Nasal Irrigation Beats Saline Sprays for Stuffy Nose

It is an interesting observation how mainstream medicine (MSM) denigrates natural health care methods proven effective for eons, that is unless a drug company seems to come up with the idea, post facto.

In my work I have been advising nasal washing for decades and people are so amzaed at how it brings about true relief.

I offer an herbal nasal 'inhaler' along with a nasal washing kit and also a salt inhaler for both children an adults. And I'm happy to answer any inquiry about the products, including how you can order. Remember that our work is supported by profits from our sales and service along with donations this BLOG is sponsored by a 501c3 tax-exempt and non-profit organization.
Note that the studies showed both short-and-long-term benefits to nasal irrigation, suggesting a preventive effect.

ANN ARBOR, Mich., Nov. 19 -- For chronic rhinitis, nasal irrigation may clear sinuses substantially better than a saline spray, suggested a comparison of what has been assumed to be equivalent treatments.

Flushing the sinuses with salt water about doubled short-term improvements in symptom severity and frequency compared with saline spray, reported Melissa A. Pynnonen, M.D., of the University of Michigan here, and colleagues in the November issue of the Archives of Otolaryngology -- Head & Neck Surgery.
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"The irrigations help people significantly," Dr. Pynnonen said. "The amount of improvements people get is similar to the amount of improvement that patients with chronic sinus and nasal problems get after sinus surgery."

The results suggest irrigation may be ready to move beyond the otolaryngologist's armamentarium into primary care, the investigators said.

Both irrigation and sprays have been used as adjuvant treatments to medical therapy for allergies and other chronic nasal and sinus conditions. But "nasal saline sprays are often used as an alternative to saline irrigations because saline spray is often perceived to be equivalent to and better tolerated than irrigation," the researchers said.

So the researchers conducted a randomized, controlled trial comparing the two methods in 121 adults with chronic nasal and sinus symptoms, such as nasal stuffiness and thick nasal discharge. Symptoms were similar between groups at baseline.

Participants were taught how to use nasal irrigation or nasal saline spray and continued treatment twice daily for eight weeks in addition to their usual medications.

Symptom scores improved in both groups during treatment (P0.001 at weeks two, four, and eight), but the irrigation group consistently scored better than the saline group. The symptom severity changes from baseline were, respectively:

12.2 versus 6.7 points on a 100-point scale at two weeks (P=0.05).
16.2 versus 7.4 points at four weeks (P=0.002).
15.0 versus 8.5 points at eight weeks (P=0.04).

Symptom frequency also improved more in the irrigation group. Whereas almost all patients (93% to 95%) reported nasal or sinus symptoms "often or always" at baseline, only 40% of the irrigation group compared with 61% of the spray group reported the same at week eight (adjusted odds ratio: 0.49, absolute risk reduction: 0.2, P=0.01).

So the number needed to treat with saline irrigation was five to reduce symptom frequency and seven to have a clinically significant, 16-point or greater improvement in symptom severity.

Adverse events, most commonly nasal drainage after treatment, were similar between groups. Use of other medications, whether prescription or over-the-counter, was likewise similar between groups throughout the study.

However, compliance with irrigation dropped over time compared with the spray (92% versus 97% at week two, 81% versus 93% at week four, and 79% versus 93% at week eight, P=0.03).

While the researchers called the 79% compliance high, they added that it "suggests that our results are a conservative estimate of the true benefit of irrigation therapy."

These benefits compared with saline spray could "be due to greater volume, increased delivery pressure, and mechanical debridement achieved with irrigations," Dr. Pynnonen and colleagues said.

Whatever the mechanism, the findings are likely generalizable to the millions of patients with nasal and sinusitis-like symptoms seen in primary care every day, they said.

Furthermore, the magnitude of improvements with nasal irrigation (range 12.2 to 16.2 points) was not substantially different from improvements seen with sinus surgery (19 to 22 points) in one study and was greater than that with oral prednisone (10 points) in another.

"This finding is even more remarkable given the nominal cost and minimal risk of this saline intervention," they wrote.

The study was supported by NeilMed Pharmaceuticals.

Primary source: Archives of Otolaryngology -- Head & Neck Surgery
Source reference:
Pynnonen MA, et al "Nasal saline for chronic sinonasal symptoms: a randomized controlled trial"Arch Otolaryngol Head Neck Surg 2007; 133: 1115-1120.

Nasal Irrigation Flushes Away Kids' Cold Symptoms

BRNO, Czech Republic, Jan. 21 -- Nasal irrigation with a saline solution of processed seawater may clear up children's cold symptoms faster than standard medication alone and prevent them from returning, researchers here found.

