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Several decades have passed since irrigation of maxillary sinuses generally became a treatment of the past. A more recent concept of biofilms may have evoked new interest in this past procedure, fraught with its own issues. In this study, the authors assessed the role of maxillary sinus irrigation in addition to intravenous and oral augmentin, oxymetazoline and intranasal flixonase in a control and study group comprising 15 and 24 patients respectively. All had symptoms of chronic rhinusitis as defined by the European Position Paper (2020) on the subject. Assessment was made in terms of SNOT20 QoL questionnaire which included symptoms of chronic rhinusitis plus psychological symptoms such as ‘waking up tired’. Only the last of these was found to be significantly better in the irrigated group. In assessment by pre- and post-treatment endoscopy, there was no significant difference between the irrigated and the non-irrigated groups. The same was the case for Lund-Mackay CT scores before and after the treatment. The results were assessed six weeks after the treatment and again after one to two years. Improvement occurred in both groups but was not significantly different. Equal number of ‘failures’ - that is patients requiring FESS - were found in either group. Perhaps culture and sensitivity guided irrigation to include local antibiotics and use of the procedure longer than four days may have made a difference but it seems in terms of practicalities and patient convenience, the issue of maxillary sinus irrigation hardly merits rejuvenation!

Direct maxillary irrigation therapy in non-operated chronic sinusitis: a prospective randomised controlled trial.
Ronen O, Marshak T, Uri N, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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