Isotonic saline or hypertonic saline: which is best for sinusitis?

Journal of Family Practice, August, 2004 by Ahmet Karadag, Hanifi Kurtaran, Oguz Tekin, Cem Uraldi, Timucin Aydogan

TO THE EDITOR:

We have read with interest Rabago et al's letter to the editor, "Nasal irrigation as adjunctive care for acute sinusitis" (J Fam Pract 2004; 53:137). The authors recommended using hypertonic saline nasal irrigation once dally at the onset of sinus symptoms until resolution. But there are 3 important disadvantages for hypertonic saline. Hypertonic saline challenge leads to histamine release and can be used as a simple diagnostic test for allergic rhinitis and may provide a model for nasal hyperreactivity. (1) In the same study, isotonic saline dose not make these symptoms as hypertonic challenge. (1) Otherwise, hypertonic saline nasal irrigation leads to substance P release and glandular secretion by means of stimulation of nociceptive nerves, so that there can be pain in patients. (2) Furthermore, sputum induction by hypertonic saline can cause significant bronchoconstriction in patients with chronic obstructive pulmonary disease, despite pretreatment with an inhaled beta-2-agonist. (3)

Isotonic saline nasal washing has been used effectively in the treatment of sinusitis in children. (4-6) As described in the aforementioned studies, an isotonic saline solution is applied--5 dropperfuls in each nostril--at least 4 times a day until the symptoms subside. Isotonic saline solution nasal washing certainly facilitates nasal drainage and cleans the airway from any postnatal discharge.

Nasal isotonic saline solution--with evidence of beneficial effects in the treatment of acute and chronic sinusitis--is a cheap and convenient way of treating these patients. Overall, we do believe that the placebo-controlled cohort trials comparing the effectivenesses and the adverse effects of the isotonic saline and hypertonic saline use in in sinusitis will determine whether the hypertonic saline or the isotonic saline is superior.

REFERENCES

(1.) Krayenbuhl MC, Hudspith BN, Brostoff J, Scadding GK, Guesdon JL, Latchman Y. Nasal histamine release following hyperosmolar and allergen challenge. Allergy 1989; 44:25-29.

(2.) Baraniuk JN, Ali M, Yuta A, Fang SY, Naranch K. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am J Respir Crit Care Med 1999; 160:655-662.

(3.) Rytila PH, Lindqvist AE, Laitinen LA. Safety of sputum induction in chronic obstructive pulmonary disease. Eur Respir J 2000; 15:1116-1119.

(4.) Topal B, Ozsoylu S. Are antibiotics required for the treatment of acute sinusitis in children. Yeni Tip Dergisi 2001; 18(suppl):58-60.

(5.) Kurtaran H, Karadag A, Catal F, Avci Z. A reappraisal of nasal saline solution use in chronic sinusitis. Chest 2003; 124:2036-2037.

(6.) Karadag A. Nasal saline for acute sinusitis. Pediatrics 2002; 109:165.

Ahmet Karadag, MD, Hanifi Kurtaran, MD, Oguz Tekin, MD, Cem Uraldi, MD, and Timucin Aydogan, Fatih University, Faculty of Medicine, Ankara, Turkey. E-mail: kara_dag@hotmail.com