The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
David Rabago - One of the best experts on this subject based on the ideXlab platform.
-
results of a rct assessing saline and xylitol Nasal Irrigation for crs and fatigue in gulf war illness
Laryngoscope Investigative Otolaryngology, 2020Co-Authors: David Rabago, Marlon P Mundt, Tony L Kille, Chidi N ObasiAbstract:Objective To assess the efficacy of saline Nasal Irrigation (S-NI) and xylitol Nasal Irrigation (X-NI) for chronic rhinosinusitis in participants with Gulf War illness (GWI). Methods This 26 week, 3-arm (1:1:1) randomized controlled trial examined veterans meeting criteria for GWI with moderate-to-severe chronic rhinosinusitis and fatigue symptoms. All participants received standard of care for chronic rhinosinusitis (CRS); additionally, S-NI or X-NI participants added twice-daily NI using 2% saline or 5% xylitol solutions. Outcomes included disease-specific quality of life (primary; sino-Nasal outcome test [SNOT-20]; 0-100 points), overall quality of life (Short-Form 36), and fatigue (Multidimensional Fatigue Index). Outcome assessors were blind to allocation group. Intention-to-treat analysis used repeated measures modeling; statistical significance was evaluated at the two-sided α level of .05. Results Randomization (N = 40) produced three similar groups regarding sex (male, 80%), age (53.8 ± 7.8 years), duration (19.8 ± 7.7 years), and illness severity (48.5 ± 12.7 SNOT-20 points). Age- and gender-adjusted between-group comparison showed that X-NI participants, compared with control, reported improved SNOT-20 scores at 8 weeks (13.5 points, 95% confidence interval [CI] -27.9 to 0.9) and at 26 weeks (15.4 points, 95% CI -30.1 to -0.6). S-NI participants improved by 13.4 points (95% CI -28.8, 2.1) at 26 weeks compared with control.The improvement in both NI groups approached minimal clinical important difference compared to control for the SNOT-20 in the general population. Secondary outcomes were not different between groups. Satisfaction in both Irrigation groups was high. Conclusions This randomized controlled trial suggests that NI with saline or xylitol improves chronic sinus symptoms among participants with GWI with improvement scores similar to those in the general population. Level of evidence 1b, individual randomized controlled trial.
-
effectiveness of steam inhalation and Nasal Irrigation for chronic or recurrent sinus symptoms in primary care a pragmatic randomized controlled trial
Canadian Medical Association Journal, 2016Co-Authors: Paul Little, David Rabago, Beth Stuart, Mark Mullee, Tammy Thomas, Sophie Johnson, Gerry Leydon, Samantha Richardshall, Ian Williamson, Guiqing YaoAbstract:Background: Systematic reviews support Nasal saline Irrigation for chronic or recurrent sinus symptoms, but trials have been small and few in primary care settings. Steam inhalation has also been proposed, but supporting evidence is lacking. We investigated whether brief pragmatic interventions to encourage use of Nasal Irrigation or steam inhalation would be effective in relieving sinus symptoms. Methods: We conducted a pragmatic randomized controlled trial involving adults (age 18–65 yr) from 72 primary care practices in the United Kingdom who had a history of chronic or recurrent sinusitis and reported a “moderate to severe” impact of sinus symptoms on their quality of life. Participants were recruited between Feb. 11, 2009, and June 30, 2014, and randomly assigned to 1 of 4 advice strategies: usual care, daily Nasal saline Irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions. The primary outcome measure was the Rhinosinusitis Disability Index (RSDI). Patients were followed up at 3 and 6 months. We imputed missing data using multiple imputation methods. Results: Of the 961 patients who consented, 871 returned baseline questionnaires (210 usual care, 219 Nasal Irrigation, 232 steam inhalation and 210 combined treatment). A total of 671 (77.0%) of the 871 participants reported RSDI scores at 3 months. Patients’ RSDI scores improved more with Nasal Irrigation than without Nasal Irrigation by 3 months (crude change −7.42 v. −5.23; estimated adjusted mean difference between groups −2.51, 95% confidence interval −4.65 to −0.37). By 6 months, significantly more patients maintained a 10-point clinically important improvement in the RSDI score with Nasal Irrigation (44.1% v. 36.6%); fewer used over-the-counter medications (59.4% v. 68.0%) or intended to consult a doctor in future episodes. Steam inhalation reduced headache but had no significant effect on other outcomes. The proportion of participants who had adverse effects was the same in both intervention groups. Interpretation: Advice to use steam inhalation for chronic or recurrent sinus symptoms in primary care was not effective. A similar strategy to use Nasal Irrigation was less effective than prior evidence suggested, but it provided some symptomatic benefit. Trial registration: ISRCTN, no. 88204146.
