Greiff L, Andersson M, Wollmer P, Persson CG.
Dept of Otorhinolaryngology, Head & Neck Surgery, University Hospital, Lund, Sweden.
Hypertonic saline (HS) is used in sputum induction studies.
However, little is known about the physiological effects of HS on human airways in vivo.
The present study takes advantage of the fact that the airway effects of topical challenges may be accurately examined in the readily accessible nasal airway.
The present study specifically examines whether exposure to HS affects histamine challenge-induced exudation of plasma (alpha2-macroglobulin) and methacholine-induced secretion of mucin (fucose).
Isotonic saline and HS (27 and 45 g x L(-1)), with and without concomitant histamine challenges, and with and without preceding methacholine challenges, were administered onto the nasal mucosa in 16 healthy subjects.
Lavage fluid levels of alpha2-macroglobulin and fucose were analysed.
Histamine produced a significant mucosal output of plasma (alpha2-macroglobulin).
HS itself did not evoke exudation of alpha2-macroglobulin, but it significantly increased the plasma exudation effect of histamine.
Methacholine produced a significant nasal mucosal output of fucose.
HS also increased the mucin secretion (fucose), and it enhanced the secretory effect of methacholine.
The authors concluded that hypertonic saline alone evokes mucinous secretion in human nasal airways in vivo and that it also enhances the exudative and secretory effects of histamine and methacholine, respectively.
Through different mechanisms the HS exposure may also improve the recovery of soluble indices in human nasal airways.
Whether or not the present findings are translatable to human bronchial airways remains to be examined.
PMID: 12608446 [PubMed - indexed for MEDLINE]
Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R.
Department of Family Medicine, University of Wisconsin, Madison, 53715, USA.
OBJECTIVES: To test whether daily hypertonic saline nasal irrigation improves sinus symptoms and quality of life and decreases medication use in adult subjects with a history of sinusitis.
STUDY DESIGN: Randomized controlled trial.
Experimental subjects used nasal irrigation daily for 6 months.
POPULATION: Seventy-six subjects from primary care (n=70) and otolaryngology (n=6) clinics with histories of frequent sinusitis were randomized to experimental (n=52) and control (n=24) groups.
OUTCOMES MEASURED: Primary outcome measures included the Medical Outcomes Survey Short Form (SF-12), the Rhinosinusitis Disability Index (RSDI), and a Single-Item Sinus-Symptom Severity Assessment (SIA); all 3 were completed at baseline, 1.5, 3, and 6 months.
Secondary outcomes included daily assessment of compliance and biweekly assessment of symptoms and medication use.
At 6 months, subjects reported on side effects, satisfaction with nasal irrigation, and the percentage of change in their sinus-related quality of life.
RESULTS: No significant baseline differences existed between the 2 groups.
Sixty-nine subjects (90.8%) completed the study.
Compliance averaged 87%.
Experimental group RSDI scores improved from 58.4 -/+ 2.0 to 72.8 -/+ 2.2 (P < or =.05) compared with those of the control group (from 59.6 -/+ 3.0 to 60.4 -/+ 1.1); experimental group SIA scores improved from 3.9 -/+ 0.1 to 2.4 -/+ 0.1 (P < or =.05) compared with those of the control group (from 4.08 -/+ 0.15 to 4.07 -/+ 0.27).
The number needed to treat to achieve 10% improvement on RSDI at 6 months was 2.0.
Experimental subjects reported fewer 2-week periods with sinus-related symptoms (P <.05), used less antibiotics (P <.05), and used less nasal spray (P =.06).
On the exit questionnaire 93% of experimental subjects reported overall improvement of sinus-related quality of life, and none reported worsening (P <.001); on average, experimental subjects reported 57 -/+ 4.5% improvement.
Side effects were minor and infrequent.
Satisfaction was high.
We found no statistically significant improvement on the SF-12.
CONCLUSIONS: Daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis.
