Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

Do-Yang Park, Ji Ho Choi, Dong-Kyu Kim, Yong Gi Jung, Sue Jean Mun, Hyun Jin Min, Soo Kyoung Park, Jae-Min Shin, Hyung Chae Yang, Seung-No Hong, Ji-Hun Mo, Do-Yang Park, Ji Ho Choi, Dong-Kyu Kim, Yong Gi Jung, Sue Jean Mun, Hyun Jin Min, Soo Kyoung Park, Jae-Min Shin, Hyung Chae Yang, Seung-No Hong, Ji-Hun Mo

Abstract

The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.

Keywords: Equipment; Guideline; Irrigation; Saline Solution; Sinusitis; Steroids; Treatment.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Mechanism and sequence of irrigation of the nasal cavity and nose. (A) The diagram showing the location and relationship of each sinus and nasal cavity. (B-H) The irrigation fluid first hits the nasopharynx and then indirectly enters the sinus. According to cadaveric and threedimensional modeling studies, the fluid first passes through the ethmoid and nasopharynx, then the ipsilateral maxillary and sphenoid sinuses, followed by the frontal sinus and then the opposite side of the maxillary sinus.
Fig. 2.
Fig. 2.
Posture for nasal irrigation. Two head positions: (A) head down-and-forward position and (B) nose-to-ceiling position.

References

    1. Kim do H, Han K, Kim SW. Effect of chronic rhinosinusitis with or without nasal polyp on quality of life in South Korea: 5th Korea National Health and Nutrition Examination Survey Korean. Clin Exp Otorhinolaryngol. 2016 Jun;9(2):150–6.
    1. Venkatraman G, Likosky DS, Zhou W, Finlayson SR, Goodman DC. Trends in endoscopic sinus surgery rates in the Medicare population. Arch Otolaryngol Head Neck Surg. 2010 May;136(5):426–30.
    1. Ference EH, Suh JD, Tan BK, Smith SS. How often is sinus surgery performed for chronic rhinosinusitis with versus without nasal polyps. Am J Rhinol Allergy. 2018 Jan;32(1):34–9.
    1. Chapurin N, Pynnonen MA, Roberts R, Schulz K, Shin JJ, Witsell DL, et al. CHEER national study of chronic rhinosinusitis practice patterns: disease comorbidities and factors associated with surgery. Otolaryngol Head Neck Surg. 2017 Apr;156(4):751–6.
    1. Mahboubi H, Bhandarkar ND. Trends of ambulatory sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015 Apr;5(4):318–25.
    1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1–S39.
    1. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb;58(Suppl S29):1–464.
    1. Craig JR, Zhao K, Doan N, Khalili S, Lee JY, Adappa ND, et al. Cadaveric validation study of computational fluid dynamics model of sinus irrigations before and after sinus surgery. Int Forum Allergy Rhinol. 2016 Apr;6(4):423–8.
    1. Govindaraju R, Cherian L, Macias-Valle L, Murphy J, Gouzos M, Vreugde S, et al. Extent of maxillary sinus surgery and its effect on instrument access, irrigation penetration, and disease clearance. Int Forum Allergy Rhinol. 2019 Oct;9(10):1097–104.
    1. Grayson JW, Cavada M, Wong E, Lien B, Duvnjak M, Campbell R, et al. Effects of sphenoid surgery on nasal irrigation delivery. Int Forum Allergy Rhinol. 2019 Sep;9(9):971–6.
    1. Inthavong K, Shang Y, Wong E, Singh N. Characterization of nasal irrigation flow from a squeeze bottle using computational fluid dynamics. Int Forum Allergy Rhinol. 2020 Jan;10(1):29–40.
    1. Zhao K, Craig JR, Cohen NA, Adappa ND, Khalili S, Palmer JN. Sinus irrigations before and after surgery: visualization through computational fluid dynamics simulations. Laryngoscope. 2016 Mar;126(3):E90–6.
