title: Nasal saline for chronic sinonasal symptoms: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if isotonic sodium chloride (hereinafter "saline") nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays at improving quality of life and decreasing medication use.
  
  
  METHODS
  A prospective, randomized controlled trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  A total of 127 adults with chronic nasal and sinus symptoms.
  
  
  METHODS
  Patients were randomly assigned to irrigation performed with large volume and delivered with low positive pressure (n = 64) or spray (n = 63) for 8 weeks.
  
  
  METHODS
  Change in symptom severity measured by mean 20-Item Sino-Nasal Outcome Test (SNOT-20) score; change in symptom frequency measured with a global question; and change in medication use.
  
  
  RESULTS
  A total of 121 patients were evaluable. The irrigation group achieved lower SNOT-20 scores than the spray group at all 3 time points: 4.4 points lower at 2 weeks (P = .02); 8.2 points lower at 4 weeks (P < .001); and 6.4 points lower at 8 weeks (P = .002). When symptom frequency was analyzed, 40% of subjects in the irrigation group reported symptoms "often or always" at 8 weeks compared with 61% in the spray group (absolute risk reduction, 0.2; 95% confidence interval, 0.02-0.38 (P = .01). No significant differences in sinus medication use were seen between groups.
  
  
  CONCLUSIONS
  Nasal irrigations performed with large volume and delivered with low positive pressure are more effective than saline sprays for treatment of chronic nasal and sinus symptoms in a community-based population.
authors.affiliation: Department of Otolaryngology, University of Michigan Health System, 1904 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0312, USA. pynnonen@umich.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
authors.forename: Shraddha S
authors.initials: SS
authors.lastname: Mukerji
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Adams
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Terrell
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000188:drug therapy*; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D007552:Isotonic Solutions; D012965:Sodium Chloride