title: Dead Sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis: a randomized, prospective double-blind study.
abstract: BACKGROUND
  Intranasal steroids are 1 of the most frequently prescribed medications for the treatment of chronic rhinosinusitis (CRS), and saline irrigations are commonly used as an adjunct to medical therapy. We aimed to compare the efficacy of Dead Sea salt (DSS) irrigations and DSS nasal spray vs saline irrigations and topical nasal steroid spray in the treatment of symptoms of CRS.
  
  
  METHODS
  A total of 145 symptomatic adult patients without acute infection were initially enrolled and 114 completed the study. Patients completed a Sino-Nasal Outcomes Test 20 (SNOT-20) survey (primary outcome metric) and underwent endonasal examination, acoustic rhinometry, and smell testing (secondary outcome metrics). Patients were randomized to 2 groups. The experimental group (n = 59) self-administered hypertonic DSS spray and DSS irrigation; the control group (n = 55) self-administered fluticasone spray and hypertonic saline irrigation and spray. Patients and staff were blinded to group assignment. Outcomes were reassessed at 4 weeks.
  
  
  RESULTS
  The 2 groups were homogeneous with respect to pretreatment primary and secondary outcome metrics. Dropout rates were 30% in the DSS group and 36.6% in the control group. Both groups showed significant improvement in mean SNOT-20 scores following treatment; however, the degree of improvement was not significantly different between groups (p = 0.082). There were no significant changes in secondary outcome metrics between the 2 groups.
  
  
  CONCLUSIONS
  For patients with CRS, treatment with DSS irrigations and sprays appears as effective for symptom reduction as a combination of hypertonic saline irrigations and sprays and a topical steroid spray.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, 30 N. Michigan Ave, Chicago, IL 60602, USA. hednnek@aol.com
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Craig
authors.initials: C
authors.lastname: Hamilton
authors.forename: Christian G
authors.initials: CG
authors.lastname: Samuelson
authors.forename: Alexander
authors.initials: A
authors.lastname: Maley
authors.forename: Meghan N
authors.initials: MN
authors.lastname: Wilson
authors.forename: T K
authors.initials: TK
authors.lastname: Venkatesan
authors.forename: Ninos J
authors.initials: NJ
authors.lastname: Joseph
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012220:Rhinitis / Q000628:therapy*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012646:Self Administration; D012852:Sinusitis / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage*; D007507:Therapeutic Irrigation / Q000379:methods*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride