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Guideline
. 2022 Feb;15(1):5-23.
doi: 10.21053/ceo.2021.00654. Epub 2022 Feb 15.

Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

Do-Yang Park  1 , Ji Ho Choi  2 , Dong-Kyu Kim  3 , Yong Gi Jung  4 , Sue Jean Mun  5 , Hyun Jin Min  6 , Soo Kyoung Park  7 , Jae-Min Shin  8 , Hyung Chae Yang  9 , Seung-No Hong  10 , Ji-Hun Mo  11
Affiliations
Guideline

Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults

Do-Yang Park et al. Clin Exp Otorhinolaryngol. 2022 Feb.

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.

Keywords: Equipment; Guideline; Irrigation; Saline Solution; Sinusitis; Steroids; Treatment.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
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.
Fig. 2.
Fig. 2.
Posture for nasal irrigation. Two head positions: (A) head down-and-forward position and (B) nose-to-ceiling position.
See this image and copyright information in PMC

References

    1. Kim do H, Han K, Kim SW. Effect of chronic rhinosinusitis with or without nasal polyp on quality of life in South Korea: 5th Korea National Health and Nutrition Examination Survey Korean. Clin Exp Otorhinolaryngol. 2016 Jun;9(2):150–6. - PMC - PubMed
    1. Venkatraman G, Likosky DS, Zhou W, Finlayson SR, Goodman DC. Trends in endoscopic sinus surgery rates in the Medicare population. Arch Otolaryngol Head Neck Surg. 2010 May;136(5):426–30. - PMC - PubMed
    1. Ference EH, Suh JD, Tan BK, Smith SS. How often is sinus surgery performed for chronic rhinosinusitis with versus without nasal polyps. Am J Rhinol Allergy. 2018 Jan;32(1):34–9. - PMC - PubMed
    1. Chapurin N, Pynnonen MA, Roberts R, Schulz K, Shin JJ, Witsell DL, et al. CHEER national study of chronic rhinosinusitis practice patterns: disease comorbidities and factors associated with surgery. Otolaryngol Head Neck Surg. 2017 Apr;156(4):751–6. - PMC - PubMed
    1. Mahboubi H, Bhandarkar ND. Trends of ambulatory sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015 Apr;5(4):318–25. - PubMed

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