    1. Principi N, Esposito S. Nasal irrigation: an imprecisely defined medical procedure. Int J Environ Res Public Health. 2017 May;14(5):516.
    1. Sanan A, Rabinowitz M, Rosen M, Nyquist G. Topical therapies for refractory chronic rhinosinusitis. Otolaryngol Clin North Am. 2017 Feb;50(1):129–41.
    1. Patel ZM, Thamboo A, Rudmik L, Nayak JV, Smith TL, Hwang PH. Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol. 2017 Feb;7(2):119–27.
    1. Adappa ND, Wei CC, Palmer JN. Nasal irrigation with or without drugs: the evidence. Curr Opin Otolaryngol Head Neck Surg. 2012 Feb;20(1):53–7.
    1. Shi JB, Fu QL, Zhang H, Cheng L, Zhu DD, et al. Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy. 2015 May;70(5):533–9.
    1. Hirsch AG, Stewart WF, Sundaresan AS, Young AJ, Kennedy TL, Scott Greene J, et al. Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample. Allergy. 2017 Feb;72(2):274–81.
    1. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat 10. 2014 Feb;(260):1–161.
    1. Ahn JC, Kim JW, Lee CH, Rhee CS. Prevalence and risk factors of chronic rhinosinusitus, allergic rhinitis, and nasal septal deviation: results of the Korean National Health and Nutrition Survey 2008-2012. JAMA Otolaryngol Head Neck Surg. 2016 Feb;142(2):162–7.
    1. Hirsch AG, Nordberg C, Bandeen-Roche K, Tan BK, Schleimer RP, Kern RC, et al. Radiologic sinus inflammation and symptoms of chronic rhinosinusitis in a population-based sample. Allergy. 2020 Apr;75(4):911–20.
    1. Tomassen P, Newson RB, Hoffmans R, Lotvall J, Cardell LO, Gunnbjornsdottir M, et al. Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis: a GA² LEN study. Allergy. 2011 Apr;66(4):556–61.
    1. Dietz de Loos D, Lourijsen ES, Wildeman MA, Freling NJ, Wolvers MD, Reitsma S, et al. Prevalence of chronic rhinosinusitis in the general population based on sinus radiology and symptomatology. J Allergy Clin Immunol. 2019 Mar;143(3):1207–14.
    1. Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 2004 May;193:3–5.
    1. Ray NF, Baraniuk JN, Thamer M, Rinehart CS, Gergen PJ, Kaliner M, et al. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. 1999 Mar;103(3 Pt 1):408–14.
    1. Wahid NW, Smith R, Clark A, Salam M, Philpott CM. The socioeconomic cost of chronic rhinosinusitis study. Rhinology. 2020 Apr;58(2):112–25.
    1. Lourijsen ES, Fokkens WJ, Reitsma S. Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps. Rhinology. 2020 Jun;58(3):213–7.
    1. Bhattacharyya N. Assessing the additional disease burden of polyps in chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2009 Mar;118(3):185–9.
    1. Blackwell DL, Collins JG, Coles R. Summary health statistics for U.S. adults: National Health Interview Survey, 1997. Vital Health Stat 10. 2002 May;(205):1–109.
    1. Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the “top 10” physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med. 2003 Jan;45(1):5–14.
    1. Rudmik L. Economics of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2017 Apr;17(4):20.
    1. Rudmik L, Smith TL, Schlosser RJ, Hwang PH, Mace JC, Soler ZM. Productivity costs in patients with refractory chronic rhinosinusitis. Laryngoscope. 2014 Sep;124(9):2007–12.
    1. Remenschneider AK, Scangas G, Meier JC, Gray ST, Holbrook EH, Gliklich RE, et al. EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope. 2015 May;125(5):1056–61.
    1. Stjarne P, Odeback P, Stallberg B, Lundberg J, Olsson P. High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in Swedish primary care. Prim Care Respir J. 2012 Jun;21(2):174–9.
