Nasal Irrigation Is Effective for Sinusitis & Nasal Allergies

 
Nasal Irrigation Is Effective for Sinusitis & Nasal Allergies
 
By Lilly Zhang, Ph.D.
Upper respiratory disease (including sinusitis, flu and colds, environmental asthma and related conditions) has become America's first environmental epidemic, with nearly one-third of Americans suffer from chronic allergic sinusitis, rhinosinusitis, asthma or bronchitis, the most common chronic disease in the United States. Those conditions account for millions of physician visits yearly, accounting for billions in health care costs. Nasal and sinus complaints are the most common causes for people to consult physicians. Traditional treatments for sinusitis include the use of medications and endoscopic surgery, the latter recommended when the sinus passages are permanently blocked. Most medical treatments like decongestants, nasal sprays and pain relievers only treat the symptoms. In contrast, theSinuPro Nasal Care System attacks the triggering problems by removing the cause of the symptoms. Nasal irrigation was recommended for the treatment of nasal diseases at the American Academy of Family Physicians' Scientific Assembly in 2004. The physicians in the ENT area highly recommend nasal irrigation to patients with nasal problems. Below are some of the published clinical reports which strongly support our clinical observations (see separate reports). 
Dr. Mark Ebell:  Saline Nasal Irrigation for Frequent Sinusitis. American Family Physician Vol. 70(4), Aug. 2004 Study Design: Randomized controlled trial. 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. Bottom Line: Nasal irrigation is an inexpensive, easy, and effective treatment for a condition considered intractable by many. Daily nasal irrigation is a highly effective treatment for patients with frequent sinusitis.
 
Dr. Michel O. Nasal irrigation in case of rhinosinusitis. Laryngorhinootologie. 2006 Jun; 85(6):448-58 (German). Nasal irrigation has proven in several recently published articles its clinical effectiveness and its neglectable rate of side effects even in children and during pregnancy. In most guidelines for the treatment of various nasal pathological conditions nasal irrigation is recommended as stand alone or as additional therapy. Although no common treatment protocol exists, a isotonic (0.9 %) or slightly hypertonic solution (3 - 5 %) is suggested because of its positive influence upon mucociliary clearance. Buffered solutions bring a more pleasant feeling during rinsing, which explains also the beneficial effect of natural brine solutions. In children, nasal irrigation can save antibiotics and reduce decongestant to nil. Important is the hygienic application in order not to introduce additional pathogenic germs into the nasal system.
 
Drs Friedman M, Vidyasagar R, Joseph N.A Randomized, Prospective, Double-Blind Study on the Efficacy of Dead Sea Salt Nasal Irrigations. Laryngoscope. 2006 May 16 (Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, and the Division of Otolaryngology, Advocate Illinois Masonic Medical Center, Chicago) OBJECTIVE:: The objective of this randomized, prospective, double-blind study was to compare nasal irrigation using hypertonic Dead Sea salt (DSS) solution with hypertonic saline in the treatment of chronic rhinosinusitis and improvement of quality of life (QOL). METHODS:: With Institutional Review Board approval, 42 adults seeking treatment for chronic rhinosinusitis in a tertiary university-affiliated medical center were studied. After history and endonasal examination, computed tomography imaging, and QOL survey (Standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)]), patients were randomized to self-administered hypertonic saline spray and irrigation twice daily or hypertonic DSS spray and irrigation. Patients were reassessed weekly and at 1 month. RESULTS:: Both groups had similar symptoms and RQLQ(S) scores before treatment and had significant improvement after treatment. However, the DSS patients had significantly better symptom relief and only the DSS group showed improved RQLQ(S) scores. CONCLUSIONS:: We present a short-term study providing level I evidence on the superiority of DSS over saline nasal irrigation for treatment of chronic rhinosinusitis.
 
