Abstract Title: Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study. Abstract Source: Laryngoscope. 2011 Nov ;121(11):2468-72. Epub 2011 Oct 12. PMID: 21994147 Abstract Author(s): Joshua D Weissman, Francisca Fernandez, Peter H Hwang Article Affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A. Abstract: OBJECTIVES/HYPOTHESIS: To determine the tolerability of xylitol mixed with water as a nasal irrigant and to evaluate whether xylitol nasal irrigation results in symptomatic improvement of subjects with chronic rhinosinusitis. STUDY DESIGN: A prospective, randomized, double-blinded, controlled crossover pilot study. METHODS: Twenty subjects were instructed to perform sequential 10-day courses of daily xylitol and saline irrigations in a randomized fashion, with a 3-day washout irrigation rest period at the start of each treatment arm. Collected data included patient characteristics, along with Sino-Nasal Outcome Test 20 (SNOT-20) and Visual Analog Scale (VAS) scores reported at the beginning and end of each irrigation course. RESULTS: Fifteen of the 20 subjects (75%) returned their SNOT-20 and VAS data for analysis. There was a significant reduction in SNOT-20 score during the xylitol phase of irrigation (mean drop of 2.43 points) as compared to the saline phase (mean increase of 3.93 points), indicating improved sinonasal symptoms (P = .0437). There was no difference in VAS scores. No patient stopped performing the irrigations owing to intolerance of the xylitol, although its sweet taste was not preferred by three subjects (21%). One patient reported transient stinging with xylitol. CONCLUSIONS: Xylitol in water is a well-tolerated agent for sinonasal irrigation. In the short term, xylitol irrigations result in greater improvement of symptoms of chronic rhinosinusitis as compared to saline irrigation. Article Published Date : Nov 01, 2011

Abstract Title: Saline nasal irrigation for acute upper respiratory tract infections. Abstract Source: Cochrane Database Syst Rev. 2010(3):CD006821. Epub 2010 Mar 17. PMID: 20238351 Abstract Author(s): Jessica C Kassel, David King, Geoffrey Kp Spurling Article Affiliation: School of Population Health, University of Queensland, Brisbane, Australia. Abstract: BACKGROUND: Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation, and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and mucolytic drugs, and often antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for chronic or allergic sinusitis, but little is known about its effect on acute URTIs. OBJECTIVES: To evaluate the efficacy of saline nasal irrigation in treating the symptoms of acute URTIs. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to May 2009), EMBASE (1974 to May 2009), CINAHL (1982 to May 2009), AMED (1985 to 2009) and LILACS (May 2009). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs. DATA COLLECTION AND ANALYSIS: Two review authors (DK, GS) independently assessed trial quality and extracted data. All data were analysed using Cochrane Review Manager software. MAIN RESULTS: Three RCTs (618 participants) were included. Most results showed no difference between nasal saline treatment and control. However, there was limited evidence of benefit with nasal saline irrigation in adults. One study showed a mean difference of 0.3 day (out of eight days) for symptom resolution, but this was not significant. Nasal saline irrigation was associated with less time off work in one study. Minor discomfort was not uncommon and 40% of babies did not tolerate nasal saline drops. AUTHORS' CONCLUSIONS: Included trials were too small and had too high a risk of bias to be confident about the possible benefits of nasal saline irrigation in acute URTIs. Future trials should involve much larger numbers of participants and be rigorously designed and controlled. Article Published Date : Jan 01, 2010

Abstract Title: Efficacy of nasal irrigation in the treatment of acute sinusitis in children. Abstract Source: Int J Pediatr Otorhinolaryngol. 2009 Dec;73(12):1696-701. Epub 2009 Sep 27. PMID: 19786306 Abstract Author(s): Yun-Hu Wang, Chun-Ping Yang, Min-Sho Ku, Hai-Lun Sun, Ko-Huang Lue Article Affiliation: Division of Allergy, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan. Abstract: BACKGROUND: Nasal irrigation has been used as an adjunctive therapy of sinonasal disease including acute/chronic sinusitis and allergic rhinitis. Several published articles reported it also improves clinical sinus symptoms. OBJECTIVE: To evaluate the effectiveness of normal saline nasal irrigation in the management of acute sinusitis in children. DESIGN: This was a randomized, prospective placebo-controlled study. METHODS: We included 69 participants with acute sinusitis. 30 of 69 participants underwent normal saline nasal irrigation. 39 of 69 participants were not receiving nasal irrigation. All participants performed nasal peak expiratory flow rate (nPEFR) test, nasal smear examination, radiography (Water's projection) and requested to complete the Pediatric Rhinoconjunctivitis Quality of Life Questionnaires (PRQLQ) at the baseline visit. All participants were requested to record the symptom diary card every day and were followed-up every 1 week during this period. A physical examination, nasal smear and nPEFR were performed at each visit, and all daily diary cards collected. At the final visit, the symptoms diaries were reviewed and participants were requested to complete the PRQLQ again. The nPEFR, radiography (Water's projection) and nasal smear were also repeated. RESULTS: Normal saline irrigation group significantly improved mean PRQLQ values and nPEFR values at medium (T=2.816, P<0.05) and final period (T=2.767, P<0.05) compared with the other group. Although there were no statically significant improving rate of radiography (Water's projection) in among two groups (T=0.545, P>0.05), but normal saline irrigation group was better than the other group. The improval rate of mean TSS in the irrigation group significantly improved all symptoms compared with the placebo group, in which rhinorrhea, nasal congestion, throat itching, cough and sleep quality improved. 27 of 66 (40.9%) participants with atopy, 16 of 27 (53.33%) participants underwent normal saline irrigation. Normal saline irrigation atopy group significantly improved rhinorrhea, nasal congestion, throat itching and sleep quality symptoms compared with non-irrigation atopy group. Normal saline irrigation atopy group significantly improved nPEFR values at final period (Z=2.53, P<0.05). CONCLUSION: This study evidence that normal saline nasal irrigation improves Pediatric Rhinoconjunctivitis Quality of Life and decreases acute sinusitis symptoms. Nasal irrigation is an effective adjunctive treatment for pediatric acute sinusitis. Normal saline nasal irrigation in atopy children also improves allergic-related symptoms. We may need larger, longer and extended study to assess the conclusion. Article Published Date : Dec 01, 2009

