Comparison of nasal douching with isotonic saline versus Ringer lactate in chronic rhinosinusitis: a randomized controlled trial
Keywords:Chronic rhinosinusitis, SNOT 20, Isotonic saline, Ringer lactate
Background: Nasal douching is a best effective and simple treatment procedure for chronic rhinosinusitis. This study compares the efficacy of nasal douching with isotonic saline solution versus ringer lactate solution in patients suffering from chronic rhinosinusitis.
Methods: This randomized control trial was conducted among the patients with chronic rhinosinusitis who were attending the outpatient department of Otorhinolaryngology in Chettinad Hospital and Research Institute, Chennai, during the study period from June 2019 to December 2019. After randomization group A and B includes thirty cases of chronic rhinosinusitis each and they received nasal douching with saline and Ringer lactate two times a day for a period of three weeks and assessed using sino-nasal outcome test (SNOT) 20 during pre-treatment and post treatment. Data was entered in Microsoft excel and data analysis was done using SPSS version 17.
Results: On assessing the overall SNOT 20 mean score, in both group A and group B, there was statistically significant improvement post treatment score when compare to pre-treatment scores. But the differences in improvement between the two groups were not found to be significant.
Conclusions: Though isotonic saline and ringer lactate solution showed significant improvement after treatment both these are same with respect to efficacy in the treatment of douching for chronic rhinosinusitis with no difference in outcome.
Brown CL, Graham SM. Nasal irrigations: Good or bad? Curr Opin Otolaryngol Head Neck Surg. 2004;12:9-13.
Lanza DC, Kennedy DW. Adult rhinusitis defined. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):1-7.
Lund VJ, Holmstrom M, Scadding GK. Functional endoscopic sinus surgery in the management of chronic rhinosinusitis. An objective assessment. J Laryngol Otol. 1991;105:832-5.
Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary of Otorhinolaryngologists. Rhinology. 2012;50:1-12.
Garavello W, Romagnoli M, Sordo L, Gaini RM, Di Berardino C, Angrisano A. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Ped Allergy Immunol. 2003;14:140-3.
Kim CH, Song MH, Young EA, Lee JG, Yoon JH. Effect of hypo-, iso- and hypertonic saline irrigation on secretory mucins and morphology of cultured human nasal epithelial cells. Acta Otolaryngol. 2005;125:1296-300.
Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;110:1189-93.
Kumar J, Padiyar BV, Priya M, Arun K. The Effect of Hypertonic Saline Versus Isotonic Saline Irrigation Following Endoscopic Sinus Surgery- A Comparative Study. Glob J Oto. 2018;(5):555-8.
Harvey RJ, Goddard JC, Wise SK, Schlosser RJ. Effects of endo-scopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg. 2008;(1):137-42.
Talbot AR, Herr TM, Parsons D. Mucociliary clearance and buffered hypertonic saline. Laryngoscope. 1997;(4):500-3.
Report of the Rhinosinusitis Task Force Committee Meeting. Alexandria, Virginia, August 17, 1996. Otolaryngol Head Neck Surg 1997;117(3 Pt 2):1-68.
Piccirillo JF, Merritt MG Jr, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg. 2002;126:41-7.
Harvey RJ, Goddard JC, Wise SK, Schlosser RJ. Effects of endo-scopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg. 2008;139(1):137-42.
Unal M, Seymen HO. Effect of Ringer-Lactate and isotonic saline solutions on mucociliary clearance of tracheal epithelium: an experimental study in rats. J Laryngol Otol. 2002;116(7):536-8.
Keojampa KB, Nguyen MH, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004;131(5):679-82.
Tomooka LT, Murphy C, and Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;110(7):1189-93.
Boek WM, Keles N, Graamans K, Huizing EH. Physiologic and hypertonic saline solutions impair ciliary activity in vitro. Laryngoscope. 1999;109:396-9
Low TH, Woods CM, Ullah S, Carney AS. A double-blind randomized controlled trial of normal saline, lactated Ringer's and hypertonic saline nasal irrigation solution after endoscopic sinus surgery. Am J Rhinol Allergy. 2014;28(3):225-31.
Homer JJ, Dowley AC, Condon L, El-Jassar P, Sood S. The effect of hypertonicity on nasal mucociliary clearance. Clin Otolaryngol Allied Sci. 2000;25(6):558-60.
Shone GR, Yardley MP, Knight LC. Mucociliary function in the early weeks after nasal surgery. Rhinology. 1990;28(4):265-8.
Friedman M, Hamilton C, Samuelson CG, Maley A, Wilson MN, Venkatesan TK, et al. Dead Sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis: a randomized, prospective double‐blind study. Int Forum Allergy Rhinol. 2012;2(3):252-7.
Tripathy SM, Panda R. Comparative study of hypertonic saline nasal douching versus normal saline nasal douching in post operative endoscopic sinus surgery patients. Int J Otorhinolaryngol Head Neck Surg. 2019;5(3):598-602.
Kurtaran H, Ugur KS, Yilmaz CS, Kaya M, Yuksel A, Ark N, et al. The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study. Braz J Otorhinolaryngol. 2018;84(2):185-90.