-
effectiveness of Nasal Irrigation for chronic rhinosinusitis and fatigue in patients with gulf war illness protocol for a randomized controlled trial
Contemporary Clinical Trials, 2015Co-Authors: Supriya Hayer, David Rabago, Marlon P Mundt, Aleksandra Zgierska, Tony L Kille, Iliya Amaza, Christopher L Coe, Larissa I Zakletskaia, Dean D KrahnAbstract:Abstract Introduction Gulf War Illness (GWI) affects 1 in 7 returned Persian Gulf War veterans. Quality-of-life impact is large; there is no cure. Chronic sinus symptoms and fatigue are common. Nasal Irrigation with saline (NI-S) or xylitol (NI-X) improve sinus symptoms and fatigue in the general population. This trial will assess the effect of NI-S and NI-X on sinus and fatigue symptoms, economic outcomes and pro-inflammatory milieu among participants with GWI. Methods 75 participants (age 35 to 65 years, 25 in each of three arms) with GWI will be recruited from the Veteran's Administration and the community. They will use routine care for sinus symptoms and fatigue and be randomized to continued usual care alone or additional therapy with NI-S or NI-X. Participants will be able to adjust specific elements of the NI procedure. The primary outcome (SinoNasal Outcome Test, SNOT-20) and other self-reported assessments will occur at baseline, 8 and 26 weeks; lab assessment of pro-inflammatory cellular and cytokine profiles will occur at baseline and 26 weeks. Other outcomes will include fatigue-specific and overall health-related quality of life, pro-inflammatory cellular and cytokine profiles, cost-effectiveness and participant satisfaction. Results Baseline demographic and clinical data from the first 10 participants show effective participant recruitment, enrollment, randomization, retention and data collection. Conclusion Early study conduct suggests that our participant-oriented approach will yield high rates of participant adherence and data capture, facilitating robust analysis. Results of this study will clarify the value of NI for chronic sinus symptoms and fatigue among patients with GWI. Clinical trial registration clinicaltrials.gov identifier NCT01700725 .
-
saline Nasal Irrigation for upper respiratory conditions
American Family Physician, 2009Co-Authors: David Rabago, Aleksandra ZgierskaAbstract:Saline Nasal Irrigation is an adjunctive therapy for upper respiratory conditions that bathes the Nasal cavity with spray or liquid saline. Nasal Irrigation with liquid saline is used to manage symptoms associated with chronic rhinosinusitis. Less conclusive evidence supports the use of spray and liquid saline Nasal Irrigation to manage symptoms of mild to moderate allergic rhinitis and acute upper respiratory tract infections. Consensus guidelines recommend saline Nasal Irrigation as a treatment for a variety of other conditions, including rhinitis of pregnancy and acute rhinosinusitis. Saline Nasal Irrigation appears safe, with no reported serious adverse events. Minor adverse effects can be avoided with technique modification and salinity adjustment.
-
the prescribing patterns of wisconsin family physicians surrounding saline Nasal Irrigation for upper respiratory conditions
WMJ : official publication of the State Medical Society of Wisconsin, 2009Co-Authors: David Rabago, Aleksandra Zgierska, Paul E Peppard, Amy BamberAbstract:Context Upper respiratory conditions are common and have a significant impact on patient quality of life, medical resource expenditure, and antibiotic use. Saline Nasal Irrigation (SNI) is an adjunctive therapy for upper respiratory conditions; clinical studies suggest that use of SNI may be effective for symptoms of upper respiratory conditions, and its popularity seems to be growing. The prescribing patterns of physicians regarding SNI have not yet been studied. Objective To assess the use among family physicians in Wisconsin of SNI, determine how and for which conditions they recommend SNI, and the degree to which they experience clinical success with SNI. Method This was assessed by an electronic questionnaire of 330 practicing family physicians in the Wisconsin Academy of Family Physicians and Wisconsin Research and Education Network. Results Analysis showed 286 of 330 respondents (87%) have used SNI as adjunctive care for a variety of upper respiratory conditions including chronic rhinosinusitis (91%), acute bacterial rhinosinusitis (67%), seasonal allergic rhinitis (66%), viral upper respiratory infection (59%), other allergic rhinitis (48%), irritant-based congestion (48%), and rhinitis of pregnancy (17%). Respondents also reported having used SNI prior to antibiotics for acute bacterial rhinosinusitis (77%). Use patterns varied regarding type of SNI administration, dosing frequency, saline concentration, and patient education. Conclusions This questionnaire-based study suggests that SNI is used by family physicians for a variety of upper respiratory conditions though recommendation and patient education styles, dosing schedules, and solution types vary.
