The Use of Irrigations with Topical Additives for the Treatment of Chronic Rhinosinusitis
|Jonathan M. Lee, MD
Assistant Professor, Dept. of Otorhinolaryngology
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
About the author: Jonathan M. Lee is Assistant Professor of Clinical Otorhinolaryngology: Head and Neck Surgery, Department: Otorhinolaryngology: Head and Neck Surgery
Chronic rhinosinusitis is a disease characterized by the inflammation, or swelling, of the lining of the nose and sinuses. This swelling can result in common symptoms such as facial pain or pressure, difficulty breathing through the nose, nasal drainage, and decreased smell. While we don’t know the exact mechanism behind why some people suffer from this chronic condition, we know that it is a big problem- resulting in over 20 million physician visits in the United States each year.
The efficacy and safety of nasal saline irrigation as a treatment for the symptoms of chronic rhinosinusitis have been supported by numerous studies. Some research has also demonstrated that a high-volume and low-pressure irrigation method, such as a squeeze bottle, is the optimal method of delivery. Given the long list of possible side effects from the systemic oral antibiotics and steroids that are typically used to treat chronic rhinosinusitis, there has been a strong interest in the use of topical medications that can be delivered via nasal saline irrigation.
The use of topical steroids such as budesonide has been shown to result in significant improvement in the symptoms of chronic rhinosinusitis, particularly for those patients suffering from nasal polyps. Multiple trials have also assessed the role of various topical antibiotics and antifungals. To date, the results of these studies have been mixed, and no clear consensus exists regarding their use. Additional studies are needed to help clarify the role and efficacy of these topical medications in the future.