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The effects of nasal irrigation with various solutions after endoscopic sinus surgery: systematic review and meta-analysis

Published online by Cambridge University Press:  02 August 2018

X Z Chen ,
S Y Feng ,
L H Chang ,
X P Lai ,
X H Chen ,
Xia Li  and
G H Zhang
X Z Chen
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
S Y Feng
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
L H Chang
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
X P Lai
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
X H Chen
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Xia Li
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
G H Zhang*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
*
Author for correspondence: Dr Gehua Zhang, Department of Otolaryngology – Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, China Fax: +86 020 8525 3045 E-mail: zhanggeh@mail.sysu.edu.cn
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Abstract

Background

Nasal irrigation is commonly performed in patients with chronic rhinosinusitis after functional endoscopic sinus surgery. This study systematically assessed the clinical efficacy of nasal irrigation from the medical literature.

Methods

The PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched using a comprehensive strategy, limited to English-language articles, published from October 1971 to March 2017, and comprising human subjects.

Results

A total of 824 trials were identified, 5 of which, involving 331 participants, were included in this systematic review. After selection, only three trials were eligible for inclusion in a meta-analysis. Nasal irrigation using normal saline and various solutions was found to be effective in reducing symptom scores and endoscopic scores for chronic rhinosinusitis patients after functional endoscopic sinus surgery. Comparison of outcome measures, such as eosinophil count reduction, revealed that various solutions are more effective than normal saline alone; however, no statistical significance was found in terms of reduced symptom or endoscopic scores.

Conclusion

Based on the current limited evidence, nasal irrigation is an effective therapy for chronic rhinosinusitis patients after functional endoscopic sinus surgery. However, when comparing various solutions with normal saline, no significant difference was found in symptom scores or endoscopic scores.

Keywords

Nasal LavageChronic SinusitisSaline SolutionSodium ChlorideEndoscopy
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 673 - 679
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr G Zhang takes responsibility for the integrity of the content of the paper