Aleksandra Zgierska - One of the best experts on this subject based on the ideXlab platform.
-
effectiveness of Nasal Irrigation for chronic rhinosinusitis and fatigue in patients with gulf war illness protocol for a randomized controlled trial
Contemporary Clinical Trials, 2015Co-Authors: Supriya Hayer, David Rabago, Marlon P Mundt, Aleksandra Zgierska, Tony L Kille, Iliya Amaza, Christopher L Coe, Larissa I Zakletskaia, Dean D KrahnAbstract:Abstract Introduction Gulf War Illness (GWI) affects 1 in 7 returned Persian Gulf War veterans. Quality-of-life impact is large; there is no cure. Chronic sinus symptoms and fatigue are common. Nasal Irrigation with saline (NI-S) or xylitol (NI-X) improve sinus symptoms and fatigue in the general population. This trial will assess the effect of NI-S and NI-X on sinus and fatigue symptoms, economic outcomes and pro-inflammatory milieu among participants with GWI. Methods 75 participants (age 35 to 65 years, 25 in each of three arms) with GWI will be recruited from the Veteran's Administration and the community. They will use routine care for sinus symptoms and fatigue and be randomized to continued usual care alone or additional therapy with NI-S or NI-X. Participants will be able to adjust specific elements of the NI procedure. The primary outcome (SinoNasal Outcome Test, SNOT-20) and other self-reported assessments will occur at baseline, 8 and 26 weeks; lab assessment of pro-inflammatory cellular and cytokine profiles will occur at baseline and 26 weeks. Other outcomes will include fatigue-specific and overall health-related quality of life, pro-inflammatory cellular and cytokine profiles, cost-effectiveness and participant satisfaction. Results Baseline demographic and clinical data from the first 10 participants show effective participant recruitment, enrollment, randomization, retention and data collection. Conclusion Early study conduct suggests that our participant-oriented approach will yield high rates of participant adherence and data capture, facilitating robust analysis. Results of this study will clarify the value of NI for chronic sinus symptoms and fatigue among patients with GWI. Clinical trial registration clinicaltrials.gov identifier NCT01700725 .
-
saline Nasal Irrigation for upper respiratory conditions
American Family Physician, 2009Co-Authors: David Rabago, Aleksandra ZgierskaAbstract:Saline Nasal Irrigation is an adjunctive therapy for upper respiratory conditions that bathes the Nasal cavity with spray or liquid saline. Nasal Irrigation with liquid saline is used to manage symptoms associated with chronic rhinosinusitis. Less conclusive evidence supports the use of spray and liquid saline Nasal Irrigation to manage symptoms of mild to moderate allergic rhinitis and acute upper respiratory tract infections. Consensus guidelines recommend saline Nasal Irrigation as a treatment for a variety of other conditions, including rhinitis of pregnancy and acute rhinosinusitis. Saline Nasal Irrigation appears safe, with no reported serious adverse events. Minor adverse effects can be avoided with technique modification and salinity adjustment.