    1. Teul I, Baran S, Czerwinski F, Lorkowski J. Quality of life of patients with diseases of sinuses. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):691–7.
    1. Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995 Jul;113(1):104–9.
    1. Garbutt J, Spitznagel E, Piccirillo J. Use of the modified SNOT-16 in primary care patients with clinically diagnosed acute rhinosinusitis. Arch Otolaryngol Head Neck Surg. 2011 Aug;137(8):792–7.
    1. Hopkins C, Browne JP, Slack R, Lund V, Topham J, Reeves B, et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otolaryngol. 2006 Oct;31(5):390–8.
    1. Rudmik L, Mace J, Soler ZM, Smith TL. Long-term utility outcomes in patients undergoing endoscopic sinus surgery. Laryngoscope. 2014 Jan;124(1):19–23.
    1. Chester AC, Sindwani R, Smith TL, Bhattacharyya N. Fatigue improvement following endoscopic sinus surgery: a systematic review and meta-analysis. Laryngoscope. 2008 Apr;118(4):730–9.
    1. Chester AC, Sindwani R, Smith TL, Bhattacharyya N. Systematic review of change in bodily pain after sinus surgery. Otolaryngol Head Neck Surg. 2008 Dec;139(6):759–65.
    1. Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope. 2011 Dec;121(12):2672–8.
    1. Rosenfeld RM, Shiffman RN, Robertson P, Department of Otolaryngology State University of New York Downstate Clinical Practice Guideline Development Manual, Third Edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg. 2013 Jan;148(1 Suppl):S1–55.
    1. American Academy of Pediatrics Steering Committee on Quality Improvement Classifying recommendations for clinical practice guidelines. Pediatrics. 2004 Sep;114(3):874–7.
    1. Chong LY, Head K, Hopkins C, Philpott C, Glew S, Scadding G, et al. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016 Apr;4(4):CD011995.
    1. Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021 Mar;11(3):213–739.
    1. Orlandi RR, Kingdom TT, Hwang PH. International Consensus Statement on Allergy and Rhinology: rhinosinusitis executive summary. Int Forum Allergy Rhinol. 2016 Feb;6 Suppl 1:S3–21.
    1. Baraniuk JN, Ali M, Yuta A, Fang SY, Naranch K. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am J Respir Crit Care Med. 1999 Aug;160(2):655–62.
    1. Giotakis AI, Karow EM, Scheithauer MO, Weber R, Riechelmann H. Saline irrigations following sinus surgery: a controlled, single blinded, randomized trial. Rhinology. 2016 Dec;54(4):302–10.
    1. Freeman SR, Sivayoham ES, Jepson K, de Carpentier J. A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Clin Otolaryngol. 2008 Oct;33(5):462–5.
    1. Wang J, Shen L, Huang ZQ, Luo Q, Li MY, Tu JH, et al. Efficacy of buffered hypertonic seawater in different phenotypes of chronic rhinosinusitis with nasal polyps after endoscopic sinus surgery: a randomized double-blind study. Am J Otolaryngol. 2020;41(5):102554.
    1. Pinto JM, Elwany S, Baroody FM, Naclerio RM. Effects of saline sprays on symptoms after endoscopic sinus surgery. Am J Rhinol. 2006 Mar-Apr;20(2):191–6.
    1. Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg. 2007 Nov;137(5):815–21.
    1. Nikakhlagh S, Abshirini H, Lotfi M, Mohammad S, Mohammadi NS. A comparison between the effects of nasal lavage with hypertonic, isotonic and hypotonic saline solutions for the treatment of chronic sinusitis. J Glob Pharma Technol. 2016 Jan;8(12):68–73.
    1. Ural A, Oktemer TK, Kizil Y, Ileri F, Uslu S. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol. 2009 May;123(5):517–21.
    1. Berjis N, Sonbolastan SM, Okhovat SH, Narimani AA, Razmjui J. Normal saline versus hypertonic 3% saline: it’s efficacy in nonacute rhinosinusitis. Iran J Otorhinolaryngol. 2011 Winter;23(1):23–8.
