Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study

American Journal of Otolaryngology Received 1 November 2009 published online 31 May 2010.
Giancarlo Ottaviano, MDa, Gino Marioni, MDa, Claudia Staffieri, MDb, Luciano Giacomelli, BDc, Rosario Marchese-Ragona, MDa, Andy Bertolin, MDa, Alberto Staffieri, MDa

Abstract

Objectives

Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]).

Methods

In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month.

Results

An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month.
Conclusions

Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations.

a Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Padova, Italy
b Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Treviso, Italy
c Anatomic Pathology Section, Department of Medical/Diagnostic Sciences and Special Therapies, University of Padova, Padova, Italy
Corresponding author. Otolaryngology Section, Department of Medical and Surgical Specialties, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 0 49 8212010; fax: +39 0 49 8213113.