This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • General Rhinology  • Paranasal Sinus Disease  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Controlled Trial

Melissa A. Pynnonen, MD; Shraddha S. Mukerji, MD; H. Myra Kim, ScD; Meredith E. Adams, MD; Jeffrey E. Terrell, MD

Arch Otolaryngol Head Neck Surg. 2007;133(11):1115-1120.

Objective  To determine if isotonic sodium chloride (hereinafter "saline") nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays at improving quality of life and decreasing medication use.

Design  A prospective, randomized controlled trial.

Setting  Community.

Participants  A total of 127 adults with chronic nasal and sinus symptoms.

Interventions  Patients were randomly assigned to irrigation performed with large volume and delivered with low positive pressure (n = 64) or spray (n = 63) for 8 weeks.

Main Outcome Measures  Change in symptom severity measured by mean 20-Item Sino-Nasal Outcome Test (SNOT-20) score; change in symptom frequency measured with a global question; and change in medication use.

Results  A total of 121 patients were evaluable. The irrigation group achieved lower SNOT-20 scores than the spray group at all 3 time points: 4.4 points lower at 2 weeks (P = .02); 8.2 points lower at 4 weeks (P < .001); and 6.4 points lower at 8 weeks (P = .002). When symptom frequency was analyzed, 40% of subjects in the irrigation group reported symptoms "often or always" at 8 weeks compared with 61% in the spray group (absolute risk reduction, 0.2; 95% confidence interval, 0.02-0.38 (P = .01). No significant differences in sinus medication use were seen between groups.

Conclusion  Nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays for treatment of chronic nasal and sinus symptoms in a community-based population.

Trial Registration  clinicaltrials.gov Identifier: NCT00318006

Author Affiliations: Departments of Otolaryngology (Drs Pynnonen, Adams, and Terrell) and Biostatistics and Center for Statistical Consultation and Research (Dr Kim), University of Michigan Health System, Ann Arbor; and Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston (Dr Mukerji).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Concordant genotype of upper and lower airways P aeruginosa and S aureus isolates in cystic fibrosis
Mainz et al.
Thorax 2009;64:535-540.
ABSTRACT | FULL TEXT  

A 51-Year-Old Woman With Acute Onset of Facial Pressure, Rhinorrhea, and Tooth Pain: Review of Acute Rhinosinusitis
Hwang
JAMA 2009;301:1798-1807.
ABSTRACT | FULL TEXT