Clinical Question: Does daily nasal irrigation with hypertonic saline improve symptoms in patients with frequent sinus infections?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Sinus infections often are recurrent and can be difficult to treat. The Yogic tradition advocates daily rinsing of the nasal passage with a hypertonic saline solution as a way to clean things out. Previous studies, although showing promising results, have been small and poorly designed. In this clinical trial, the authors identified primary care patients with two episodes of acute sinusitis or one episode of chronic sinusitis per year for two consecutive years. The mean age of participants was 42 years, 74 percent were women, only 5 percent were smokers, and most had recurrent episodes of acute sinusitis rather than chronic sinusitis.

Patients were randomized to usual care (n = 24) or to an experimental group (n = 52) that received instruction in using the SinuCleanse nasal cup with 2 percent saline buffered with baking soda. Patients completed a diary to record daily adherence to the nasal irrigation protocol, filled out a symptom survey every two weeks, and completed a more extensive set of outcome measures at six weeks, three months, and six months. Groups were similar at baseline. Although not blinded, allocation to groups was concealed appropriately, randomization was valid, and analysis was by intention to treat.

At six months, there was a clinically and statistically greater improvement in the Rhinosinusitis Disability Index and the Single Item Symptom Severity Assessment for patients using nasal irrigation. Significant improvements were evident in sinus headache, frontal pain, frontal pressure, and nasal congestion, while use of antibiotics and nasal spray was reduced. Although 10 subjects reported side effects (e.g., nasal irritation, nasal burning, nosebleeds), all 44 patients who completed the final questions about satisfaction said they would continue to use nasal irrigation.

Bottom Line: Nasal irrigation is an inexpensive, easy, and effective treatment for a condition considered intractable by many. Daily nasal irrigation using 2 percent saline is a highly effective treatment for patients with frequent sinusitis. (Level of Evidence: 1b–)