Nasal irrigation with or without drugs: the evidence.

Nithin D Adappa, Calvin C Wei, James N Palmer

Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

Current opinion in otolaryngology & head and neck surgery 2012 Feb

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To review the recent literature of nasal irrigations with or without drugs, including delivery systems, nasal saline, antibiotics, antifungals, steroids, surfactants, and interleukin (IL)-5 modulators, for the treatment of chronic rhinosinusitis (CRS). As antibiotic resistance increases in CRS, culture-directed, rather than empiric, topical antibiotics are increasingly critical in optimal treatment. Topical irrigation with mupirocin significantly reduces Staphylococcus aureus biofilm mass in vitro. Surfactants and humanized anti-IL-5 monoclonal antibody are novel therapies demonstrating promising results in CRS. Physiologic saline irrigation is beneficial in the treatment of symptoms of CRS. Low-level evidence supports the effectiveness of topical antibiotics in the treatment of CRS. The use of topical antifungals is not supported by the majority of studies. Intranasal steroids are beneficial in the treatment of CRS with nasal polyposis. There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without nasal polyposis.

Citation

Nithin D Adappa, Calvin C Wei, James N Palmer. Nasal irrigation with or without drugs: the evidence. Current opinion in otolaryngology & head and neck surgery. 2012 Feb;20(1):53-7