-
the prescribing patterns of wisconsin family physicians surrounding saline Nasal Irrigation for upper respiratory conditions
WMJ : official publication of the State Medical Society of Wisconsin, 2009Co-Authors: David Rabago, Aleksandra Zgierska, Paul E Peppard, Amy BamberAbstract:Context Upper respiratory conditions are common and have a significant impact on patient quality of life, medical resource expenditure, and antibiotic use. Saline Nasal Irrigation (SNI) is an adjunctive therapy for upper respiratory conditions; clinical studies suggest that use of SNI may be effective for symptoms of upper respiratory conditions, and its popularity seems to be growing. The prescribing patterns of physicians regarding SNI have not yet been studied. Objective To assess the use among family physicians in Wisconsin of SNI, determine how and for which conditions they recommend SNI, and the degree to which they experience clinical success with SNI. Method This was assessed by an electronic questionnaire of 330 practicing family physicians in the Wisconsin Academy of Family Physicians and Wisconsin Research and Education Network. Results Analysis showed 286 of 330 respondents (87%) have used SNI as adjunctive care for a variety of upper respiratory conditions including chronic rhinosinusitis (91%), acute bacterial rhinosinusitis (67%), seasonal allergic rhinitis (66%), viral upper respiratory infection (59%), other allergic rhinitis (48%), irritant-based congestion (48%), and rhinitis of pregnancy (17%). Respondents also reported having used SNI prior to antibiotics for acute bacterial rhinosinusitis (77%). Use patterns varied regarding type of SNI administration, dosing frequency, saline concentration, and patient education. Conclusions This questionnaire-based study suggests that SNI is used by family physicians for a variety of upper respiratory conditions though recommendation and patient education styles, dosing schedules, and solution types vary.
-
the efficacy of hypertonic saline Nasal Irrigation for chronic sinoNasal symptoms
Otolaryngology-Head and Neck Surgery, 2005Co-Authors: David Rabago, Bruce Barrett, Marlon P Mundt, Aleksandra Zgierska, Thomas R Pasic, Rob MaberryAbstract:Objective To assess quality of life (QOL) in patients with sinoNasal symptoms in response to hypertonic saline Nasal Irrigation (HSNI), and to assess HSNI use patterns. Study design and setting The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinoNasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. Results Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 ± 2.6 points to 80.6 ± 2.4 points ( P P P Conclusions Participants with chronic sinoNasal symptoms reported improved QOL and frequent, satisfying use of HSNI. Significance HSNI is an effective adjunctive treatment of chronic sinoNasal symptoms.
-
efficacy of daily hypertonic saline Nasal Irrigation among patients with sinusitis a randomized controlled trial
Journal of Family Practice, 2002Co-Authors: David Rabago, Bruce Barrett, Marlon P Mundt, Aleksandra Zgierska, James A Bobula, Rob MaberryAbstract:tionnaire 93% of experimental subjects reported overall improvement of sinus-related quality of life, and none reported worsening (P < .001); on average, experimental subjects reported 57 ± 4.5% improvement. Side effects were minor and infrequent. Satisfaction was high. We found no statistically significant improvement on the SF-12. ■ CONCLUSIONS Daily hypertonic saline Nasal Irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis. Primary care physicians can feel comfortable recommending this therapy. ■ KEY WORDS Sinusitis, Nasal Irrigation, quality of life. (J Fam Pract 2002; 51:1049‐1055)
Richard J Harvey - One of the best experts on this subject based on the ideXlab platform.
-
impact of draf iii draf iib and draf iia frontal sinus surgery on Nasal Irrigation distribution
International Forum of Allergy & Rhinology, 2020Co-Authors: Henry P Barham, Christian A Hall, Stephen C Hernandez, Harry E Zylicz, Megan M Stevenson, Brittany A Zito, Richard J HarveyAbstract:BACKGROUND Delivery of topical pharmacotherapy to the paraNasal sinuses remains integral to the management of chronic rhinosinusitis. The frontal sinus remains a difficult access site for Irrigations, often limited by its position relative to the nostril and ethmoid sinus. In view of the previous demonstration of improved frontal sinus Irrigation with Draf III vs Draf IIa, in this work we sought to evaluate topical access of Draf IIb relative to Draf IIa and Draf III modification of the frontal sinus outflow tract. METHODS Unfixed human cadaver heads were dissected using Draf IIa, Draf IIb, and Draf III frontal sinusotomies. Draf IIa, Draf IIb, and Draf III frontal sinusotomies were performed in progressive sequence on each cadaver head. Nasal Irrigation fluid access to the frontal sinus was tested after each successive frontal sinus intervention. Irrigations were performed using Frankfort horizontal and vertex positioning. Blinded reviewers were then asked to evaluate Nasal Irrigation access based on an ordinal scale. RESULTS Eight cadaveric specimens (age, 78 ± 12.3 years; 62.5% female) were assessed. The greatest distribution scores were recorded by Draf III, then IIb, and then IIa (90.7% vs 81.3% vs 50.1%; p < 0.001). Similarly, the rate of lavage was greatest with Draf III (50% vs 12.5% vs 12.5%). Vertex positioning and increasing volume trended toward improved distribution but did not reach statistical significance. CONCLUSION Adequate delivery of topical therapy to the paraNasal sinuses by Nasal Irrigation remains critical in the postoperative state. Although increasing the dimensions of the frontal recess improves Nasal Irrigation delivery, the Draf III procedure provides the optimal delivery of pharmacotherapy in those with frontal sinus disease.
