Nasal saline irrigation is an effective treatment for sinusitis.
Ninety-two percent of patients in the United Kingdom and 85% to 98% in the United States are prescribed antibiotics for sinus infections, despite their ineffectiveness, as shown in studies. According to a British study led by Williamson, an antibiotic (amoxicillin) and a nasal steroid (budesonide) were no more effective than a placebo for treating acute sinusitis. Sharp and colleagues reviewed four years of data on treatments recommended for sinusitis and concluded that "antibiotics and inhaled nasal corticosteroids are being used more often than their published efficacies would encourage." But now clinical support is growing for an effective-and cheaper-alternative to antibiotics or steroids.
The home remedy, nasal saline rinsing, is also known as nasal irrigation or washes. In a 12-week trial by Slapak and colleagues, children with colds and sinus infections received standard medications like decongestants, with or without saline washes. The saline-wash group had fewer blocked noses and sore throats than those who didn't use saline washes. The saline-wash group also took fewer drugs, including antibiotics, and had fewer sick days. A 2007 Cochrane Collaboration review of studies involving adults and children showed that saline rinses are beneficial in the treatment of rhinosinusitis. Slapak and colleagues speculate that saline solutions wash away inflammatory compounds and allow cilia to sweep away mucus and debris.
In practice. Patients generally perform nasal rinses once or twice daily. Several over-the-counter products are available, including premeasured packets that combine baking soda with salt to reduce the sting, notes Donald Leopold, coauthor of the Sharp study. "According to my patients, Sinus Rinse is the easiest and most convenient method," he told AJN. He also recommends sprays like Ocean for "little sprays throughout the day." Patients who don't want to buy premixed solution can mix their own, by dissolving iodine-free salt and baking soda in lukewarm distilled or boiled water. (For additional information, Leopold recommends the book Nuances of Nasal and Sinus Self-Help, by his colleague Susan F. Rudy.) There are several products for delivering the saline solution, including "neti pots" (which resemble small teapots), soft bulb syringes, or adapters that are placed on the end of dental irrigators. A recipe and step-by-step procedure for saline irrigation are available online from the American Academy of Allergy, Asthma and Immunology (http://www.aaaai.org/patients/publicedmat/sinusitis/rinse.stm).
Carol Potera