Primary care physicians can feel comfortable recommending this therapy.
- Clinical Trial
- Randomized Controlled Trial
PMID: 12540331 [PubMed - indexed for MEDLINE]
Olson DE, Rasgon BM, Hilsinger RL Jr.
Department of Head and Neck Surgery, Kaiser Permanente Medical Center, Oakland, California 94611-5963, USA.
OBJECTIVE: To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation.
STUDY DESIGN: Prospective, controlled comparison.
METHODS: Eight healthy adult volunteers received nasal irrigation with 40 mL of isotonic, nonionic contrast material immediately before having coronal computed tomography to visualize distribution of solution in the paranasal sinuses.
For each study subject, three methods of irrigation were used: irrigation using positive-pressure irrigation, irrigation using negative-pressure irrigation, and irrigation using a nebulizer.
For each subject, three-dimensional computer reconstructions of the irrigated paranasal sinus airspaces were used to compare contrast solution volume and distribution achieved by the three methods.
RESULTS: Of the three methods used, two methods, positive-pressure and negative-pressure irrigation, distributed contrast solution widely to ethmoid and maxillary sinuses, but distribution of contrast solution was more uniform using positive-pressure irrigation than using negative-pressure irrigation.
The nebulization method distributed contrast solution poorly and resulted in a significantly lower volume of retained contrast solution (P <.05).
CONCLUSION: Judged solely on the basis of solution distribution in the nasal sinuses, nasal irrigation is effective when either positive-pressure or negative-pressure irrigation is used but is ineffective when a nebulizer is used.
PMID: 12172251 [PubMed - indexed for MEDLINE]
Talbot AR, Herr TM, Parsons DS.
ENT Department, Sydney Hospital, Australia.
Nasal irrigations have been used for centuries without any scientific data to determine efficacy.
For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery.
A simple study was undertaken using volunteers without any significant sinonasal disease.
Patients served as their own control using a saccharin clearance test before any nasal irrigation was used.
Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested.
On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test.
The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.
PMID: 9111380 [PubMed - indexed for MEDLINE]
Silber G, Proud D, Warner J, Naclerio R, Kagey-Sobotka A, Lichtenstein L, Eggleston P.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
Hyperosmolar environments induce histamine release from mast cells and basophils in vitro.
To assess whether the same stimulus induces mediator release in vivo, 15 healthy human volunteers underwent nasal challenges with instilled solutions of differing osmolalities: lactated Ringer's solution (257 +/- 3 mOsm/kg), isosmolar mannitol (277 +/- 6 mOsm/kg), and hyperosmolar mannitol (869 +/- 8 mOsm/kg).
The effect of these challenges on the volume, osmolality, and inflammatory mediator content of subsequent 5-ml isosmolar lavages was determined.
The volumes of lavages returned after hyperosmolar challenges were significantly greater than those after isosmolar challenges (5.5 +/- 0.2 ml versus 4.2 +/- 0.1 ml; p less than 0.01) and these lavage solutions had higher osmolalities.
Even when corrected for increased volumes, the lavages after hyperosmolar challenges contained significantly higher quantities of inflammatory mediators such as histamine (29.0 versus 10.1 ng; p less than 0.01), TAME-esterase activity (32.7 versus 11.1 cpm x 10(-3); p less than 0.01), and immunoreactive leukotrienes (9.9 versus 3.4 ng; p less than 0.01).
The changes in mediators were dose dependent in that incremental increase in challenge osmolality were associated with incremental increases in histamine release.
Therefore, when exposed to hyperosmolar stimuli in vivo, the nasal respiratory airway releases inflammatory mediators and fluid rapidly shifts into the airway lumen.
It has been suggested that the mediator release observed on breathing cold and dry air is due to increased osmolality of airway secretions; the present data confirm that osmotic variations at the airway surface can provide an adequate stimulus for cell activation.
PMID: 2449834 [PubMed - indexed for MEDLINE]