Does nasal irrigation (NI) improve outcomes in children with primary ciliary dyskinesia (PCD)?: a scoping review

Abstract

Introduction: PCD is a rare disease of motile cilia in the airways resulting in loss of mucociliary clearance. In PCD, nasal symptoms are often reported as the most bothersome affecting sleep, smell, taste and hearing, and are considered socially unacceptable. Expert consensus recommends NI but admits a lack of evidence in PCD. Children and parents are often reluctant to commence NI and worry children will not tolerate it.

Methods: We conducted database searches for studies in English using defined terms. Due to a lack of PCD specific studies, we expanded the search to include other causes of rhinosinusitis (RS). We included blinded randomised control trials, surveys and retrospective cohort studies and used CASP to critically appraise them. Outcomes included health related quality of life (HRQoL) scores or patient reported total symptom scores (TSS). We excluded objective outcomes e.g. microbiology from this review given the differing pathophysiology of PCD from other causes of RS.

Results: 7 studies combining 446 children (2-18yrs) were included. Methods of NI delivery differed across studies to include 15-30ml disposable syringe or NeilMed Sinus Rinse 120/240mls. 4 studies reporting HRQoL & 5 reporting TSS showed statistically significant improvement regardless of cause of RS, delivery method or addition of antibiotics. 342/446 (77%) children tolerated NI.

Conclusions: NI is an acceptable, effective intervention in children 2-18yrs. In disease groups studied, symptoms were reduced with improved HRQoL where NI was tolerated. Given the differing pathophysiology, a good quality RCT is needed to determine the usefulness of NI in children with PCD and to standardise delivery.