Most of the routine primary care employed in treating the overall symptoms of chronic or recurrent sinus infections (sinusitis) is not always effective. A new systematic lead study revealed that nasal irrigation was more effective in treating the symptoms of chronic or recurrent sinusitis in primary care setting than steam inhalation.
Sinusitis, also known as rhinosinusitis or sinus infection, is an infection or inflammation of the lining of the sinus cavities often followed by signs and symptoms of thick nasal mucus, plugged nose, fever, headache, pain and pressure in the head and face. Depending on the progression, acute rhinosinusitis usually lasts less than 4 weeks while chronic rhinosinusitis lasts for more than 12 weeks. Sinusitis, either chronic or recurrent, affects the quality of life similar to congestive heart disease and chronic pulmonary disease. Usually, most of the antibiotics prescribed for treating sinusitis have modest antibiotic resistance. Most research studies have revealed that steam inhalation was widely advocated in treating symptoms of sinusitis and respiratory tract infections in primary care settings, but had no evidence of benefit and while causing harm by thermal injury. In addition, nasal saline irrigation has been reported to benefit patients in secondary care settings. Therefore, randomized controlled trial study was carried by Moore and his primary care group, at the University of Southampton, United Kingdom to identify the effectiveness of nasal irrigation or steam inhalation in routine primary care for treating the symptoms of chronic or recurrent sinusitis. The key findings of the study were published in the Canadian Medical Association Journal, 2016.
In order to understand the impact of sinusitis symptoms on quality of life, researchers recruited 871 adult participants with a history of chronic or recurrent sinusitis as study subjects from different primary care centers in the United Kingdom between 2009 and 2014. Subjects were randomly assigned to undergo four treatments (usual care, daily nasal saline irrigation, daily steam inhalation, or combined treatment with both interventions) and the treatment outcome was measured by the Rhinosinusitis Disability Index (RSDI) at every 3 and 6 months. Out of the total study subjects, 210 patients received usual care, 219 were with nasal irrigation, 232 with steam inhalation and 210 with combined treatment. It was interesting to notice that 77% of study participants reported having improved RSDI scores at 3 months with nasal irrigation when compared with controls. Moreover, by 6 months there was a significant improvement in the RSDI score with nasal irrigation and fewer patients used over-the-counter medications or intended to consult a doctor in future episodes. However, steam inhalation reduced headaches in the sinusitis patients but had no significant effect on other treatment outcomes.
The present study addressed the effectiveness of using nasal irrigation or steam inhalation for chronic or recurrent sinus symptoms. Nasal irrigation revealed a potential improvement in the primary outcome as well as in several secondary outcomes. However, a similar strategy to use steam inhalation was not effective. The lack of baseline RSDI scores, lack of proper evidence on wear and tear using multiple imputations, bias in general symptom reports and evidence in defining groups of sinusitis, and specific timing of nasal irrigation were some of the limitations associated with the study. Further research on nasal irrigation is needed in order to address the key role it plays in relieving the symptoms of acute sinusitis, and the extent of coaching required.
Written By: Manche Santoshi, PhD