    1. Culig J, Leppee M, Vceva A, Djanic D. Efficiency of hypertonic and isotonic seawater solutions in chronic rhinosinusitis. Med Glas (Zenica) 2010 Aug;7(2):116–23.
    1. Liu L, Pan M, Li Y, Tan G, Yang Y. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020 Sep-Oct;86(5):639–46.
    1. Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, Snidvongs K. Hypertonic saline versus isotonic saline nasal irrigation: systematic review and meta-analysis. Am J Rhinol Allergy. 2018 Jul;32(4):269–79.
    1. 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 May-Jun;28(3):225–31.
    1. Green A, Smallman LA, Logan AC, Drake-Lee AB. The effect of temperature on nasal ciliary beat frequency. Clin Otolaryngol Allied Sci. 1995 Apr;20(2):178–80.
    1. Mwimbi XK, Muimo R, Green MW, Mehta A. Making human nasal cilia beat in the cold: a real time assay for cell signalling. Cell Signal. 2003 Apr;15(4):395–402.
    1. Nimsakul S, Ruxrungtham S, Chusakul S, Kanjanaumporn J, Aeumjaturapat S, Snidvongs K. Does heating up saline for nasal irrigation improve mucociliary function in chronic rhinosinusitis. Am J Rhinol Allergy. 2018 Mar;32(2):106–11.
    1. Sauvalle M, Alvo A. Effect of the temperature of nasal lavages on mucociliary clearance: a randomised controlled trial. Eur Arch Otorhinolaryngol. 2018 Sep;275(9):2403–6.
    1. Adelson RT, Kennedy DW. Paranasal sinus exostoses: possible correlation with cold temperature nasal irrigation after endoscopic sinus surgery. Laryngoscope. 2013 Jan;123(1):24–7.
    1. Yoon HY, Lee HS, Kim IH, Hwang SH. Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis. Clin Otolaryngol. 2018 Apr;43(2):525–32.
    1. Harvey RJ, Snidvongs K, Kalish LH, Oakley GM, Sacks R. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery. Int Forum Allergy Rhinol. 2018 Apr;8(4):461–70.
    1. Jang DW, Lachanas VA, Segel J, Kountakis SE. Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2013 Sep;3(9):708–11.
    1. Kosugi EM, Moussalem GF, Simoes JC, Souza Rde P, Chen VG, Saraceni Neto P, et al. Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis. Braz J Otorhinolaryngol. 2016 Mar-Apr;82(2):191–7.
    1. Kang TW, Chung JH, Cho SH, Lee SH, Kim KR, Jeong JH. The effectiveness of budesonide nasal irrigation after endoscopic sinus surgery in chronic rhinosinusitis with asthma. Clin Exp Otorhinolaryngol. 2017 Mar;10(1):91–6.
    1. Tait S, Kallogjeri D, Suko J, Kukuljan S, Schneider J, Piccirillo JF. Effect of budesonide added to large-volume, low-pressure saline sinus irrigation for chronic rhinosinusitis: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2018 Jul;144(7):605–12.
    1. Rawal RB, Deal AM, Ebert CS, Jr, Dhandha VH, Mitchell CA, Hang AX, et al. Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial. Rhinology. 2015 Sep;53(3):227–34.
    1. Seiberling KA, Chang DF, Nyirady J, Park F, Church CA. Effect of intranasal budesonide irrigations on intraocular pressure. Int Forum Allergy Rhinol. 2013 Sep;3(9):704–7.
    1. Man LX, Farhood Z, Luong A, Fakhri S, Feldman RM, Orlander PR, et al. The effect of intranasal fluticasone propionate irrigations on salivary cortisol, intraocular pressure, and posterior subcapsular cataracts in postsurgical chronic rhinosinusitis patients. Int Forum Allergy Rhinol. 2013 Dec;3(12):953–7.
    1. Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2016 Mar;6(3):228–32.
