Nasal saline is effective as sole treatment of chronic rhinosinusitis and as adjunctive therapy, according to the results of a meta-analysis published online in the July 18 issue of the Cochrane Database of Systematic Reviews.
"The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions," write Richard Harvey from John Radcliffe Hospital in Oxford, United Kingdom, and colleagues. "There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis."
The authors note that treatment regimens may incorporate nasal saline irrigation used once to more than 4 times daily, typically requiring much patient effort. However, it has been difficult to distinguish any additional benefit from saline vs that of other therapeutic interventions used in the regimen.
Using the Cochrane Ear, Nose, and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials through 2006, MEDLINE from 1950 to 2006, and EMBASE from 1974 to 2006, the authors searched through November 2006 for randomized controlled trials of saline irrigation vs no treatment or placebo, as an adjunct to other treatments, or compared with other treatments. They also compared findings with hypertonic saline vs isotonic saline solutions.
Using Cochrane criteria, the authors evaluated the methodologic quality of trials. Symptom scores comparing saline treatment with no treatment were pooled for statistical analysis, as were symptom and radiologic scores from the hypertonic group vs isotonic group, and the other findings were described in narrative fashion.
Of 8 trials meeting the inclusion criteria, 3 compared saline irrigation with no treatment, 1 compared saline irrigation with placebo, 1 evaluated saline irrigation as an adjunct to intranasal steroid spray, 1 compared it with an intranasal steroid spray, and 2 studies compared different hypertonic solutions with isotonic saline.
The meta-analysis suggested that saline alleviated the symptoms of chronic rhinosinusitis when used alone as treatment, and some data also supported the use of saline as adjunctive therapy. However, saline was not superior to a reflexology "placebo," and it was less effective than an intranasal steroid.
Some evidence suggested that hypertonic solutions improved objective measures, but the effect on symptoms was not as clear. No recommendations could be made regarding specific solutions, dosage, or delivery.
"Saline irrigations are well tolerated," the authors write. "Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis."
The authors note that there is considerable variability in the tools used to evaluate outcomes of treatment of rhinosinusitis and that additional research is needed in this area.
"Validated and accurate patient-centered outcome tools should always be preferred over ad hoc or customised questionnaires," the authors conclude. "A review of evidence for the physiological impact of saline that might explain the beneficial effect, most appropriate delivery technique, tonicity, frequency and volume of topical nasal saline is also required."
This review had no sources of support. The authors have disclosed no relevant financial relationships. One author has disclosed being supported by Oxford Nufeld Medical Fellowship UK.
Cochrane Database Syst Rev. Published online July 18, 2007.