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DINA NURHAYATI
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30101306918 dr. Shelly Tjahyadewi, M.Kes, Sp.THT-KL
 Efficacy of Hypertonic
Saline and Normal Saline in
the Treatment of Chronic
Sinusitis
 Journal identity
Tittle
◦Efficacy of Hypertonic Saline and Normal Saline in the Treatment of
Chronic Sinusitis
Author
◦Ramabhadraiah Anil Kumar, Borlingegowda Viswanatha, Nisha
Krishna, Niveditha Jayanna, Disha Ramesh Shetty
Publisher
◦International Journal of Otolaryngology and Head & Neck Surgery
Publication year
◦2013
 Introduction

The common modalities of

absenteeism from work, frequent treatment for chronic sinusitis
Paranasal sinus disease is a revisits to the doctor and also a cause include the use of antibiotics,
common illness seen in the for significant expenditure of money decongestants, mucolytics and
general population. on over-the-counter medications. steroids.
 Nasal Irrigation
This is also
important in the
Nasal irrigation Use of normal
postoperative
aids in the saline and
period to reduce
clearance of hypertonic saline
the risk of
secretions, debris for nasal irrigation
adhesions and to
and intranasal is an inexpensive
promote
crusts technique.
osteomeatal
patency.
 Goals
This study was designed to compare the efficacy of
hypertonic saline nasal drops over that of normal
saline nasal drops in the treatment of chronic
sinusitis.

As per the null hypothesis it was assumed that there

is no difference between the two groups and finally
the results were compared which showed a
statistically significant result.
Materials and Methods
Methods Location Time

Victoria Hospital,
A double Department of
Otorhinolaryngol
blinded ogy, Bangalore From July
randomized Medical College 2009 to
and Research August 2011.
comparative Institute,
study Bangalore,
Karnataka, India
 Study Design
Fifty patients who were diagnosed with chronic sinusitis in
the age group of 18 - 45 years were selected.

They were randomized into two groups. Group A included

twenty-five cases treated with normal saline (solution A)

The remaining twenty-five cases in Group B were treated

with 3.5% hypertonic saline (solution B)

Ten drops three times a day in both nostrils for a period

of 4 weeks
 Normal saline which is
commercially available as 0.9%
Sodium chloride solution was
used as solution A.

Hypertonic solution of 3.5% Sodium

chloride was prepared by dissolving
3.5 g of sodium chloride in 100 ml
of double distilled water and was
used as solution B
 Inclusion criteria

Patients who had been treated with antibiotics, β2

agonists, topical steroids and systemic steroids
were included in the study, but the treatment was
stopped one month prior to the beginning of the
study.
 Those with any known
anatomical defect or
Exclusions mucocele that obstructs
the sinuses were
excluded from the study.
Diagnosis of Chronic Sinusitis
Two major One minor
criteria criteria

nasal
headache
discharge

Post
nasal drip
 Chronic Sinusitis Criteria
The diagnosis was
confirmed by x-ray
of paranasal sinus
(Water’s view).

Post treatment x-ray of the

paranasal sinuses (Water’s
view) was taken at the end of
4 to 6 weeks and compared
with the pretreatment x-ray.

The pre and post treatment

x-rays were graded
according to Berg et al.
X RAY GRADING
 Informed Consent

The patients were informed about the

mode of treatment and asked to
report every week for a period of one
month to assess symptoms
The research project was
approved by the Ethics
Committee of the Institution
under the protocol Good
Clinical Practices.
 TECHNIQUE

The drops were instilled

Patients advised fast upward in a sitting
to instill ten or standing position with They were immediately
drops the head pulled back to removed from the nose
in order to minimize the
intranasally allow secretions to flow salty taste and burning
three times a downwards from the sensation that may occur.

day. nose without the patient

breathing them in.
 Study Outcome
nasal
congestion

nasal
headache
discharge

sense of
facial pain
smell
 Study Outcome
nasal
congestion

nasal
headache
discharge

sense of
facial pain
smell
 Study Outcome
Tolerance for
the nasal
solution

3 = Moderate 4 = Severe
1 = No burning 2 = Mild burning
burning burning
sensation sensation
sensation sensation.
Data Analysis