References

1Fokkens, WJ, Lund, VJ, Mullol, J, Bachert, C, Alobid, I, Baroody, F et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 2012;23:1–298Google Scholar
2Snidvongs, K, Thanaviratananich, S. Update on intranasal medications in rhinosinusitis. Curr Allergy Asthma Rep 2017;17:47–59Google Scholar
3Patel, ZM, Thamboo, A, Rudmik, L, Nayak, J, Smith, T, Hwang, PH. Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2016;1:1–10Google Scholar
4Lund, VJ, Holmstrom, M, Scadding, GK. Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment. J Laryngol Otol 1991;105:832–45Google Scholar
5Subramanian, HN, Schechtman, KB, Hamilos, DL. A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis. Am J Rhinol 2002;16:303–12Google Scholar
6Achilles, N, Mosges, R. Nasal saline irrigations for the symptoms of acute and chronic rhinosinusitis. Curr Allergy Asthma Rep 2013;13:229–35Google Scholar
7Principi, N, Esposito, S. Nasal irrigation: an imprecisely defined medical procedure. Int J Environ Res Public Health 2017;14:E516Google Scholar
8Harvey, R, Hannan, SA, Badia, L, Scadding, G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev 2007;3:1–42Google Scholar
9Brown, CL, Graham, SM. Nasal irrigations: good or bad? Curr Opin Otolaryngol 2004;12:9–13Google Scholar
10Pham, V, Sykes, K, Wei, J. Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis. Laryngoscope 2014;124:1000–7Google Scholar
11Ezzat, WF, Fawaz, SA, Rabie, H, Hamdy, TA, Shokry, YA. Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis. Eur Arch Otorhinolaryngol 2015;272:2355–61Google Scholar
12Sanan, A, Rabinowitz, M, Rosen, M, Nyquist, G. Topical therapies for refractory chronic rhinosinusitis. Otolaryngol Clin North Am 2017;50:129–41Google Scholar
13Farag, AA, Deal, AM, McKinney, KA, Thorp, BD, Senior, BA, Ebert, CS Jr et al. Single-blind randomized controlled trial of surfactant vs hypertonic saline irrigation following endoscopic endonasal surgery. Int Forum Allergy Rhinol 2013;3:276–80Google Scholar
14Chiu, AG, Palmer, JN, Woodworth, BA, Doghramji, L, Cohen, MB, Prince, A et al. Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient. Am J Rhinol 2008;22:34–7Google Scholar
15Kim, ST, Sung, UH, Jung, JH, Paik, JY, Woo, JH, Cha, HE et al. The effect of maxillary sinus irrigation on early prognostic factors after endoscopic sinus surgery: a preliminary study. Am J Rhinol Allergy 2013;27:e158–61Google Scholar
16Li, N, Peters, AT. Chronic rhinosinusitis management beyond intranasal steroids and saline solution irrigations. Allergy Asthma Proc 2015;36:339–43Google Scholar
17Adappa, ND, Wei, CC, Palmer, JN. Nasal irrigation with or without drugs: the evidence. Curr Opin Otolaryngol 2012;20:53–7Google Scholar
18Higgins, JP, Green, S, eds. Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. London: Cochrane Collaboration, 2011Google Scholar
19Review Manager (RevMan) [computer program], version 5.3. Copenhagen: Nordic Cochrane Centre, Cochrane Collaboration, 2014Google Scholar
20Higgins, JP, Thompson, SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–58Google Scholar
21Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60Google Scholar
22Langhorne, P. Bias in meta-analysis detected by a simple, graphical test. Prospectively identified trials could be used for comparison with meta-analyses. BMJ 1998;316:471Google Scholar
23Jiang, RS, Hsu, SH, Liang, KL. Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery. Am J Rhinol Allergy 2015;29:435–40Google Scholar
24Jiang, RS, Liang, KL, Wu, SH, Su, MC, Chen, WK, Lu, FJ. Electrolyzed acid water nasal irrigation after functional endoscopic sinus surgery. Am J Rhinol Allergy 2014;28:176–81Google Scholar
25Macchi, A, Terranova, P, Digilio, E, Castelnuovo, P. Hyaluronan plus saline nasal washes in the treatment of rhino-sinusal symptoms in patients undergoing functional endoscopic sinus surgery for rhino-sinusal remodeling. Int J Immunopathol Pharmacol 2013;26:137–45Google Scholar
26Low, TH, Woods, CM, Ullah, S, Carney, AS. A double-blind randomized controlled trial of normal saline, lactated Ringer's, and hypertonic saline nasal irrigation solution after endoscopic sinus surgery. Am J Rhinol Allergy 2014;28:225–31Google Scholar
27Staffieri, A, Marino, F, Staffieri, C, Giacomelli, L, D'Alessandro, E, Maria, FS et al. The effects of sulfurous-arsenical-ferruginous thermal water nasal irrigation in wound healing after functional endoscopic sinus surgery for chronic rhinosinusitis: a prospective randomized study. Am J Otolaryngol 2008;29:223–9Google Scholar
28Liang, KL, Su, MC, Shiao, JY, Tseng, HC, Hsin, CH, Lin, JF et al. Amphotericin B irrigation for the treatment of chronic rhinosinusitis without nasal polyps: a randomized, placebo-controlled, double-blind study. Am J Rhinol 2008;22:52–8Google Scholar
29Liu, JJ, Chan, GC, Hecht, AS, Storm, DR, Davis, GE. Nasal saline irrigation has no effect on normal olfaction: a prospective randomized trial. Int Forum Allergy Rhinol 2014;4:39–42Google Scholar
30Lee, SH, Dominguez, R. The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck 2005;133:3–8Google Scholar
31Khianey, R, Oppenheimer, J. Is nasal saline irrigation all it is cracked up to be? Ann Allergy Asthma Immunol 2012;109:20–8Google Scholar
32Soudry, E, Wang, J, Vaezeafshar, R, Katznelson, L, Hwang, PH. Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery. Int Forum Allergy Rhinol 2016;6:568–72Google Scholar
33van den Berg, JW, de Nier, LM, Kaper, NM, Schilder, AG, Venekamp, RP, Grolman, W et al. Limited evidence: higher efficacy of nasal saline irrigation over nasal saline spray in chronic rhinosinusitis--an update and reanalysis of the evidence base. Otolaryngol Head Neck Surg 2014;150:16–21Google Scholar
34Hardy, ET, Stringer, SP, O'Callaghan, R, Arana, A, Bierdeman, MA, May, WL. Strategies for decreasing contamination of homemade nasal saline irrigation solutions. Int Forum Allergy Rhinol 2016;6:140–2Google Scholar
35Pynnonen, MA, Mukerji, SS, Kim, HM, Adams, ME, Terrell, JE. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol 2007;133:1115–20Google Scholar