Rhinosinusitis is one of the most common conditions for which patients seek relief. “While acute rhinosinusitis is usually self-limiting and resolves within a month, some patients develop chronic – and hard to treat – sinonasal symptoms,” reported Dr Mari Egan and Dr John Hickner in Saline irrigation spells relief for sinusitis sufferers (The Journal of family practice Volume 58).
“We’ve moved away from the notion that chronic rhinosinusitis is always a manifestation of persistent bacterial infection, and now recognise that there’s an inflammatory, nonbacterial component. In any given patient, several mechanisms – acting either simultaneously or independently – may contribute to sinonasal symptoms.”
Stressing their limited efficacy, Drs Egan and Hickner raised concerns that antibiotics and nasal steroids have remained the mainstays of treatment. However, encouragingly, their research also found that saline irrigation has gained popularity as an alternative approach to chronic sinusitis symptom relief.
While different studies have shown that adjunctive use of saline treatments resulted in decreased medication use overall and specifically less antibiotic use, a study by Dr Diane Heatley et al. actually found that daily nasal irrigation was so effective that it resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects and that medication usage was decreased in approximately one third of participants.
DELIVERY DEVICES AND HEAD POSITION
The goal of rinsing is to cleanse the entire nose, however, not all irrigation techniques can achieve this. According to the American Rhinologic Society studies have shown that regardless of the specific device – spray, bulb, neti pot, etc. – it is the volume that is important. “Higher volumes seem to lead to the best coverage of the nasal lining. When looking at improvement in patient symptoms, high volume nasal rinses have also been shown to be better.
“Head position during nasal irrigation may also have an impact on delivery. Placing the head down can help the rinse get to the top of the nose and the frontal sinus. Similarly, orienting the nose to the ceiling can help the rinse reach the back of the sinuses.
While saline irrigation isn’t a rhinosinusitis cure-all, as a pharmacist you are uniquely positioned and essential in explaining the benefits and usefulness of saline irrigations to patients.