    1. Soudry E, Wang J, Vaezeafshar R, Katznelson L, Hwang PH. Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016 Jun;6(6):568–72.
    1. Dawson B, Gutteridge I, Cervin A, Robinson D. The effects of nasal lavage with betamethasone cream post-endoscopic sinus surgery: clinical trial. J Laryngol Otol. 2018 Feb;132(2):143–9.
    1. Tan NC, Psaltis AJ. Latest developments on topical therapies in chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2020 Feb;28(1):25–30.
    1. Snidvongs K, Thanaviratananich S. Update on intranasal medications in rhinosinusitis. Curr Allergy Asthma Rep. 2017 Jul;17(7):47.
    1. Grayson JW, Harvey RJ. Topical corticosteroid irrigations in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019 May;9(S1):S9–15.
    1. Solares CA, Batra PS, Hall GS, Citardi MJ. Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations. Am J Otolaryngol. 2006 MayJun;27(3):161–5.
    1. Uren B, Psaltis A, Wormald PJ. Nasal lavage with mupirocin for the treatment of surgically recalcitrant chronic rhinosinusitis. Laryngoscope. 2008 Sep;118(9):1677–80.
    1. Jervis-Bardy J, Boase S, Psaltis A, Foreman A, Wormald PJ. A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis. Laryngoscope. 2012 Oct;122(10):2148–53.
    1. Ebbens FA, Scadding GK, Badia L, Hellings PW, Jorissen M, Mullol J, et al. Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2006 Nov;118(5):1149–56.
    1. Liang KL, Su MC, Shiao JY, Tseng HC, Hsin CH, Lin JF, et al. Amphotericin B irrigation for the treatment of chronic rhinosinusitis without nasal polyps: a randomized, placebo-controlled, doubleblind study. Am J Rhinol. 2008 Jan-Feb;22(1):52–8.
    1. Jiang RS, Hsu SH, Liang KL. Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery. Am J Rhinol Allergy. 2015 Nov-Dec;29(6):435–40.
    1. Jiang RS, Twu CW, Liang KL. Efficacy of nasal irrigation with 200 μg/mL amphotericin B after functional endoscopic sinus surgery: a randomized, placebo-controlled, double-blind study. Int Forum Allergy Rhinol. 2018 Jan;8(1):41–8.
    1. Zia S, Naqvi SU, Ahmed S, Farrukh MS, Sheikh SM. Role of amphotericin B in nasal irrigation for chronic rhinosinusitis with nasal polyps. J Coll Physicians Surg Pak. 2019 Aug;29(8):732–5.
    1. Wang T, Su J, Feng Y. The effectiveness topical amphotericin B in the management of chronic rhinosinusitis: a meta-analysis. Eur Arch Otorhinolaryngol. 2015 Aug;272(8):1923–9.
    1. Gelardi M, Guglielmi AV, De Candia N, Maffezzoni E, Berardi P, Quaranta N. Effect of sodium hyaluronate on mucociliary clearance after functional endoscopic sinus surgery. Eur Ann Allergy Clin Immunol. 2013 May;45(3):103–8.
    1. Macchi A, Terranova P, Digilio E, Castelnuovo P. Hyaluronan plus saline nasal washes in the treatment of rhino-sinusal symptoms in patients undergoing functional endoscopic sinus surgery for rhinosinusal remodeling. Int J Immunopathol Pharmacol. 2013 Jan-Mar;26(1):137–45.
    1. Casale M, Sabatino L, Frari V, Mazzola F, Dell’Aquila R, Baptista P, et al. The potential role of hyaluronan in minimizing symptoms and preventing exacerbations of chronic rhinosinusitis. Am J Rhinol Allergy. 2014 Jul-Aug;28(4):345–8.
    1. Cantone E, Castagna G, Sicignano S, Ferranti I, Rega F, Di Rubbo V, et al. Impact of intranasal sodium hyaluronate on the short-term quality of life of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2014 Jun;4(6):484–7.
