Venekamp, Roderick P., Ainsworth, Ben, Thomas, Tammy, Stuart, Beth, Slodkowska-Barabasz, Joanna, Mowbray, Fiona, Butler, Chris, Francis, Nick, Richards-Hall, Samantha, Harnden, Anthony, Hay, Alistair D., Hopkins, Claire, Moore, Michael, Yardley, Lucy, Verheij, Theo J.M, Zhu, Shihua and Little, Paul (2025) Saline nasal irrigation for acute sinusitis (SNIFS II): a randomised controlled pilot trial with nested process evaluation. BJGP Open. (doi:10.3399/BJGPO.2024.0307).
Abstract
Background: despite having marginal beneficial effects, antibiotics are routinely prescribed in adults with acute sinusitis. Alternative interventions for this common condition are urgently needed.
Aim: to assess the feasibility and acceptability of saline nasal irrigation for acute sinusitis.
Design & setting: randomised controlled pilot trial with nested process evaluation in 24 English general practices between October 2019 and May 2021.
Method: participants were randomised to advice to high volume hypertonic saline nasal irrigation with a delayed antibiotic prescription or usual care. Feasibility outcomes included recruitment and follow-up rates, adherence, and acceptability of the intervention.
Results: of those invited, 81/107 (76%) consented and were randomised (42 intervention, 39 usual care). Two participants were excluded due to ineligibility. Antibiotic prescribing strategies were recorded at baseline for 79/79 (100%), with no or delayed antibiotics prescribed in 60% (24/40) of the saline group versus 38% (15/39) of the usual care group. At follow-up, 80% (63/79) of participants recorded whether they consumed antibiotics or not. Among those from the intervention group who returned a symptom diary, 96% (22/23) and 65% (15/23) reported using saline nasal irrigation during the first and second week, respectively. Semi-structured interviews with 16 participants revealed that most were positive about trial participation and viewed saline nasal irrigation as acceptable, noting it as alternative to antibiotics.
Conclusion: saline nasal irrigation is deemed acceptable for adults with acute sinusitis and a trial of such intervention is feasible. A large trial is warranted to assess the effectiveness of this intervention for this common condition.
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