The effect of isotonic nasal saline irrigation on chronic rhinosinusitis symptoms in adult patients at the Kenyatta National Hospital.

Abstract

Background: Chronic rhinosinusitis (CRS) is inflammation of the sinonasal tract for longer than 12 weeks. Patients present with nasal blockage, facial pain, nasal secretions, and malaise. Nasal saline has been used as an adjunct therapy to relieve these symptoms. Main Objective: To determine the effect of saline nasal irrigation in patients with CRS as an adjunct treatment among patients at Kenyatta National Hospital. Study Design: Randomized controlled trial. Study Population: Patients 18 years and above who have been diagnosed with CRS without polyps. Study Setting: The Ear Nose and Throat clinic at The Kenyatta National Hospital. Study duration: Between March 2019 to September 2019. Methodology: A total of 50 patients diagnosed with CRS who satisfied the inclusion criteria were recruited and randomized using research randomizer into 25 control and 25 study group. Both groups continued using fluticasone furoate nasal spray and filled in the SNOT 20 questionnaire at the beginning and the end of the study. The study group self-administered nasal saline irrigation at high volume and low positive pressure twice daily for 28 days while the control group only used the nasal spray for the 28days. The study group, in addition filled a compliance diary and side effects questionnaire which was submitted on the 28th day. Data management and analysis: Data was entered into SPSS version 22, verified and analyzed. Descriptive statistics such as mean and median was used for normal and skewed variables respectively. The two groups were compared using independent t-test and paired sample t-test analysis. A p-value of ≤0.05 indicated statistical significance. Results: Study population had 44 participants with 6 previously lost to follow up, therefore 22 controls and 22 cases. The improvement in SNOT-20 scores over the 28 days from baseline was 21.1 ± 14.7(P<0.001) for the study and 13.0 ± 12.7 (P=0.02) for control groups. The Cohen‟s coefficient was 0.63. Median compliance was at 96% and the most common side effect was nasal drainage. Conclusion: Adjunct saline irrigation had marked improvement compared to those who used intranasal steroid sprays only. It has good compliance with minor side effect.