Advising patients with chronic sinus congestion to use nasal irrigation, a popular non- pharmacologic treatment, improved their symptoms, but steam inhalation did not. It can also cause burns. More than 25 million people in the United States and about 2.5 million Canadians suffer from chronic rhinosinusitis, or sinus infection.
During sinusitis, the small air-filled cavities behind the cheekbones and forehead become inflammed and blocked. This leads to nasal congestion, difficulty in breathing, headaches and a compromised quality of life. To alleviate symptoms, steam inhalation and nasal irrigation are widely suggested as an alternative to common treatment with antibiotics, which are often not effective and contribute to antibiotic resistance. Nasal irrigation which uses salt water solution to clean the nasal cavity and flush out mucus, did help relieve symptoms.
‘The practice of deep breathing over a bowl of boiling water has little or no effect on sinus patients. It can also cause burns. On the other hand, nasal irrigation was found to be more effective.’
The research team led by Paul Little, professor of primary care research at the University of Southampton, conducted a randomized controlled trial involving 871 patients from 72 primary care practices in England who were randomly assigned alternative treatments including usual care, daily nasal and saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions.
The study published in the Canadian Medical Association Journal
reported that patients who were instructed to use nasal irrigation showed improvement at three and six months as measured by the Rhinosinusitis Disability Index. Steam inhalation did not appear to alleviate sinusitis symptoms apart from reducing headaches.
Professor Paul Little said, "The threat of global antibiotics resistance is very real and we need to find alternative ways of educating and treating people who do not need to have antibiotics. We have found that even a very brief intervention of a video showing patients how to use saline nasal irrigation can improve symptoms, help people feel they do not need to see the doctor to manage the problem and reduce the amount of over the counter medication they get." It reduced headaches, decreased use of over the counter medication and reduced medicalisation, the belief in the need to see the doctor in future episodes. "The evidence of reduced medicalisation is important in the longer term given most consultations result in an antibiotic prescription and the attendant dangers of antibiotic resistance," the Professor added.
Since the impact was less than in previous studies that had used more intensive coaching about nasal irrigation, the authors suggest that further research is needed to understand how much coaching of patients is required.