Drs. Garavello W et al (University Milano-Bicocca, Monza, Italy): Nasal rinsing with hypertonic solution: an adjunctive treatment for pediatric seasonal allergic rhinoconjunctivitis. Int Arch Allergy Immunol, 137(4):310-314, 2005 Background: The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis. Methods: Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited. Twenty-two patients were randomized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season, which lasted 7 weeks. Results: The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period. This difference was statistically significant in week 6 and 7 of therapy. A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing, being statistically significant in 5 of the 7 weeks. No adverse effect was reported in the active group. Conclusions: This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis. This treatment proved to be tolerable, inexpensive and effective. 
 
Drs. Rabago D et al (University of Wisconsin Medical School): The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck Surg. 133(1):3-8, 2005. OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 +/- 2.6 points to 80.6 +/- 2.4 points (P < 0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 +/- 3.9 points to 79.7 +/- 3.7 points (P < 0.05), SNOT-20 scores improved from 43.5 +/- 5.7 points to 28.4 +/- 4.8 points, and SIA scores improved from 4.2 +/- 0.3 points to 2.6 +/- 0.3 points (P < 0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms.
 
Drs. David Rabago et al (University of Wisconsin, Department of Family Medicine): Nasal Irrigation to Treat Acute Bacterial Rhinosinusitis. American Family Physician 72:9, 2005  Although up to 98 percent of physicians prescribe antibiotics for patients with rhinosinusitis, most cases are viral or allergic rather than bacterial, and that most patients really want recommendations for symptom relief. Nasal irrigation is an adjunctive therapy for rhinosinusitis and is noted to be "possibly effective" for the relief of sinus symptoms. Nasal irrigation has been associated with decreased sinus symptom severity and recently was identified as "an important component in the management of most sinonasal conditions" that is "effective and underutilized." Nasal irrigation is an inexpensive, patient-controlled therapy that flushes the nasal cavity with saline solution, facilitating a wash of the structures within. Benefits from nasal irrigation may accrue from removal of nasal discharge and crusts, mucus thinning, and enhanced mucociliary clearance of nasal secretions. Nasal irrigation also may decrease mucosal inflammation osmotically. Randomized controlled trials (RCTs) have assessed hypertonic saline nasal irrigation for several sinus-related conditions, including acute sinusitis (three studies), chronic sinus symptoms (two studies), and chronic sinusitis (three studies). Each reported improvement in sinus symptoms and on surrogate measures such as quality-of-life scales. None reported significant adverse events. Our group recently reviewed the literature and assessed nasal irrigation for recurrent and chronic sinus symptoms in a RCT.4 We found significant improvement in quality-of-life scores and sinus symptoms, and decreased antibiotic and nasal spray use. Side effects were few, and patient satisfaction was high; reported adherence to daily nasal irrigation was 87 percent. Patients continued to note symptomatic improvement over 18 months. In a qualitative study,6 subjects reported that their use of nasal irrigation, especially at the onset of sinus symptoms, accounted for decreased medication use and physician visits, and may have prevented future episodes of rhinosinusitis.
 
Drs. Papsin B, McTavish A.: Saline nasal irrigation: Its role as an adjunct treatment. Canadan Family Physician. 49: 168-73, 2003 This article “reviewed clinical evidence on the efficacy of saline nasal irrigation for treatment of sinonasal conditions and to explore its potential benefits. Clinical trials, reviews, and treatment guidelines discussing nasal irrigation were obtained through a MEDLINE search from January 1980 to December 2001. Main Messages: Flushing the nasal cavity with saline solution promotes mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material. The procedure has been used safely for both adults and children, and has no documented serious adverse effects. Patients treated with nasal irrigation rely less on other medications and make fewer visits to physicians. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity. CONCLUSION: Nasal irrigation is a simple, inexpensive treatment that relieves the symptoms of a variety of sinus and nasal conditions, reduces use of medical resources, and could help minimize antibiotic resistance”.
 
