Clin Exp Otorhinolaryngol.  2022 Feb;15(1):5-23. 10.21053/ceo.2021.00654.

Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

• Park DY
• Choi JH
• Kim DK
• Jung YG
• Mun SJ
• Min HJ
• Park SK
• Shin JM
• Yang HC
• Hong SN
• Mo JH

• KMID: 2527110
• DOI: http://doi.org/10.21053/ceo.2021.00654

Abstract

The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.

Keyword

Sinusitis; Treatment; Guideline; Saline Solution; Equipment; Steroids; Irrigation

Figure

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  Fig. 1. Mechanism and sequence of irrigation of the nasal cavity and nose. (A) The diagram showing the location and relationship of each sinus and nasal cavity. (B-H) The irrigation fluid first hits the nasopharynx and then indirectly enters the sinus. According to cadaveric and threedimensional modeling studies, the fluid first passes through the ethmoid and nasopharynx, then the ipsilateral maxillary and sphenoid sinuses, followed by the frontal sinus and then the opposite side of the maxillary sinus.

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  Fig. 2. Posture for nasal irrigation. Two head positions: (A) head down-and-forward position and (B) nose-to-ceiling position.

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