Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: A randomized controlled trial

Our study has several limitations. It was not blinded or placebo controlled. Blinding subjects to a physical therapy is inherently difficult. Investigators who have tried to use normal saline placebos probably affected outcomes.^14-16 One trial using a fresh water (0% saline) placebo was stopped early when several control subjects developed otitis media.³² The investigators also were unblinded, possibly creating observer bias.

Methodologic and recruitment strengths of this study included effective randomization, matched control group, intention-to-treat analysis, low missing data rates, high compliance rate, and low dropout rate. Clinical strengths included significant findings on most parameters assessed. Particularly intriguing was the decreased use of antibiotics in the experimental group. This study offered strong evidence that nasal irrigation is a safe, effective, and inexpensive (nasal pot, $15; daily therapy, <$1/month) therapy for sinus disease that properly trained patients will use. Although questions about the protocol (schedule, concentration, and buffering) and indications require further study in a more diverse patient population, clinicians may confidently recommend nasal irrigation; it offers significant hope for symptomatic relief and QOL improvement for millions of individuals with sinus disease who often have few therapeutic options.

CONCLUSIONS

Daily hypertonic saline nasal irrigation improves sinus-related QOL, decreases symptoms, and decreases medication use in patients with frequent sinusitis. Primary care physicians can feel comfortable recommending this therapy.

Acknowledgments

We thank Thomas Pasic, MD, Michael McDonald, MD, and Diane Heatley, MD, Department of Otolaryngology, University of Wisconsin, Madison.