Nasal Discharge the Sole Symptom Improved by Nasal Saline Treatment in Patients with Acute Rhinosinusitis

What are the effects of nasal saline treatment in patients with acute rhinosinusitis (ARS) compared with standard treatment without saline?

BOTTOM LINE

Nasal discharge was the only symptom significantly improved by nasal saline treatment in patients with ARS.

COMMENT: I found this article to be particularly interesting, given that we use nasal saline irrigations as a component of treatment for essentially all our sinusitis patients, whether chronic or acute. While this may not necessarily change one’s recommendations and counseling since saline irrigations are safe and well-tolerated, it’s worthwhile to know that the intervention may have limited efficacy in the management of acute bacterial rhinosinusitis. —Ash Khanwalkar, MD

BACKGROUND: Nasal saline treatment washes out mucous secretion and debris from the nose and middle meatus. Although it is widely used in treating ARS, results regarding its effectiveness are inconclusive due to multiple factors that include differences in patient anatomy, infection location, and varying treatment devices, delivery methods, and regimens.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Center of Excellence in Otolaryngology, Head & Neck Surgery, Rajavithi Hospital, Bangkok, Thailand.

SYNOPSIS: Researchers identified 11 eligible studies addressing the add-on effects of nasal saline treatment in a total of 718 patients with ARS. Data were pooled for meta-analysis. Primary outcomes were composite symptom score (CSS), individual symptom score, disease-specific quality-of-life (DS-QoL) score, days to resolution, cure rate, saccharin transit time (STT), endoscopy score, and adverse events. Symptoms and DS-QoL were collected at two time points: three to 10 days and end of the study. Results showed that nasal discharge was the only symptom that improved. Saline as an add-on treatment brought no benefit to CSS and DS-QoL scores. Other outcomes also showed no benefits with saline use. Subgroup analyses showed improvement in patients with viral ARS for CSS and DS-QoL scores, and in patients using high-volume saline. More cases of nasal irritation and burning were reported in the hypertonic saline group, suggesting that isotonic saline should be encouraged for these patients. Overall, authors concluded that saline treatment should be recommended to a selected group of these patients. Study limitations included limited numbers of included studies for each meta-analysis.

CITATION: Chitsuthipakorn W, Kanjanawasee D, Hoang MP, et al. Benefits of nasal saline treatment in acute rhinosinusitis: Systematic review and meta-analysis. Int Forum Allergy Rhinol. 2022;12:1006–1017.