    1. Mozzanica F, Preti A, Gera R, Bulgheroni C, Cardella A, Albera A, et al. Double-blind, randomised controlled trial on the efficacy of saline nasal irrigation with sodium hyaluronate after endoscopic sinus surgery. J Laryngol Otol. 2019 Apr;133(4):300–8.
    1. Cantone E, Iengo M. Effect of sodium hyaluronate added to topical corticosteroids in chronic rhinosinusitis with nasal polyposis. Am J Rhinol Allergy. 2016 Sep;30(5):340–3.
    1. Savietto E, Marioni G, Maculan P, Pettorelli A, Scarpa B, Simoni E, et al. Effectiveness of micronized nasal irrigations with hyaluronic acid/isotonic saline solution in non-polipoid chronic rhinosinusitis: a prospective, randomized, double-blind, controlled study. Am J Otolaryngol. 2020 Jul-Aug;41(4):102502.
    1. Weissman JD, Fernandez F, Hwang PH. Xylitol nasal irrigation in the management of chronic rhinosinusitis: a pilot study. Laryngoscope. 2011 Nov;121(11):2468–72.
    1. Lin L, Tang X, Wei J, Dai F, Sun G. Xylitol nasal irrigation in the treatment of chronic rhinosinusitis. Am J Otolaryngol. 2017 Jul-Aug;38(4):383–9.
    1. Kim DH, Kim Y, Lim IG, Cho JH, Park YJ, Kim SW, et al. Effect of postoperative xylitol nasal irrigation on patients with sinonasal diseases. Otolaryngol Head Neck Surg. 2019 Mar;160(3):550–5.
    1. Hashemian F, Baghbanian N, Majd Z, Rouini MR, Jahanshahi J, Hashemian F. The effect of thyme honey nasal spray on chronic rhinosinusitis: a double-blind randomized controlled clinical trial. Eur Arch Otorhinolaryngol. 2015 Jun;272(6):1429–35.
    1. Lee VS, Humphreys IM, Purcell PL, Davis GE. Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial. Int Forum Allergy Rhinol. 2017 Apr;7(4):365–72.
    1. Ooi ML, Jothin A, Bennett C, Ooi EH, Vreugde S, Psaltis AJ, et al. Manuka honey sinus irrigations in recalcitrant chronic rhinosinusitis: phase 1 randomized, single-blinded, placebo-controlled trial. Int Forum Allergy Rhinol. 2019 Dec;9(12):1470–7.
    1. Salami A, Dellepiane M, Strinati F, Guastini L, Mora R. Sulphurous thermal water inhalations in the treatment of chronic rhinosinusitis. Rhinology. 2010 Mar;48(1):71–6.
    1. Passali FM, Crisanti A, Passali GC, Cianfrone F, Bocchi M, Messineo G, et al. Efficacy of inhalation therapy with water of Salsomaggiore (Italy) in chronic and recurrent nasosinusal inflammation treatment. Clin Ter. 2008 May-Jun;159(3):175–80.
    1. Passali D, Lauriello M, Passali GC, Passali FM, Cassano M, Cassano P, et al. Clinical evaluation of the efficacy of Salsomaggiore (Italy) thermal water in the treatment of rhinosinusal pathologies. Clin Ter. 2008 May-Jun;159(3):181–8.
    1. Ottaviano G, Marioni G, Staffieri C, Giacomelli L, Marchese-Ragona R, Bertolin A, et al. Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study. Am J Otolaryngol. 2011 May-Jun;32(3):235–9.
    1. Yu MS, Kim BH, Kang SH, Lim DJ. Low-concentration hypochlorous acid nasal irrigation for chronic sinonasal symptoms: a prospective randomized placebo-controlled study. Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1527–33.
    1. Pigret D, Jankowski R. Management of post-ethmoidectomy crust formation: randomized single-blind clinical trial comparing pressurized seawater versus antiseptic/mucolytic saline. Rhinology. 1996 Mar;34(1):38–40.
