Takaisin Tulosta

Nasal irrigations for rhinosinusitis in children

Evidence summaries
Helena Liira
15.9.2006

Level of evidence: C

Nasal irrigations are probably not helpful in the treatment of rhinosinusitis in children.

80 children with sinusitis were treated with amoxycillin and a decongestive preparation «Maes JJ, Clement PA. The usefulness of irrigation ...»1. In 50 of them healing was incomplete and the usefulness of irrigation of the maxillary sinus was studied: one group was treated with antroscopy and sinuscopy while the second group did not receive this treatment (control). In both groups control X-rays were performed after three weeks. There was no significant difference between the two groups.

A placebo-controlled prospective study was performed to evaluate conservative treatment of chronic maxillary sinusitis in children. Antibiotic treatment and drainage did not seem to have a permanent curative effect «Otten FW. Conservative treatment of chronic maxill...»2.

In a randomized double blind study, the effect of nasal wash with hypertonic saline (HS) (3.5%) versus normal saline (NS) (0.9%) were compared in thirty patients with chronic sinusitis aged 3 to 16 «Shoseyov D, Bibi H, Shai P, Shoseyov N, Shazberg G...»3. They were randomly divided into two treatment groups matched by age and severity of the disease. All patients were treated for 4 weeks and evaluated by two clinical scores (cough and nasal secretions/postnasal drip [PND]) and by a radiology score at the beginning and end of the study. The HS group improved significantly in all scores (average +/- SD): cough score, from 3.6 +/- 0.51 to 1.6 +/- 0.74; nasal secretion/PND score, from 2.86 +/- 0.35 to 1.6 +/- 0.74; and radiology score, from 8.06 +/- 1.28 to 2.66 +/- 1.04. The NS treatment group showed significant improvement only in the PND score (from 2.66 +/- 0.49 to 1.53 +/- 0.83) but no significant change in both the cough score (from 3.53 +/- 0.52 to 3.33 +/- 0.49) and the radiology score (from 8.13 +/- 1.25 to 7.86 +/- 0.91). Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).

References

  1. Maes JJ, Clement PA. The usefulness of irrigation of the maxillary sinus in children with maxillary sinusitis on the basis of the Water's X-ray. Rhinology 1987 Dec;25(4):259-64. «PMID: 2448862»PubMed
  2. Otten FW. Conservative treatment of chronic maxillary sinusitis in children. Long-term follow-up. Acta Otorhinolaryngol Belg 1997;51(3):173-5. «PMID: 9350317»PubMed
  3. Shoseyov D, Bibi H, Shai P, Shoseyov N, Shazberg G, Hurvitz H. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol 1998 May;101(5):602-5. «PMID: 9600495»PubMed