Drs. Zeiger RS, Schatz M: Chronic Rhinitis: A Practical Approach to Diagnosis and Treatment. Immunology & Allergy Practice. 4, 4:26-35. "Nasal tissue appears to benefit greatly from warm irrigation with saline. Saline irrigation augments mucociliary flow, liquifies tenacious mucus, soothes irritated tissue, augments repair processes, reduces forceful nose blowing, and improves olfaction. Its use should be considered for all patients with chronic rhinitis; benefit appears maximal for rhinitis medicamentosa, atrophic rhinitis, nasopharyngitis, and sinusitis. Emphasis on avoidance of allergens and non-specific precipitants and the use of intranasal saline is the initial approach to pregnant women with rhinitis."
 
Drs. Brown CL; Graham SM: Nasal irrigations: good or bad? Curr Opin Otolaryngol Head Neck Surg, 12(1):9-13, 2004   PURPOSE OF REVIEW Nasal irrigations are often mentioned as adjunctive measures in treating many sinonasal conditions. Despite their widespread use, much mystique and uncertainty exist about the indications and therapeutic mechanisms of nasal irrigations. RECENT FINDINGS Studies of nasal irrigations continue to report the benefits in managing sinonasal complaints. Apart from improved patient symptomatology, prescription medication use is often decreased. When nasal irrigations are combined with other medical modalities, patients with chronic sinusitis may not require surgical intervention as often. In particular, patients using hypertonic saline nasal irrigations reported better outcomes. Different devices and techniques exist. Positive-pressure methods are more effective than nebulizers. Furthermore, the popular belief that nasal irrigations need to be sterile is in question. SUMMARY: Nasal irrigations should no longer be considered merely adjunctive measures in managing sinonasal conditions. They are effective and underutilized”.
Drs. Tomooka LT, Murphy C, Davidson TM. (School of Medicine, University of California San Diego): Clinical study and literature review of nasal irrigation, Laryngoscope, 110(7):1189-1193, 2000. “Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study DESIGN: A prospective controlled clinical study. METHODS: Two hundred eleven patients with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. RESULTS: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Patients had excellent relief by daily irrigation for sinusitis, perennial allergy, seasonal allergy, postnasal drip, and associated fatigue. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. Daily nasal irrigation is well accepted by the patients. CONCLUSIONS: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease”.         
Drs. Heatley DG, McConnell KE, Kille TL, Leverson GE.: Nasal irrigation for the alleviation of sinonasal symptoms, Otolaryngol Head Neck Surg. 125(1):44-48, 2001. “OBJECTIVE: To determine the effect of nasal irrigation on sinonasal symptoms. STUDY DESIGN: A total of 150 adult subjects with chronic sinusitis symptoms were recruited from the community and assigned to 1 of 3 treatment groups: nasal irrigation with bulb syringe, nasal irrigation with nasal irrigation pot, or control treatment with reflexology massage. Groups 1 and 2 performed daily hypertonic saline irrigation with 1 device for 2 weeks and then with the other device for 2 weeks. Group 3 performed reflexology massage daily for 2 weeks. Prospective data collected included pretreatment Medical Outcomes Study Short Form, pretreatment and posttreatment Rhinosinusitis Outcomes Measure, daily medication use, subjective treatment efficacy, and preference of irrigation method. RESULTS: There was a significant and equivalent improvement in Rhinosinusitis Outcomes Measure 31 score after 2 weeks of intervention in each treatment group; 35% of subjects reported decreased use of sinus medication. CONCLUSION:Daily nasal irrigation was efficacious and resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects. Medication usage was decreased in approximately one third of participants regardless of intervention”.
Drs. Tano L, Tano K. A daily nasal spray with saline prevents symptoms of rhinitis. Acta Otolaryngol. 2004 Nov;124(9):1059-1062. OBJECTIVE: To ascertain whether a daily nasal spray with physiological saline could prevent symptoms of common cold in a population of otherwise healthy adults. RESULTS: A total of 69 subjects completed the 20-week diary period. For 60 of them, compliance during the spray period exceeded 60% and their data were used in the statistical calculations. During the spray period the number of days with nasal secretion and/or blocked nose (mean 6.4 days) was significantly (p=0.027) lower than that during the observation period (mean 11 days). Furthermore, the participants had a mean of 0.7 episodes of upper respiratory tract infection during the spray period, compared with 1.0 episodes during the observation period (p=0.05). CONCLUSION: A daily nasal irrigtion with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults”.
Drs. Berger ME, Jones OW, Ricks RC, Garrett S.: Decontaminating the nasal passages, Health Phys. 84(5 Suppl): S80-82, 2003. “Nasal irrigation (wash, rinse, douche, lavage) is an established technique used for other conditions and can be applied in decontamination of nasal passages. This paper discusses the rationale and use of nasal irrigation and how to perform the technique”.
 