Kids' stuffy and runny noses improved more in the first three weeks of treatment when frequent saline rinses were used along with standard medication than with medication alone (P0.05 for both), reported Ivo Šlapak, M.D., of Teaching Hospital Brno, and colleagues, in the January issue of the Archives of Otolaryngology -- Head & Neck Surgery.

At eight weeks, children using nasal irrigation in the prospective, open-label study still had lower scores for sore throat, cough, nasal obstruction, and secretion (P0.05 for all).
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Perhaps the most compelling result was the reduction in medication use for children who used the low-volume wash, commented Melissa A. Pynnonen, M.D., of the University of Michigan in Ann Arbor, in an interview.

Her research group has also reported benefits of nasal irrigation for adults.

But overall evidence of efficacy has been poor, the researchers said. And, it was questionable whether irrigation would be a feasible treatment for children, Dr. Pynnonen said.

"This was really well tolerated," Dr. Pynnonen said. "The question was whether you can get kids to do it, and these authors show that you can."

Their prospective, parallel-group, open-label study included 401 children ages six to 10 seen for uncomplicated cold or flu in eight pediatric outpatient clinics.

Participants were randomized to treatment with standard medication, which could include antipyretics, nasal decongestants, mucolytics, and antibiotics, alone or in combination with nasal wash, and then observed over 12 weeks.

The nasal irrigation used was a commercially available product (Physiomer) processed from Atlantic Ocean seawater using electrodialysis to maintain the concentration of trace elements and minerals, the researchers said.

Patients used the saline nasal wash in a volume of 3 to 6 mL for each nostril six times a day during acute illness and three times a day for prevention over the remainder of follow-up.

At the second office visit during the up to three-week "acute illness" phase of the study, some symptoms had improved more with the nasal irrigation than with medication alone.

The improved scores, on a scale where 1 was symptom free and 4 was severe symptoms, included:

Sore throat (1.09 with irrigation versus 1.23 for controls, P0.05).
Nasal secretion (1.79 with irrigation versus 2.10 for controls, P0.05).
Nasal breathing (1.25 with irrigation versus 1.58 for controls, P0.05).

Physicians rated health status as significantly more improved compared with baseline among those using nasal irrigation whether they entered the study with a cold (1.87 versus 2.60 on a four-point scale in which 1 is cured and 4 is no change, P0.05) or the flu (1.59 versus 2.00, P=0.02).

At the 12-week follow-up in the subsequent prevention phase, symptoms of dry cough, nasal secretion, and nasal breathing were less common or less severe among children in the nasal irrigation group than in the control group (P0.05).

Long-term saline irrigation also was associated with better parent-reported health status, fewer reported days of illness, fewer absences from school, and fewer complications (P0.05).

At the first visit, the saline nasal wash group reported less use of nasal decongestants (15.9% versus 35.6%, P0.001) and mucolytics (17.3% versus 31.7%, P=0.002).

At the follow-up visit at about week eight, medication use was lower in the nasal irrigation group for antipyretics (9.4% versus 32.7%), mucolytics (9.7% versus 36.6%), nasal decongestants (9.7% versus 46.5%), and systemic antibiotics (5.6% versus 20.8%).

All five comparisons were likewise significant at week 12 (P0.05), except that the difference in systemic antibiotic use disappeared.

"The reduced use of topical decongestants is important since they are appropriate only on a short-term basis," the researchers said.

Long-term use of topical decongestants, although common, they said, "can lead to complications, including paranasal sinusitis and histologic changes in the mucosa."

The children had more complaints about the higher volume washes and three patients reported nosebleeds, but overall it was well tolerated, Dr. Šlapak and colleagues said.

The study was limited by its unblinded design and use of symptom scores for which a clinically significant level of difference has not been established, the researchers noted.

"It is not clear whether the effect is predominantly mechanical, based on clearing mucus, or whether salts and trace elements in seawater solutions play a significant role," the researchers said.

However, the benefit is likely related to more than mucus clearance because it lasted beyond the acute phase of cold or flu, Dr. Pynnonen said.

The study was funded by Goemar Laboratoires La Madeleine.

Dr. Šlapak reported receiving speakers' honoraria from GlaxoSmithKline and Servier. Co-authors reported conflicts of interest for GlaxoSmithKline, Servier, Merck & Co., Schering-Plough, Piere Fabre, Artu, Roche, Zentiva, Pfizer, Schering AG, sanofi-aventis, Gedeon-Richter, Eli Lilly, and Astellas.

Dr. Pynnonen has received research support from NeilMed Pharmaceuticals, which makes a sinus rinse product.

Primary source: Archives of Otolaryngology -- Head & Neck Surgery
Source reference:
Šlapak I, et al "Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children"Arch Otolaryngol Head Neck Surg 2008; 134: 67-74.