Nasal saline irrigation, but not steam inhalation, modestly effective for chronic sinusitis, study finds
Compared to those who did not use nasal irrigation, those who did were more likely at 6 months to report that they would not visit a doctor for subsequent sinus symptoms, less likely to report headache at 3 months, and less likely to use over-the-counter medications.
Advising patients with chronic sinusitis to use nasal irrigation modestly improved symptoms, but advice to use steam inhalation was ineffective, according to a recent study.
British researchers conducted a randomized controlled trial of the interventions in routine primary care, examining improvement in the primary outcome, the Rhinosinusitis Disability Index (RSDI), at 3 and 6 months. Results were published online on July 18 by CMAJ.
A total of 871 participants, ages 18 to 65 years, provided baseline data and were randomly assigned to receive usual care (n=210), nasal irrigation (n=232), steam inhalation (n=219), or combined treatment (n=210). The number of patients who completed the RSDI was 671 at 3 months and 623 at 6 months. All study participants had access to usual care, which could include medications or referral at the discretion of their physicians.
RSDI scores improved more with nasal irrigation than with no nasal irrigation (crude change in score at 3 months, −7.42 vs. −5.23). Researchers estimated an adjusted mean difference between groups of −2.51 (95% CI, −4.65 to −0.37) at 3 months and −2.41 (95% CI, −4.66 to −0.16) at 6 months. At 6 months, more patients maintained a clinically important 10-point improvement in the score with nasal irrigation than without it (44.1% vs. 36.6%), and steam inhalation had no effect. The number needed to treat was about 13.
Compared to those who did not use nasal irrigation, those who did were more likely at 6 months to report that they would not visit a doctor for subsequent sinus symptoms (mean difference in score on 7-point Likert scale, 0.30; 95% CI, 0.08 to 0.53), less likely to report headache at 3 months (72.0% vs. 81.7%; P=0.004), and less likely to use over-the-counter medications (60% vs. 67.4%; P=0.051). There were no effects of steam inhalation except a reduction in headache, which was more pronounced at 3 months than 6 months.
The researchers noted limitations, such as how nearly 10% of patients who consented to the study did not provide a baseline RSDI score and how slightly less than 80% follow-up was achieved. They also noted that the primary outcome was self-reported and that the study population had varying durations of prior illness.