Nasal irrigation: From empiricism to evidence-based medicine. A review.
Nasal irrigation plays a non-negligible role in the treatment of numerous sinonasal pathologies and postoperative care. There is, however, a wide variety of protocols. The present review of the evidence-based literature sought objective arguments for optimization and efficacy. It emerged that large-volume low-pressure nasal douche optimizes the distribution and cleansing power of the irrigation solution in the nasal cavity. Ionic composition and pH also influence mucociliary clearance and epithelium trophicity. Seawater is less rich in sodium ions and richer in bicarbonates, potassium, calcium and magnesium than is isotonic normal saline, while alkaline pH and elevated calcium concentration optimized ciliary motility in vitro. Bicarbonates reduce secretion viscosity. Potassium and magnesium promote healing and limit local inflammation. These results show that the efficacy of nasal irrigation is multifactorial. Large-volume low-pressure nasal irrigation using undiluted seawater seems, in the present state of knowledge, to be the most effective protocol.
Service d'ORL et de chirurgie cervico-faciale, centre Michelet, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Bastier
Service d'ORL et de chirurgie cervico-faciale, centre Michelet, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Lechot
U1026, bio-ingénierie tissulaire, université de Bordeaux, 33000 Bordeaux, France; CIC-IT, CHU de Bordeaux, 33000 Bordeaux, France.
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Bordenave
CIC-IT, CHU de Bordeaux, 33000 Bordeaux, France.
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Durand
Service d'ORL et de chirurgie cervico-faciale, centre Michelet, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; CIC-IT, CHU de Bordeaux, 33000 Bordeaux, France. Electronic address: ludovic.de-gabory@chu-bordeaux.fr.
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de Gabory
D006801:Humans; D006863:Hydrogen-Ion Concentration; D007552:Isotonic Solutions / Q000737:chemistry; D009079:Mucociliary Clearance; D055556:Nasal Lavage; D011182:Postoperative Care; D012220:Rhinitis / Q000628:therapy; D012623:Seawater / Q000737:chemistry; D012852:Sinusitis / Q000628:therapy; D012965:Sodium Chloride / Q000737:chemistry
D007552:Isotonic Solutions; D012965:Sodium Chloride
Nasal irrigation; Saline solution; Seawater