Nasal Irrigation Improves Pediatric CRS

Can nasal irrigation be used effectively as a first-line treatment for pediatric chronic rhinosinusitis (CRS)?

Background: Rhinosinusitis is common in the pediatric population. An estimated 0.5% to 5% of these cases proceed to acute rhinosinusitis, and an unknown number of those will develop CRS. Several treatment options for pediatric CRS currently exist, and several studies have examined nasal irrigation efficacy in alleviating sinus symptoms in pediatric patients, although not extensively.

Study design: Retrospective cohort study and cross-sectional survey of 104 pediatric CRS patients diagnosed between July 2003 and January 2012, with a follow-up survey done between October 2012 and January 2013.

Setting: University of Kansas Medical Center, Kansas City.

Synopsis: The most common presenting symptoms included congestion, cough, rhinorrhea, headache, and fatigue, and the most common comorbidities were a positive allergy test, asthma, and gastroesophageal reflux disease. Prior to pediatric otolaryngology referral, patients had generally been given nasal or oral steroids, antihistamines, and montelukast sodium. For this study, all patients were prescribed six weeks of once-daily nasal irrigation. Follow-up CT scans were generally performed six weeks after the irrigation period. After six weeks of once-daily irrigation, 91 patients returned for the scheduled follow-up visit. Overall, 60 of 91 patients reported complete resolution of symptoms. Eleven of 91 patients were recommended to undergo limited bilateral middle meatal antrostomy with anterior ethmoidectomy surgery. Of the 54 patient families who completed long-term follow-up surveys, 11 reported that using irrigation for recurrent symptoms helped every time, 16 reported that it helped “some of the time,” two reported that it was “not at all helpful,” and one was unsure. Limitations included all patients coming from a single clinic setting, possible recall bias, and the fact that the authors did not prospectively collect SN-5 QoL surveys before and after irrigation treatment.

Bottom line: Despite any limitations, there is strong support for the use of once-daily saline nasal irrigation as a first-line treatment for pediatric CRS. It also reduces the need for functional endoscopic sinus surgery and CT imaging.

Citation: Pham V, Skyes K, Wei J. Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis; Laryngoscope. 2014;124:1000-1007.