Drs. Garavello W, et al, Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol. 14(2): 140-143, 2003.  Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. This randomized clinical trial demonstrated that daily nasal irrigation with hypertonic saline in children prevents seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective”.
Drs. Rabago D, Bachmann G, Hommel G, Michel O (Cologne University, Germany): Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease, Eur Arch Otorhinolaryngol. 257(10): 537-41, 2000. Their randomized, controlled, double-blind clinical trial showed that endonasal irrigations with salt solutions are effective in the treatment of chronic sinusitis.
Drs. Rabago D. et al (University of Wisconsin). Efficacy of daily saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Family Practice, 51(12): 1049-55, 2002.  Their randomized controlled clinical trial demonstrated that “daily saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis. Primary care physicians can feel comfortable recommending this therapy”.
Drs. Desrosiers et al, Nasal rinse reduces chronic rhinitis symptoms, Respiratory Reviews, Vol. 7, No 2, 2002. In a randomized, single-blinded, prospective trial, patients were given twice-a-day saline therapy for eight weeks through a nasal wash system or with a nasal spray device. A four-week observation period followed. Results were that both techniques provided greater relief from such symptoms as nasal congestion, pain, and postnasal drip than did previous treatments. Furthermore, the moderate improvement persisted through the end of the four-week observation period. However, the researchers noted that results obtained through lavage were superior to those produced with a nasal spray, leading them to conclude that nasal lavage could be a viable treatment for patients with chronic rhinitis”.
Drs. Shoseyov D, et al.: Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis, J Allergy Clinical  Immunol. 101(5): 602-605, 1998. Chronic sinusitis is a common disease in children, especially those with allergies, that is caused by impaired drainage from the sinuses. Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency. Their randomized double blind study showed that daily nasal wash with saline is an efficient treatment of chronic sinusitis.
Drs. Michael Kaliner and David W Kenned: Management of Sinusitis: Current Clinical Strategies. Sinusitis Disease Management Guide. PDR 2000.  If the patient has recurrent disease he may buy a nasal irrigator, particularly effective after surgery (page 121).  Treatment of Chronic Sinusitis - Nasal washing twice a day is recommended (page 122).
Drs. Keerl R, Weber R, Muller C, Schick B: Effectiveness and tolerance of nasal irrigation followingparanasal sinus surgery, Laryngorhinootologie. 76(3): 137-41, 1997. Effectiveness and acceptance of the cleaning of the nose with saline solution after endonasal sinus surgery was clinically evaluated. It was found that “rinsing of the nose after endonasal sinus surgery is judged positively by most of the patients and is integrated well in the daily routine. Although it is most common to sniff saline solution out of the hand, existing research recommends usage of warm saline in combination with the nasal douche”.
Drs. Robert Ivker: The Complete Self-Care Guide to Holistic Medicine, 1999 (Book). It was concluded that “nasal irrigation is extremely helpful for flushing infected sinuses or cleansing the membranes of the nose and sinuses”.
Dr. Georgitis JW: Nasal Hyperthermia and Simple Irrigation for Perennial Rhinitis. Chest 106,5:1487-1491, 1994. "Conclusions: This study demonstrated the usefulness of large particle vapor treatment and saline solution irrigation in reducing inflammatory mediators in nasal secretions and indirectly supports the clinical efficacy of these treatments for chronic rhinitis."
Drs. Mabry, R.L.: Therapeutic Agents In The Medical Management Of Sinusitis.  Inflammatory diseases of the sinuses. Otolaryngologic Clinics Of North America, Volume 26, Number 4, pp 561, 1993. “Not only is the nasal irrigator beneficial for patients with bothersome thick postnasal secretions, but also is especially helpful for postoperative cleansing following nasal surgery”.
Dr. Grossan M: Irrigation of the Child’s Nose. Clinical Pediatrics 13,3:229-231, 1974. "Treatment by nasal irrigation is indicated for chronic purulent sinusitis, chronic adenoid infection, dacryocystorhinitis secondary to nasal infection, and chronic rhinitis. Often stubborn otitis media or serous otitis will not improve until after the nasal pus is removed."
Drs. Rachelevsky G S, Slavin R G et al.: Sinusitis: Acute, Chronic and Manageable, Patient Care. 131:4, 1997. “A particularly helpful strategy for acute and chronic sinusitis is saline washing using a nasal irrigator. It is so effective in clearing the blocked passages that, if it is done regularly, some patients with persistent or chronic sinusitis need no drug treatment at all”.
 