    1. Fooanant S, Chaiyasate S, Roongrotwattanasiri K. Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery. J Med Assoc Thai. 2008 Oct;91(10):1558–63.
    1. Tantilipikorn P, Tunsuriyawong P, Jareoncharsri P, Bedavanija A, Assanasen P, Bunnag C, et al. A randomized, prospective, doubleblind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery. J Med Assoc Thai. 2012 Jan;95(1):58–63.
    1. Passali D, Fiorella R, Camaioni A, Villari G, Mora E, Passali GC, et al. Glucan solution nasal spray vs saline in the treatment of chronic rhinosinusitis: a multi-centric double blind randomized clinical trial. Clin Ter. 2007 Mar-Apr;158(2):139–45.
    1. Farag AA, Deal AM, McKinney KA, Thorp BD, Senior BA, Ebert CS, Jr, et al. Single-blind randomized controlled trial of surfactant vs hypertonic saline irrigation following endoscopic endonasal surgery. Int Forum Allergy Rhinol. 2013 Apr;3(4):276–80.
    1. NeilMed Pharmaceuticals Inc . Santa Rosa (CA): NeilMed Pharmaceuticals Inc; What type of water should I use for my neti pot? [Internet] 2021 [cited 2021 Jan 12]. Available from: .
    1. Sowerby LJ, Wright ED. Tap water or “sterile” water for sinus irrigations: what are our patients using. Int Forum Allergy Rhinol. 2012 Jul-Aug;2(4):300–2.
    1. Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, et al. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012 Nov;55(9):e79–85.
    1. Hardy ET, Stringer SP, O’Callaghan R, Arana A, Bierdeman MA, May WL. Strategies for decreasing contamination of homemade nasal saline irrigation solutions. Int Forum Allergy Rhinol. 2016 Feb;6(2):140–2.
    1. Ordemann AG, Stanford JK, 2nd, Sullivan DC, Reed JM. Can contaminated water be rendered safe for nasal saline irrigations. Laryngoscope. 2017 Jul;127(7):1513–9.
    1. van den Berg JW, de Nier LM, Kaper NM, Schilder AG, Venekamp RP, Grolman W, et al. Limited evidence: higher efficacy of nasal saline irrigation over nasal saline spray in chronic rhinosinusitis: an update and reanalysis of the evidence base. Otolaryngol Head Neck Surg. 2014 Jan;150(1):16–21.
    1. Pynnonen MA, Mukerji SS, Kim HM, Adams ME, Terrell JE. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg. 2007 Nov;133(11):1115–20.
    1. Rabago D, Pasic T, Zgierska A, Mundt M, Barrett B, Maberry R. The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck Surg. 2005 Jul;133(1):3–8.
    1. Salib RJ, Talpallikar S, Uppal S, Nair SB. A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products SterimarTM and Sinus RinseTM following functional endoscopic sinus surgery. Clin Otolaryngol. 2013 Aug;38(4):297–305.
    1. Taccariello M, Parikh A, Darby Y, Scadding G. Nasal douching as a valuable adjunct in the management of chronic rhinosinusitis. Rhinology. 1999 Mar;37(1):29–32.
    1. Heatley DG, McConnell KE, Kille TL, Leverson GE. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg. 2001 Jul;125(1):44–8.
    1. Thomas WW, 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ. Distribution of topical agents to the paranasal sinuses: an evidencebased review with recommendations. Int Forum Allergy Rhinol. 2013 Sep;3(9):691–703.
    1. Succar EF, Turner JH, Chandra RK. Nasal saline irrigation: a clinical update. Int Forum Allergy Rhinol. 2019 May;9(S1):S4–8.
    1. Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007 Jul;(3):CD006394.
    1. Moller W, Schuschnig U, Khadem Saba G, Meyer G, Junge-Hulsing B, Keller M, et al. Pulsating aerosols for drug delivery to the sinuses in healthy volunteers. Otolaryngol Head Neck Surg. 2010 Mar;142(3):382–8.
