ToileTTES NASAL SYRASA D'RASAF - D'A + saline Irrigation

Transcription

1 TOILETTES NASALES QUESTION : L usage d eau salée lors d un rhume banal aide-t-il à prévenir l apparition d une sinusite ou d une otite? AUTEUR : Geneviève Gagnon (MAI 2008) P : tout patient, et en particulier ceux qui souffrent de sinusites ou d otites à répétition et qui présentent des symptômes d IVRS I : toilettes nasales avec salin C : rien O : effet sur l incidence d otites ou de sinusites CONTEXTE : Nous recommandons souvent aux patients de se laver le nez avec du salin lorsqu ils se présentent à la mini-urgence avec des symptômes d IVRS. RECHERCHE : Cochrane : avec «nasal saline irrigations» : 1 revue «Other reviews» : Rien Central Register of Controlled Trials : 6 résultats dont 3 avec des «outcomes» cliniques Clinical evidence : Informations intéressantes Best bets, Info-poems : RIEN Pub med : 2 études RÉSULTATS: 1) Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2007, Issue 3. Background: The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Treatment strategies often include the use of topical saline from once to more than four times a day. Considerable patient effort is often involved. Any additional benefit has been difficult to discern from other treatments. Objectives: To evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis. Search strategy: Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue ), MEDLINE (1950 to 2006) and EMBASE (1974 to 2006). The date of the last search was November 2006.

2 Selection criteria: Randomised controlled trials in which saline was evaluated in comparison with either no treatment, a placebo, as an adjunct to other treatments or against treatments. The comparison of hypertonic versus isotonic solutions was also compared. Data collection and analysis: Trials were graded for methodological quality using the Cochrane approach (modification of Chalmers 1990). Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis. A narrative overview of the remaining results is presented. Main results: Eight trials were identified that satisfied the inclusion criteria. Three studies compared topical saline against no treatment, one against placebo, one as an adjunct to and one against an intranasal steroid spray. Two studies compared different hypertonic solutions against isotonic saline. There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology 'placebo'. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear. Authors' conclusions: Saline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis. 2) Pynnonen MA, Mukerji SS, Kim HM, Adams ME, Terrell JE. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Archives of otolaryngology--head & neck surgery 2007 Nov ; 133 (11) : p 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. Design: A prospective, randomized controlled trial. Setting: Community. Participants: A total of 127 adults with chronic nasal and sinus symptoms. Interventions: 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.

3 Main outcome measures: 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, (P =.01). No significant differences in sinus medication use were seen between groups. CONCLUSION: 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. 3) Friedman M, Vidyasagar R, Joseph N. A randomized, prospective, doubleblind study on the efficacy of dead sea salt nasal irrigations. The Laryngoscope 2006 Jun ; 116 (6): p Objective: The objective of this randomized, prospective, double-blind study was to compare nasal irrigation using hypertonic Dead Sea salt (DSS) solution with hypertonic saline in the treatment of chronic rhinosinusitis and improvement of quality of life (QOL). Methods: With Institutional Review Board approval, 42 adults seeking treatment for chronic rhinosinusitis in a tertiary university-affiliated medical center were studied. After history and endonasal examination, computed tomography imaging, and QOL survey (Standardized Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ(S)]), patients were randomized to self-administered hypertonic saline spray and irrigation twice daily or hypertonic DSS spray and irrigation. Patients were reassessed weekly and at 1 month. Results: Both groups had similar symptoms and RQLQ(S) scores before treatment and had significant improvement after treatment. However, the DSS patients had significantly better symptom relief and only the DSS group showed improved RQLQ(S) scores. CONCLUSION: We present a short-term study providing level I evidence on the superiority of DSS over saline nasal irrigation for treatment of chronic rhinosinusitis. Medical Subject Headings (MeSH)

4 4) Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. The Laryngoscope 2000 Jul; 110 (7): p Objectives/Hypothesis: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study design: A prospective controlled clinical study. Methods: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. Results: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. CONCLUSION: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease. 5) CLINICAL EVIDENCE : recherche avec nasal saline irrigation, nose, rhinitis Il y a une section sur le rhume qui ne mentionne pas les toilettes nasales. Les «saline nasal washes» figurent sous les interventions dont on ne connaît pas l efficacité dans le traitement de la sinusite aigüe. 6) PapsinB., McTavish A.Saline nasal irrigation: Its role as an adjunct treatment. Can Fam Physician Feb; 49: Objective: To review clinical evidence on the efficacy of saline nasal irrigation for treatment of sinonasal conditions and to explore its potential benefits. Quality of evidence: Clinical trials, reviews, and treatment guidelines discussing nasal irrigation were obtained through a MEDLINE search from January 1980 to December Most trials were small and some were not controlled; evidence, therefore, is level II, or fair. Main message: Flushing the nasal cavity with saline solution promotes mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material. The procedure has been used safely for both adults and children, and has no documented serious adverse effects. Patients treated with nasal irrigation rely less on other medications and make fewer visits to physicians. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity.

5 CONCLUSION: Nasal irrigation is a simple, inexpensive treatment that relieves the symptoms of a variety of sinus and nasal conditions, reduces use of medical resources, and could help minimize antibiotic resistance. 7) Brown CL., Graham SM. Nasal irrigations: good or bad? Curr Opin Otolaryngol head Neck surg 2004 Feb;12(1):9-13. Purpose of review: Nasal irrigations are often mentioned as adjunctive measures in treating many sinonasal conditions. Despite their widespread use, much mystique and uncertainty exist about the indications and therapeutic mechanisms of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence challenges some of the assumptions underlying the use of nasal irrigations. Recent findings: Studies of nasal irrigations continue to report the benefits in managing sinonasal complaints. Apart from improved patient symptomatology, prescription medication use is often decreased. When nasal irrigations are combined with other medical modalities, patients with chronic sinusitis may not require surgical intervention as often. In particular, patients using hypertonic saline nasal irrigations reported better outcomes. Different devices and techniques exist. Positive-pressure and negative-pressure methods are probably more effective than nebulizers. Furthermore, the popular belief that nasal irrigations need to be sterile is in question. SUMMARY: Nasal irrigations should no longer be considered merely adjunctive measures in managing sinonasal conditions. They are effective and underutilized. Some of the persisting unanswered questions will only be answered by further research. ***Sont inclues ici des études rejetées ou non retenues par la revue Cochrane. CONCLUSION : Il n est pas possible, sur la base des études qui existent actuellement, d affirmer que les toilettes nasales préviennent les sinusites ou les otites. On peut cependant conseiller aux patients qui ont des symptômes "rhino-nasaux" (ou naso-rhinaux) de se rincer le nez avec de l'eau salée : cela soulage et n'induit que peu d'effets secondaires. Par intérêt, j'ai ajouté des études qui prétendent que l'eau hypertonique est préférable aux mélanges isotoniques, et que la méthode "à basse pression" c'est-à-dire à quatre pattes avec la tête appuyée sur le plancher (quatre fois par jour) est plus efficace que les irrigations en jet.