Nasal Irrigation Methods:
There are different techniques to do this: flushing each nostril by using high capacity syringes, purchasing a special cup (neti pot) or simply rinsing by hand. However, these traditional methods have several limitations: 
·  Not easy to perform: they require experience for a correct performance and are uncomfortable to do.
·  Not effective: insufficient irrigation.
·  Risk to spread infection to the middle ear: because of the head position and the uncontrolled pressure.
The most convenient way to perform effective and safe nasal irrigation is using NasalCare Nasal Rinse Kit. This system allows easy irrigation of both nose and sinuses with a sufficient volume (240 mL) in a few minutes. In addition, the unit produces continue flow that greatly increases the mechanical effect of these washes.
 
The current available irrigation devices are presented in the following table for comparison with our newly invented NasalCare™ Nasal Rinse Starter Kit.  t makes NasalCare™ unique?
NasalCare™ is patent-protected, clinically proven, and FDA approved medical device. It consists a nasal irrigator and 30 packets of nasal rinse mix.
 
The Patented, Unique Nasal Irrigator:
The irrigator is composed of a bottle with a cap that links to a suction tube, a pair of one-way air and liquid valves, a one-size-fit-all nostril fitting, and a dust-preventive cover. The smart design of the device lets you keep your head upright during washing. The one-way liquid valve permits the fluid to flow only from the suction tube into the nostril but not back to the bottle, preventing contamination of the solution and bottle. The one-way air valve allows air to flow into the bottle to prevent negative pressure in the bottle which allows continue nasal irrigation. The flow speed of the liquid is easily controlled by the user’s hand. All those futures together create continual solution flow along the nasal floor and cleanse nasal and sinus passages more effectively, user-friendly, comfortable, and simpler than using neti pots or other nasal rinse products. More over it opens up congested sinuses by drawing out mucus and debris.
 
The Patented, Unique Nasal Rinse Mix

This patented nasal rinse mix is much better than regular saline. It is scientifically formulated with special sea salt, sodium citrate, sodium bicarbonate and aloe vera extract. Each packet makes one bottle of washing solution (8 oz). This unique solution not only ensures maximum comfort during the washing process but also provides a very pleasant, soothing, moistening, and fresh sensation. It does not cause any stinging or burning like most of other products do. The system makes the nasal irrigation simple, easy, neat, comfortable, and relaxing.

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