-
corticosteroid Nasal Irrigations are more effective than simple sprays in a randomized double blinded placebo controlled trial for chronic rhinosinusitis after sinus surgery
International Forum of Allergy & Rhinology, 2018Co-Authors: Kornkiat Snidvongs, Richard J Harvey, Larry Kalish, Gretchen M Oakley, Raymond SacksAbstract:BACKGROUND:Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. METHODS:The objective was to determine if corticosteroid delivered via a Nasal Irrigation or via a simple Nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a Nasal Irrigation followed by a Nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or Irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinoNasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. RESULTS:A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid Nasal Irrigation group had greater improvement in Nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid Irrigation group. CONCLUSION:In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by Nasal Irrigation is superior to simple Nasal spray in postsurgical patients.
-
fluid residuals and drug exposure in Nasal Irrigation
Otolaryngology-Head and Neck Surgery, 2009Co-Authors: Richard J Harvey, Nick I Debnath, Aviva Srubiski, Ben Bleier, Rodney J SchlosserAbstract:OBJECTIVE: Topical treatment options in chronic rhinosinusitis (CRS) are growing with our increased understanding of the inflammatory process. Additives to Irrigation devices have become popular. A...
Raymond Sacks - One of the best experts on this subject based on the ideXlab platform.
-
corticosteroid Nasal Irrigations are more effective than simple sprays in a randomized double blinded placebo controlled trial for chronic rhinosinusitis after sinus surgery
International Forum of Allergy & Rhinology, 2018Co-Authors: Kornkiat Snidvongs, Richard J Harvey, Larry Kalish, Gretchen M Oakley, Raymond SacksAbstract:BACKGROUND:Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. METHODS:The objective was to determine if corticosteroid delivered via a Nasal Irrigation or via a simple Nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a Nasal Irrigation followed by a Nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or Irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinoNasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. RESULTS:A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid Nasal Irrigation group had greater improvement in Nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid Irrigation group. CONCLUSION:In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by Nasal Irrigation is superior to simple Nasal spray in postsurgical patients.
-
frontal sinus surgery and sinus distribution of Nasal Irrigation
International Forum of Allergy & Rhinology, 2016Co-Authors: Henry P Barham, Vijay R Ramakrishnan, Anna Knisely, Lyndon S Chan, Dakshika A Gunaratne, Jared D Weston, Sheran Seneviratne, George N Marcells, Raymond SacksAbstract:Background Effective mucus lavage and delivery of topical pharmaceuticals are central to successful management of chronic rhinosinusitis (CRS). The frontal sinus remains difficult to penetrate with topical therapies. This study evaluates the benefit of Draf III frontal dissection compared to traditional Draf IIa for distribution of topical therapies. Methods Fresh human cadaver heads were dissected sequentially with Draf IIa frontal sinusotomy and then Draf III procedures. Each cavity was irrigated with pediatric (120 mL) and adult (240 mL) Irrigation bottles with 1/1000 10% fluorescein-labeled free water in 2 fixed positions (vertex and Frankfort horizontal). An endoscope at a fixed position within the frontal sinus recorded frontal sinus and frontal recess penetration. The images then underwent blinded evaluation of fluid distribution scored as 0 to 4 (Nasal cavity only, frontal recess, medial one-half, lateral one-half, and lavage). Ordinal distribution score was analyzed with Kendall's tau-b. Results Eight specimens (age 76 ± 11.2 years; 50% female) were assessed. Draf III was superior to Draf IIa in ability to achieve frontal sinus distribution of Irrigation (90.6% vs 50.1%, p < 0.001). Vertex head position improved distribution (90.6% vs 50.1%, p < 0.001), was synergistic with Draf III (100% with 87.5% lavage, p < 0.001), but was unable to overcome Draf IIa (81.2% with 25% lavage, p < 0.001). Irrigation volume trended toward improved distribution with larger volume Irrigations. Conclusion Successful treatment of sinoNasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning.
