In this randomized controlled study of 871 patients, researchers found a slight improvement (44.1% for users of nasal irrigation vs. 36.6% for those using another treatment method) based on a measurement of clinical and self-reported symptoms from patients with sinus infections who were given instructions in how to use a salt solution to wash the inside of their nostrils.
Patient volunteers in the study were assigned to one of four groups: those receiving a nasal irrigation solution, steam, a combination of steam and nasal irrigation and “usual care” which referred to medications or referral, at the discretion of the physician. The study found that after six months there was a very modest decrease among nasal irrigation users in the use of over-the-counter medications (59.4% v. 68.0%) and those intending to seek medical consultation for symptom relief in the future.
The release uses careful language throughout and doesn’t over-sell the benefits. But the release is lacking on data that would quantify the benefits as well as information on cost and harms.
This matters because chronic sinus infections are a reason millions of people may be prescribed antibiotics, even though such medicines often do not help the symptoms. Reducing the use of antibiotics could help the world avoid the growth of resistant bacteria — which are a big threat. This study about alternatives of nasal irrigation (washing with salt solution) or inhaling steam is aimed at proving that people can feel better without as frequent of doctor visits and without antibiotics — which often are not effective and contribute to the resistance problem. But the study itself showed such modest improvement for patients that it didn’t contribute greatly to this desired outcome.
The release does not mention cost. Normal saline can easily be made at home or purchased from a local pharmacy. The cost is low in both cases and it should have been mentioned in the story especially in contrast to the cost of antibiotics.
The benefits information was pretty spare. We would have liked some numbers — rather than simply this sentence:
“Patients who were instructed to use nasal irrigation showed improvement at 3 and 6 months, as measured by the Rhinosinusitis Disability Index. Steam inhalation did not appear to alleviate symptoms of sinusitis.”
How much improvement? Is there a percentage or absolute number that could have been included?
According to the published study, “By 6 months, significantly more patients maintained a 10-point clinically important improvement in the RSDI score with nasal irrigation (44.1% v. 36.6%); fewer used over-the-counter medications (59.4% v. 68.0%) or intended to consult a doctor in future episodes.”
There is no mention of harms. While considered to be safe, there are risks to nasal irrigation that include a potential failure to seek appropriate medical attention as well as infection, headache and nosebleed, according this consumer fact sheet by the FDA.
The release makes clear that this was a randomized controlled trial of about 871 patients who were followed for six months. We think this helps the reader judge the quality of the evidence.
This release does not make any comment on the study funders. According to the UK clinical trial registry, the study was sponsored by the University of Southampton (UK).
The release talks about alternatives for sinus infections ranging from doctor visits and potential prescriptions to at-home use of nasal irrigation or steam inhalation.
Nasal irrigation and steam are both widely available.
The release does not make a claim for the novelty of this trial. However, the study itself states it is “one of few studies to address the effectiveness of brief advice to use nasal irrigation” and “the largest trial in any setting.” Both of those facts belonged in the release.
There is no unjustifiable language. We would quibble with the use of the word “prevention” in the title, however. This research did nothing to study preventing sinus infections. It studied improving symptoms.
Systematic, Criteria-Driven
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