NASAL IRRIGATIONS: FROM EMPIRICAL PRACTICE TO EVIDENCE-BASED MEDICINE
P.L.Bastier et al.
Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Nov;132(5):281-5
Nasal irrigations play a recognised and non-negligible role in the treatment of several nasosinusal pathologies and in the postoperative medication of such pathologies. This literature review proposes an evaluation, in line with evidence-based medicine, of the indications and how to use them to maximise their efficacy.
The literature analysis highlights how, although there is currently no unique consensus on the method to be used for nasal irrigations in order to reach all the paranasal cavities, the following is preferable:
- nasal Irrigation under positive pressure rather than a negative pressure (suction) or nebulisation
- The administration of large volumes of solution (at least 150 cc)
- the use of an adapter for sealing the nostril through which washing is performed to avoid or minimise reflux
- The use of an appliance with a seal to prevent the reflux within it of solution already delivered to avoid contamination of the solution itself, made of washable plastic suitable for microwave and that dispenses approximately 5ml/s of saline.
Composition of the solution
From the literature, it is not always possible to determine the composition of the solution on the market with only a few exceptions, however it has been observed that the best effectiveness is obtained with the use of solutions similar to seawater and i.e. hypertonic saline solutions buffered with bicarbonate to reduce the viscosity of the mucus and possibly enriched with calcium and magnesium ions.
Clinical advantages of washings with seawater like solutions
The literature examined highlights how nasal irrigations with hypertonic saline solution:
- have improved the symptoms of the paediatric population with allergic rhinitis reducing the need to use antihistamines and corticosteroids.
- have improved the symptoms of allergic and non-allergic chronic sinusitis significantly more consistently than the use of steroids and antihistamines without washings.
- have proved to be effective in controlling symptoms in mild or moderate allergic oculorhinitisto the same extent as antihistamines or topical steroids.
- have reduced the number of episodes of recurring acute rhinitis in children, also minimising the need for pharmacological therapy and any complications
- have accelerated healing in acute sinusitis associated with standard therapy
- in the postoperative phase any nasosinusal intervention have demonstrated a fundamental effectiveness in accelerating healing by removing crusts, mucus and fibrin.