Abstract Title: A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Abstract Source: Clin Otolaryngol. 2008 Oct;33(5):462-5. PMID: 18983380 Abstract Author(s): S R M Freeman, E S G Sivayoham, K Jepson, J de Carpentier Abstract: OBJECTIVE: To assess whether saline reduces postoperative signs following endoscopic sinus surgery (ESS). DESIGN: Within subject, single blinded randomised controlled trial. SETTING: Single secondary referral centre. PARTICIPANTS: Adults undergoing bilateral ESS for chronic rhinosinusitis or nasal polyposis. INTERVENTION: Saline douching of one side of the nasal cavity, three times per day for 6 weeks. MAIN OUTCOME MEASURES: Presence of adhesions, polyps, crusting, discharge or oedema under endoscopic examination at 3 weeks and 3 months postoperative. RESULTS: Twenty-three patients were recruited. Attendance was 22 patients at 3 weeks and 17 patients at 3 months. At 3 weeks saline douching significantly improved the presence of discharge (P = 0.046) and non-significantly improved the presence of oedema (P = 0.059) with minimal difference with regard to polyps (P = 0.32) and no difference with adhesions or crusting. At 3 months there was minimal difference with regard to crusting (P = 0.18) and oedema (P = 0.32) and no difference with adhesions, discharge and polyps. CONCLUSIONS: Saline douching reduces nasal discharge and may improve oedema during the healing phase following ESS which may represent a possible anti-inflammatory role. No long-term effect was found. Article Published Date : Oct 01, 2008

Abstract Title: Nasal irrigation for chronic sinus symptoms in patients with allergic rhinitis, asthma, and nasal polyposis: a hypothesis generating study. Abstract Source: WMJ. 2008 Apr;107(2):69-75. PMID: 18593081 Abstract Author(s): David Rabago, Emily Guerard, Don Bukstein Article Affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: Rhinosinusitis is a common, expensive disorder with a significant impact on patients' quality of life. Chronic sinus symptoms are associated with allergic rhinitis, asthma, and nasal polyposis. Saline nasal irrigation is an adjunctive therapy for rhinosinusitis and sinus symptoms. Prior studies suggest that hypertonic saline nasal irrigation (HSNI) may be effective for symptoms associated with allergy, asthma, and nasal polyposis. OBJECTIVE: To assess the degree to which subjects using nasal irrigation for chronic sinus symptoms also reported improvements in symptoms related to allergy, asthma, or nasal polyposis. DESIGN: Qualitative study using in-depth long interviews of 28 participants in a prior qualitative nasal irrigation study. All participants were receiving daily nasal irrigation. RESULTS: Transcripts of interviews were systematically examined. Twelve of 21 subjects with allergic rhinitis spontaneously reported that HSNI improved symptoms. Two of 7 subjects with asthma and 1 of 2 subjects with nasal polyposis reported a positive association between HSNI use and asthma or nasal polyposis symptoms. Transcript content was organized into themes that included: (1) HSNI resulted in improvement of allergic rhinitis and asthma symptoms, and (2) HSNI should be used for symptoms of allergic rhinitis. CONCLUSIONS: This hypothesis-generating study offers qualitative evidence that suggests patients with frequent rhinosinusitis and daily sinus symptoms, symptoms of concomitant allergic rhinitis, asthma, or polyposis may improve with HSNI. The parent studies offer strong evidence that HSNI is an effective adjunctive treatment for symptoms of chronic rhinosinusitis. Larger prospective studies are needed in patients with these diagnoses. Article Published Date : Apr 01, 2008

