Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis,☆☆,

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Abstract

Background: Chronic sinusitis (CS) is a common disease in children, especially those with allergies, that is caused by impaired drainage from the sinuses. Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objective: We performed a randomized double blind study to compare the effect of nasal wash with hypertonic saline (HS) (3.5%) versus normal saline (NS) (0.9%) on CS. Methods: Thirty patients with CS aged 3 to 16 years were studied. They were randomly divided into two treatment groups matched by age and severity of the disease. Each individual was treated with either HS or NS for 4 weeks. All patients were evaluated by two clinical scores (cough and nasal secretions/postnasal drip [PND]) and by a radiology score at the beginning of the study and after 4 weeks. Results: The HS group improved significantly in all scores (average ± SD): cough score, from 3.6 ± 0.51 to 1.6 ± 0.74; nasal secretion/PND score, from 2.86 ± 0.35 to 1.6 ± 0.74; and radiology score, from 8.06 ± 1.28 to 2.66 ± 1.04. The NS treatment group showed significant improvement only in the PND score (from 2.66 ± 0.49 to 1.53 ± 0.83) but no significant change in both the cough score (from 3.53 ± 0.52 to 3.33 ± 0.49) and the radiology score (from 8.13 ± 1.25 to 7.86 ± 0.91). Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups. Conclusion: HS nasal wash is an efficient treatment of CS.(J Allergy Clin Immunol 1998;101:602-5)

Section snippets

Methods

Thirty-four children 3 to 16 years of age were enrolled in the study. They were given a diagnosis of chronic maxillary sinusitis according to the criteria described by Shapiro and Rachlefsky4, 7 during the summer seasons (June to September) of the years 1993 and 1994. They had been treated in the past with antibiotics for 3 weeks or more (seven patients in the HS group and three in the NS group), β2-agonists (eight in the HS group and 12 in the NS group), nasal steroids (two in the HS group and

Results

Thirty-four patients began the study, but four patients (three from the HS group and one from the NS group) could not tolerate the treatment because of the burning feeling in the nose and throat and left the study after 1 to 4 days.

The clinical and radiology scores were calculated as means ± SD. There was no significant difference between the readings of the radiology scores of the two investigators.

Fifteen patients (eight boys and seven girls, age 3 to 16 years old [median age, 9 years]) were

Discussion

Sinusitis is an increasingly recognized common and important cause of morbidity.2 Many patients with sinusitis experience chronic cough, fatigue, and lassitude characteristic of the disease. The prevalence of CS among patients with respiratory complaints is estimated to be as high as 73% of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 years of age.3 CS also complicates 5% to 10% of the upper respiratory infections of young children.8 New

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    From athe Pediatric Department, Bikur Cholim Hospital, Hadassa Medical School, Jerusalem; bPediatric Pulmonology, Barzilai Hospital, Ashkelon; cSHIRAM Asaf Harofe Medical Center, Zerifin; and dFamily Medicine Clinic Havazelet, Kupat Cholim Klalit, Rehovot.

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    Reprint requests: David Shoseyov, MD, Pediatric Pulmonology Clinic, Bikur Cholim Hospital, Strauss St. 5, Jerusalem, 91004, Israel.

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