DATA

CHI
SQUARE
TEST

UNPAIRED
“T” TEST
Result and Analysis
 The following
observations were made
in fourty two patients Eight patients (16%)
General
who completed the defaulted from the study
Result
treatment schedule group of fifty patients.
proposed in the study.
Patients in group B had significant
improvement in nasal congestion
by the end of fourth week when
compared to group A.
Patients reported relief of
headache in both groups but
comparison between the two
groups showed significant
improvement in group B
Facial pain subsided in both the
groups by the end of second or
third week of treatment and the
difference was found to be
statistically insignificant between
the two groups
 Loss of smell was reported by
eight patients in group A and in
eleven patients in group B and
in both the groups it improved The difference was
with treatment. found to be
statistically
insignificant between
the two groups
Patients reported clear nasal secretions
and reduction in the quantity of
secretions by the end of fourth week in
both the groups. group B showed
significant improvement by the end of
fourth week.
It was observed that both groups
showed improvement in their
overall symptoms but, group B
showed significant improvement
when compared to group A.

Figure 1. shows radiological
improvement in one of the
patients, after treatment
with hypertonic saline 3.5%
nasal drops.
X-rays were graded and given scores accordingly. There was no
statistical significance in distribution of cases between the two groups.
In group B, highly significant downgrading in radiological score was
noticed (from 5.67 ± 1.32 to 3.62 ± 1.43); whereas in group A there was
no such improvement (from 5.38 ± 1.43 to 4.71 ± 1.42) (p = 0.001)
In group A 85.7% patients did not complain
of any burning sensation.
Mild burning sensation was reported by
14.3% in group A and 57.1% in group B.
Moderate burning sensation was reported
None of the patients
by 19% of patients in group B. None of the in both the groups
patients in both the groups reported severe reported severe
burning sensation burning sensation
Discussion
 Discussion
•Hypertonic VS 3.5 % hypertonic
Normal Salin saline solutions
nasal solution
• It is the concentration of sea
used to reduce water and is considered
symptoms of harmless and better tolerated by
chronic sinusitis the patients, even children.
mechanism action of hypertonic saline
nasal solutions
decreases mucosal
improves
edema and mechanically clears
mucociliary
inflammatory inspissated mucus
function
mediators

mild
antibacterial
vasoconstrictive
property
effect
 Discussion
causes an increase
Hypererosmolarity in Ca2+ release stimulate the ciliary
of the airway fluids from intercellular beat frequency
stores

possibly by regulating the use or

availability of adenosine
triphosphate by ciliary
axoneme.
 Discussion
Radiological analysis in group A showed that there were nine
patients with right maxillary sinus haziness; eight with left sided
haziness and four with bilateral haziness.
In group B there were eleven patients with right maxillary sinus
haziness; seven with left sided haziness and three had bilateral
haziness.
The analysis of pre-treatment and post-treatment radiological
scores revealed highly significant improvement in group B (from 5.67
± 1.32 to 3.62 ± 1.43) compared to group A (from 5.38 ± 1.43 to 4.71
± 1.42) (p = 0.001).
 Conclusion

Hypertonic saline nasal

The study showed that
solution was well tolerated
3.5% hypertonic saline
by the patients and the
nasal solution was more
treatment of patients with
efficacious than 0.9%
chronic sinusitis with 3.5%
normal saline solution in
hypertonic saline nasal
the treatment of patients
solution improved their
with chronic sinusitis.
quality of life.
Critical appraisal
 Critical Appraisal
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 Abstract
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 Bahan dan Metode
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 PICO Analysis

PATIENT INTERVENTION

Pasien dengan Sinusitis • Irigasi Larutan Hipersaline

Kronis 3,5%

COMPARISON OUTCOME

Irigasi Larutan Normal Saline • VAS

0,9% • Efektifitas pengobatan
 Bukti valid
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