Nasal saline as a placebo in a rhinosinusitis study

Abstract

Dear editor I read with interest Mainz et al’s article in the February issue of your journal.1 The authors concluded that sinonasal inhalation of vibrating antibiotic aerosols appears promising for reducing pathogen colonization of paranasal sinuses and for control of symptoms in patients with cystic fibrosis. We have an objection to their study methods. It is well known that isotonic saline solution nasal washing facilitates nasal drainage and cleans the airway of any postnasal discharge (including allergens); furthermore, it can be effective when applied appropriately.2–6 Isotonic saline solution is applied (five dropperfuls in each nostril) at least four times a day until the symptomatology subsides.2 In addition, isotonic saline solution irrigation has been found to reduce inflammatory mediators (histamine, prostaglandin D2, and leukotriene C4) and allergens in nasal secretions.7 For these reasons, nasal washing with saline is effective against pathologies of the upper respiratory tract that occur via inflammatory mediators, namely, the common cold, acute and chronic sinusitis, and, in particular, rhinitis.7 As a result, nasal saline, administered with the correct technique, can be as effective as nasal drugs; therefore, it cannot be used as a placebo in a rhinosinusitis study.