This study evaluated the effect of daily nasal irrigation (also known as nasal wash) on the quality of life, symptoms, and medication use of patients with chronic sinus complaints. Sinus disease is common, affects quality of life, is expensive, and is a source of significant medication use. Nasal irrigation is an ancient technique in which salt water is allowed to gently bathe the nasal cavity, facilitating a gentle wash of the structures within.

In a randomized controlled trial, we trained 52 patients with histories of sinus disease to use daily nasal irrigation, and compared their experience to 24 matched control subjects. We assessed quality of life, patients' compliance and satisfaction with nasal irrigation, sinus symptoms, and medication use. The group using nasal irrigation exhibited improved quality of life, less frequent symptoms, and used antibiotics and nasal sprays less often. They were compliant with nasal irrigation, liked using it, and suffered few side effects.

The results of this randomized controlled trial were published in the December 2002 issue of the Journal of Family Practice.

Two follow-up studies have been published which add to the parent study. In the first follow-up study, we wanted to determine whether subjects would continue to use nasal irrigation in a less structured setting and whether the control subjects would use nasal irrigation if trained and followed in an unstructured manner. We therefore followed the original intervention subjects for an additional 12 months, and trained the initial control group subjects to use nasal irrigation for their chronic sinus conditions and followed them for 12 months. Both groups experienced similar improvement in quality of life and decreased nasal symptoms. Use patterns stabilized at about 3 nasal irrigations per week, used by some subjects on a strict schedule and by others only as needed.

In the second follow-up we wanted to know how users of nasal irrigation experienced the process of learning to use the therapy, and how they continues to use it at home. So we conducted interviews with 28 subjects. Their discussions centered around four main themes: 1) nasal irrigation was effective for their chronic symptoms and 2) it empowered them to care more for chronic sinus symptoms on their own rather than always seek a physician's input. 3) There are some impediments to doing nasal irrigation such as time require and the initial sensation of water in the nasal cavity, but that 4) these barriers were overcome by good instruction and integration of nasal irrigation into subjects' at-hom daily routines.

We conclude from these studies that nasal irrigation is an effective adjunctive therapy for chronic sinus symptoms and may be tried as an adjunctive therapy for infectious rhinosinusitis (acute sinusitis).

Two further studies are planned: 1) an assessment of nasal irrigation for allergic rhinitis asthma and polyposis, and 2) a systematic review of the nasal irrigation literature.