    1. Foreman A, Wormald PJ. Can bottle design prevent bacterial contamination of nasal irrigation devices. Int Forum Allergy Rhinol. 2011 Jul-Aug;1(4):303–7.
    1. Kofonow JM, Bhuskute A, Doghramji L, Palmer JN, Cohen NA, Chiu AG. One-way valve bottle contamination rates in the immediate post-functional endoscopic sinus surgery period. Am J Rhinol Allergy. 2011 Nov-Dec;25(6):393–6.
    1. Psaltis AJ, Foreman A, Wormald PJ, Schlosser RJ. Contamination of sinus irrigation devices: a review of the evidence and clinical relevance. Am J Rhinol Allergy. 2012 May-Jun;26(3):201–3.
    1. Williams GB, Ross LL, Chandra RK. Are bulb syringe irrigators a potential source of bacterial contamination in chronic rhinosinusitis. Am J Rhinol. 2008 Jul-Aug;22(4):399–401.
    1. Lee JM, Nayak JV, Doghramji LL, Welch KC, Chiu AG. Assessing the risk of irrigation bottle and fluid contamination after endoscopic sinus surgery. Am J Rhinol Allergy. 2010 May-Jun;24(3):197–9.
    1. Welch KC, Cohen MB, Doghramji LL, Cohen NA, Chandra RK, Palmer JN, et al. Clinical correlation between irrigation bottle contamination and clinical outcomes in post-functional endoscopic sinus surgery patients. Am J Rhinol Allergy. 2009 Jul-Aug;23(4):401–4.
    1. Keen M, Foreman A, Wormald PJ. The clinical significance of nasal irrigation bottle contamination. Laryngoscope. 2010 Oct;120(10):2110–4.
    1. Nikolaou E, Mitsi E, Ferreira DM, Bartolo A, Leong SC. Assessing the ideal microwave duration for disinfection of sinus irrigation bottles: a quantitative study. Clin Otolaryngol. 2018 Feb;43(1):261–6.
    1. Morong S, Lee JM. Microwave disinfection: assessing the risks of irrigation bottle and fluid contamination. Am J Rhinol Allergy. 2012 Sep-Oct;26(5):398–400.
    1. Shargorodsky J, Lane AP. What is the best modality to minimize bacterial contamination of nasal saline irrigation bottles. Laryngoscope. 2015 Jul;125(7):1515–6.
    1. U.S. Food and Drug Administration . Silver Spring (ML): U.S. Food and Drug Administration; 2021. Is rinsing your sinuses with neti pots safe? [Internet] [cited 2021 Jan 12]. Available from: .
    1. Bogaert GA, Goeman L, de Ridder D, Wevers M, Ivens J, Schuermans A. The physical and antimicrobial effects of microwave heating and alcohol immersion on catheters that are reused for clean intermittent catheterisation. Eur Urol. 2004 Nov;46(5):641–6.
    1. Merkus P, Ebbens FA, Muller B, Fokkens WJ. Influence of anatomy and head position on intranasal drug deposition. Eur Arch Otorhinolaryngol. 2006 Sep;263(9):827–32.
    1. Saijo R, Majima Y, Hyo N, Takano H. Particle deposition of therapeutic aerosols in the nose and paranasal sinuses after transnasal sinus surgery: a cast model study. Am J Rhinol. 2004 Jan-Feb;18(1):1–7.
    1. Olson DE, Rasgon BM, Hilsinger RL., Jr Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope. 2002 Aug;112(8 Pt 1):1394–8.
    1. Kayarkar R, Clifton NJ, Woolford TJ. An evaluation of the best head position for instillation of steroid nose drops. Clin Otolaryngol Allied Sci. 2002 Feb;27(1):18–21.
    1. Craig JR, Palmer JN, Zhao K. Computational fluid dynamic modeling of nose-to-ceiling head positioning for sphenoid sinus irrigation. Int Forum Allergy Rhinol. 2017 May;7(5):474–9.

Source: PubMed

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