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Compliance and efficacy of saline irrigation in pediatric chronic rhinosinusitis
Sang Duk Hong1, Joon Ho Kim2, Hyo Yeol Kim1
1Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Insights
Nasal irrigation is well-tolerated and effective for children with chronic rhinosinusitis (CRS). This treatment should be considered for pediatric CRS management, reducing the need for surgery.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Clinical Therapeutics
Background:
- Chronic rhinosinusitis (CRS) presents a significant challenge in pediatric care.
- Refractory CRS cases often require intensive medical management, including antibiotics and nasal corticosteroids.
- Evaluating complementary therapies is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the compliance and effectiveness of nasal irrigation in children diagnosed with CRS.
- To evaluate the clinical course of pediatric CRS patients undergoing nasal irrigation.
- To determine the impact of nasal irrigation on the need for surgical intervention.
Main Methods:
- A cohort of 77 children with refractory CRS was enrolled.
- Patients received education on nasal irrigation techniques and were encouraged to perform it 1-3 times daily.
- Nasal symptoms, Lund-MacKay CT scores, and endoscopic evaluations were used to assess outcomes at baseline and after one month, with follow-up for at least two months.
Main Results:
- 63.6% of patients demonstrated good compliance with nasal irrigation.
- Patients with good compliance showed significantly higher rates of subjective and objective improvement (73.5%) compared to those with poor compliance (50.0%).
- The rate of surgical intervention was significantly lower in the good compliance group (16.3%) versus the poor compliance group (42.9%).
Conclusions:
- Nasal irrigation is a relatively well-tolerated and effective treatment for pediatric chronic rhinosinusitis.
- A compliance rate of 63.6% was observed, with better outcomes in compliant patients.
- Nasal saline irrigation is recommended as a primary therapeutic option for CRS in children.
Objective:
The objective of this study was to evaluate compliance with and effectiveness of nasal irrigation in children with chronic rhinosinusitis (CRS) and to assess its clinical course.
Methods:
Seventy-seven children with refractory CRS resistant to medical treatment including antibiotics and nasal corticosteroids were included. We evaluated patients' nasal symptom and Lund Mackay CT scores at baseline. All patients were educated about nasal irrigation and encouraged to perform nasal irrigation 1-3 times a day. After 1 month, patients were reevaluated regarding compliance with the protocol and improvement of CRS by assessing symptom score and endoscopic evaluation. The patients were followed up for at least two months to assess need for further treatment including surgery.
Results:
Mean age of patients was 8.3 years ranging from 4 to 13 years. Mean follow-up duration with nasal saline irrigation was 6.2 months (2-32 months). Forty nine patients (63.6%) successfully carried out nasal irrigation during follow-up (good compliance [GC] group) and 28 patients (36.4%) did not successfully carry out nasal irrigation (poor compliance [PC] group). There were no significant differences between GC and PC groups regarding clinical characteristics and baseline Lund-MacKay CT scores. Subjective and objective improvements were observed in 36 patients (73.5%) in the GC group and 14 patients (50.0%) in the PC group. Surgery including endoscopic sinus surgery and/or adenoidectomy was performed in 8 patients (16.3%) in the GC group and 12 patients (42.9%) in the PC group. The rate of surgical treatment was significantly different between the groups (p=0.019).
Conclusion:
Nasal irrigation in children with long standing CRS is relatively well tolerated (63.6%) and effective. Nasal saline irrigation should be considered as a primary treatment tool in CRS even in pediatric age group.
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