Kornkiat Snidvongs - One of the best experts on this subject based on the ideXlab platform.
-
hypertonic saline versus isotonic saline Nasal Irrigation systematic review and meta analysis
American Journal of Rhinology & Allergy, 2018Co-Authors: Dichapong Kanjanawasee, Kornkiat Snidvongs, Kachorn Seresirikachorn, Wirach ChitsuthipakornAbstract:BackgroundSaline Nasal lavage is one of the treatments of sinoNasal diseases. Evidence from basic research favors hypertonic saline (HS) over isotonic saline (IS) for mucociliary clearance, but evi...
-
does heating up saline for Nasal Irrigation improve mucociliary function in chronic rhinosinusitis
American Journal of Rhinology & Allergy, 2018Co-Authors: Suthanma Nimsakul, Saran Ruxrungtham, Supinda Chusakul, Jesada Kanjanaumporn, Songklot Aeumjaturapat, Kornkiat SnidvongsAbstract:Background Mucociliary function is affected by temperature. Exposure to cold air may impair ciliary beat frequency. While saline Nasal Irrigation improves in ciliary beat activity, there is no evidence supporting the use of heated saline Irrigation in treating patients with chronic rhinosinusitis. Objective To compare the effects of heated saline to room-temperature saline Nasal Irrigation on mucociliary clearance in chronic rhinosinusitis patients. Methods Adult patients with chronic rhinosinusitis were randomized into two groups receiving either heated saline or room-temperature saline Nasal Irrigation. Healthy subjects were included as control. Saccharin transit time was measured before and after Nasal Irrigation. Nasal patency was assessed by peak Nasal inspiratory flow, anterior rhinomanometry, acoustic rhinometry, Nasal obstruction score, and breathe-comfort score. Any adverse events were reported. Results Twenty-three patients with chronic rhinosinusitis and nine healthy subjects were enrolled. Saccharin transit time was decreased after Nasal Irrigation in both heated saline subgroup (baseline 12.3 ± 4.5 min vs. postIrrigation 8.4 ± 4.9 min, p = 0.05) and room-temperature subgroup (baseline 12.8 ± 5.0 min vs. postIrrigation 8.9 ± 4.2 min, p = 0.01). The saccharin transit time improvement was not different between heated saline (3.8 ± 6.2 min) and room-temperature saline (3.8 ± 4.0 min), p = 0.13. Postheated saline Irrigation saccharin transit time of chronic rhinosinusitis patients (8.4 ± 4.9 min) was not different to healthy subjects (9.2 ± 3.7 min), p = 0.69. Nasal patency was not different between groups. There was no adverse event reported. Conclusion Nasal saline Irrigation is beneficial to patients with chronic rhinosinusitis on mucociliary improvement. Warming saline is not necessary and adds no additional benefit to room-temperature saline Irrigation.
-
corticosteroid Nasal Irrigations are more effective than simple sprays in a randomized double blinded placebo controlled trial for chronic rhinosinusitis after sinus surgery
International Forum of Allergy & Rhinology, 2018Co-Authors: Kornkiat Snidvongs, Richard J Harvey, Larry Kalish, Gretchen M Oakley, Raymond SacksAbstract:BACKGROUND:Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. METHODS:The objective was to determine if corticosteroid delivered via a Nasal Irrigation or via a simple Nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a Nasal Irrigation followed by a Nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or Irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinoNasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. RESULTS:A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid Nasal Irrigation group had greater improvement in Nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid Irrigation group. CONCLUSION:In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by Nasal Irrigation is superior to simple Nasal spray in postsurgical patients.
-
does Nasal Irrigation enter paraNasal sinuses in chronic rhinosinusitis
American Journal of Roentgenology, 2008Co-Authors: Kornkiat Snidvongs, Supinda Chusakul, Songklot Aeumjaturapat, Pattraporn Chaowanapanja, Puangmali PraweswararatAbstract:BackgroundNasal Irrigation is widely used in treating sinoNasal diseases. Not only does it remove static secretions and promote mucociliary clearance, but, in chronic rhinosinusitis, Nasal flush is...