Abstract Title: Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Abstract Source: Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115-20. PMID: 18025315 Abstract Author(s): Melissa A Pynnonen, Shraddha S Mukerji, H Myra Kim, Meredith E Adams, Jeffrey E Terrell Abstract: 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. Article Published Date : Nov 01, 2007

Abstract Title: Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Abstract Source: Cochrane Database Syst Rev. 2007(3):CD006394. Epub 2007 Jul 18. PMID: 17636843 Abstract Author(s): R Harvey, S A Hannan, L Badia, G Scadding Article Affiliation: Royal National Throat Nose and Ear Hospital, London/John Radcliffe Hospital, Oxford, Otolaryngology, Head&Neck Surgery/Cochrane ENT Disorders Group, Level LG1 West Wing, John Radcliffe Hospital, Oxford, UK, OX3 9DU. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: BACKGROUND: The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Treatment strategies often include the use of topical saline from once to more than four times a day. Considerable patient effort is often involved. Any additional benefit has been difficult to discern from other treatments. OBJECTIVES: To evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis. SEARCH STRATEGY: Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2006), MEDLINE (1950 to 2006) and EMBASE (1974 to 2006). The date of the last search was November 2006. SELECTION CRITERIA: Randomised controlled trials in which saline was evaluated in comparison with either no treatment, a placebo, as an adjunct to other treatments or against treatments. The comparison of hypertonic versus isotonic solutions was also compared. DATA COLLECTION AND ANALYSIS: Trials were graded for methodological quality using the Cochrane approach (modification of Chalmers 1990). Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis. A narrative overview of the remaining results is presented. MAIN RESULTS: Eight trials were identified that satisfied the inclusion criteria. Three studies compared topical saline against no treatment, one against placebo, one as an adjunct to and one against an intranasal steroid spray. Two studies compared different hypertonic solutions against isotonic saline. There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology 'placebo'. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear. AUTHORS' CONCLUSIONS: Saline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis. Article Published Date : Jan 01, 2007

Abstract Title: The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Abstract Source: Otolaryngol Head Neck Surg. 2005 Jul;133(1):3-8. PMID: 16025044 Abstract Author(s): David Rabago, Thomas Pasic, Aleksandra Zgierska, Marlon Mundt, Bruce Barrett, Rob Maberry Article Affiliation: Department of Family Medicine, University of Wisconsin Medical School-Madison, 53715, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. STUDY DESIGN AND SETTING: The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinonasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 +/- 2.6 points to 80.6 +/- 2.4 points (P<0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 +/- 3.9 points to 79.7 +/- 3.7 points (P<0.05), SNOT-20 scores improved from 43.5 +/- 5.7 points to 28.4 +/- 4.8 points, and SIA scores improved from 4.2 +/- 0.3 points to 2.6 +/- 0.3 points (P<0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms. Article Published Date : Jul 01, 2005

Abstract Title: Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. Abstract Source: J Fam Pract. 2002 Dec;51(12):1049-55. PMID: 12540331 Abstract Author(s): David Rabago, Aleksandra Zgierska, Marlon Mundt, Bruce Barrett, James Bobula, Rob Maberry Article Affiliation: Department of Family Medicine, University of Wisconsin, Madison, 53715, USA. This email address is being protected from spambots. You need JavaScript enabled to view it. Abstract: OBJECTIVES: To test whether daily hypertonic saline nasal irrigation improves sinus symptoms and quality of life and decreases medication use in adult subjects with a history of sinusitis. STUDY DESIGN: Randomized controlled trial. Experimental subjects used nasal irrigation daily for 6 months. POPULATION: Seventy-six subjects from primary care (n=70) and otolaryngology (n=6) clinics with histories of frequent sinusitis were randomized to experimental (n=52) and control (n=24) groups. OUTCOMES MEASURED: Primary outcome measures included the Medical Outcomes Survey Short Form (SF-12), the Rhinosinusitis Disability Index (RSDI), and a Single-Item Sinus-Symptom Severity Assessment (SIA); all 3 were completed at baseline, 1.5, 3, and 6 months. Secondary outcomes included daily assessment of compliance and biweekly assessment of symptoms and medication use. At 6 months, subjects reported on side effects, satisfaction with nasal irrigation, and the percentage of change in their sinus-related quality of life. RESULTS: No significant baseline differences existed between the 2 groups. Sixty-nine subjects (90.8%) completed the study. Compliance averaged 87%. Experimental group RSDI scores improved from 58.4 -/+ 2.0 to 72.8 -/+ 2.2 (P Article Published Date : Dec 01, 2002

Abstract Title: Clinical study and literature review of nasal irrigation. Abstract Source: Laryngoscope. 2000 Jul;110(7):1189-93. PMID: 10892694 Abstract Author(s): L T Tomooka, C Murphy, T M Davidson Article Affiliation: School of Medicine, University of California San Diego, USA. Abstract: OBJECTIVES/HYPOTHESIS: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study DESIGN: A prospective controlled clinical study. METHODS: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. RESULTS: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. CONCLUSIONS: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease. Article Published Date : Jul 01, 2000