Ancient Remedy for Chronic Rhinosinusitis Comes with Fresh Warnings

He cited, as an example, an over-the-counter nasal spray that contains xylitol, a 5-carbon sugar with antibacterial properties. “This is a product that I know is clean and sterile, and you just spray it four or five times in each nostril. I’ve seen great results with it, and clinical studies show that it can enhance bacterial killing [Proc Natl Acad Sci USA. 2000;97(21):11614-11619].”

Why not use nasal irrigation, often deemed a relatively benign therapy, in a more widespread fashion? “I’m not so sure how benign it is,” Dr. Asher said. “I think there are people who convert from an acute upper respiratory infection to a chronic sinus condition as a result of nasal irrigation.”

That may occur, he noted, “because patients sometimes don’t follow the correct procedure when irrigating or because the saline solution irritates their nose, which causes more swelling of the nasal mucosa and which then causes the sinuses to back up. But whatever the cause, I have definitely seen this in my practice.”

Dr. Asher said he has another reservation about widespread use of nasal irrigation for chronic sinusitis. “It ignores the fact that this condition isn’t just related to the lining of the nose,” he said. “In most people, it’s more of a systemic problem associated with compromised immune function, which in turn can promote mucosal inflammation and congestion. So my interventions—many from the ranks of complementary/alternative medicine [CAM]—focus on improving their immune function and reducing nasal inflammation.” (see “CAM Therapy Effective for Chronic Sinusitis”).

What Not To Do

Clearly, there are many differing views on how best to manage patients with chronic sinusitis. For Dr. Wei, the best way to find agreement, perhaps, is to focus not so much on what to do for these patients, but on what not to do. “We can’t just keep throwing ‘Z-Paks’ at the problem,” she said. “There’s enough study data and clinical evidence showing that that approach is not working. It’s time for something different, and nasal irrigation is a wonderful place to start.”