Articulo De Otorrino

The Laryngoscope
C
V 2012 The American Laryngological,

Rhinological and Otological Society, Inc.

Comparison of Buffered and Nonbuffered Nasal Saline Irrigations in
Treating Allergic Rhinitis
Supinda Chusakul, MD; Sukanya Warathanasin, MD; Naphorn Suksangpanya, MD;
Chuntima Phannaso, BSc; Saran Ruxrungtham, MD; Kornkiat Snidvongs, MD;
Songklot Aeumjaturapat, MD
Objectives/Hypothesis:We aimed to study the effect of alkalinity of isotonic nasal saline irrigation on nasal symptoms,
mucociliary clearance, nasal patency, and patient’s preference in patients with allergic rhinitis (AR).
Study Design: A double-blind, randomized, three-arm crossover study.
Methods: Patients with AR were enrolled. Three kinds of isotonic nasal saline irrigations: nonbuffered (pH 6.2–6.4), bufferedwith mild alkalinity (pH 7.2–7.4), and buffered with alkalinity (pH 8.2–8.4) were given one at a time, in different orders.
Patients rinsed their nose with 240 ml of one solution twice daily for 10 days and then swapped to the others. The washout
period was at least 5 days. Primary outcomes were nasal symptoms, mucociliary clearance time, and nasal patency. Outcomes
were compared betweenbaseline and posttreatment and also between various kinds of solution. Secondary outcomes were
patients’ preference and adverse events.
Results: Thirty-six subjects entered the study, and there were no dropouts. Overall nasal symptom was significantly
improved from baseline (P ¼ 0.03) only by buffered solution with mild alkalinity. Sneezing was significantly improved from
baseline (P ¼ 0.04) only bybuffered solution with alkalinity. No other significant improvements were achieved by any solution. When comparing between the three nasal irrigations, there were no differences in all parameters. The patients significantly preferred the buffered solution with mild alkalinity (P ¼ 0.02).
Conclusions: Buffered isotonic saline with some degree of alkalinity may improve nasal symptoms. Isotonicsaline irrigations, regardless of alkalinity, may not improve mucociliary function and nasal patency. Buffered isotonic saline with mild
alkalinity is the most preferred.
Key Words: Nasal saline irrigation, buffered saline, allergic rhinitis, pH, preference, nasal patency, mucociliary function.
Level of Evidence: 1b.
Laryngoscope, 123:53–56, 2013

INTRODUCTION
Nasal saline irrigation has beenincreasing in popularity. and it has been proven as an effective adjunctive
treatment for various sinonasal conditions such as
chronic rhinosinusitis, postnasal, or sinus surgery and
allergic rhinitis.1–9 The advantages of nasal saline irrigation in allergic rhinitis may be through direct
cleansing of thick mucus, dust particles, or allergens
that deposit on the nasal mucosa, or reducing theinflammatory mediators such as histamine, prostaglandins, leukotrienes10,11 and sICAM-1 in the nasal
From the Department of Otolaryngology, Faculty of Medicine (S.C.,
Chulalongkorn University, Bangkok, Thailand; and
Department of Otolaryngology (C.P.), King Chulalongkorn Memorial
Hospital, Bangkok, Thailand; Department of Preventive and Social
Medicine, Faculty of Medicine ( S . R .),Chulalongkorn University,
Bangkok, Thailand.
Editor’s Note: This Manuscript was accepted for publication July
2, 2012.
This study was supported by the Ratchadapisek Somphot Fund,
Chulalongkorn University. The authors have no other funding, financial
relationships, or conflicts of interest to disclose.
Send correspondence to Supinda Chusakul, MD, Department of
Otolaryngology, Faculty of Medicine,Chulalongkorn University, Bangkok
10330, Thailand. E-mail: supinda.ent@gmail.com
S.W., N.S., K.S., S.A.),

DOI: 10.1002/lary.23617

Laryngoscope 123: January 2013

cavity.12 Its benefits effect on mucociliary function has
been shown.13–15 The formula used varies from one institution to the other regarding tonicity and alkalinity of
the solution. Isotonic saline was found to be the...