Evidence map›Paper›PMID 27431306›Full record

Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2016

Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial.

Paul Little, Beth Stuart, Mark Mullee, Tammy Thomas, Sophie Johnson, Gerry Leydon, David Rabago, Samantha Richards-Hall, Ian Williamson, Guiqing Yao and 4 more

Open access · goldAbstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 2 pooled it
3.5field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Review
  5. Article
  6. Frequency and causes of self-medication in patients with chronic rhinosinusitis, North of Iran, 2018-2019.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2022
    Article
  7. Article
  8. Review
  9. Article
  10. Reducing antimicrobial resistance through population empowerment.The European journal of general practice · 2017
    Article
  11. Article
  12. Nasal irrigation.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2016
    Article
  13. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 1 institution in 1 country.

Paul LittlePrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis. p.little@soton.ac.uk.
Beth StuartPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Mark MulleePrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Tammy ThomasPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Sophie JohnsonPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Gerry LeydonPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
David RabagoPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Samantha Richards-HallPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Ian WilliamsonPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Guiqing YaoPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
James RafteryPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Shihua ZhuPrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Michael MoorePrimary Care Group (Little, Stuart, Moore, Thomas, Johnson, Williamson), Health Economic Analyses Team (Yao, Raftery, Zhu) and Research Design Service South Central (Mullee), Primary Care and Population Sciences Unit (Leydon), University of Southampton, Southampton, UK; Patient and Public Involvement Collaborator (Richards-Hall), Southampton, UK; Department of Family Medicine and Community Health (Rabago), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
SNIFS Study Team
University of Southampton · GB

Funding

Department of Health RP-PG-0407-10098
6 · The paper itself

Abstract

backgroundSystematic reviews support nasal saline irrigation for chronic or recurrent sinus symptoms, but trials have been small and few in primary care settings. Steam inhalation has also been proposed, but supporting evidence is lacking. We investigated whether brief pragmatic interventions to encourage use of nasal irrigation or steam inhalation would be effective in relieving sinus symptoms.

methodsWe conducted a pragmatic randomized controlled trial involving adults (age 18-65 yr) from 72 primary care practices in the United Kingdom who had a history of chronic or recurrent sinusitis and reported a "moderate to severe" impact of sinus symptoms on their quality of life. Participants were recruited between Feb. 11, 2009, and June 30, 2014, and randomly assigned to 1 of 4 advice strategies: usual care, daily nasal saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions. The primary outcome measure was the Rhinosinusitis Disability Index (RSDI). Patients were followed up at 3 and 6 months. We imputed missing data using multiple imputation methods.

resultsOf the 961 patients who consented, 871 returned baseline questionnaires (210 usual care, 219 nasal irrigation, 232 steam inhalation and 210 combined treatment). A total of 671 (77.0%) of the 871 participants reported RSDI scores at 3 months. Patients' RSDI scores improved more with nasal irrigation than without nasal irrigation by 3 months (crude change -7.42 v. -5.23; estimated adjusted mean difference between groups -2.51, 95% confidence interval -4.65 to -0.37). By 6 months, significantly more patients maintained a 10-point clinically important improvement in the RSDI score with nasal irrigation (44.1% v. 36.6%); fewer used over-the-counter medications (59.4% v. 68.0%) or intended to consult a doctor in future episodes. Steam inhalation reduced headache but had no significant effect on other outcomes. The proportion of participants who had adverse effects was the same in both intervention groups.

interpretationAdvice to use steam inhalation for chronic or recurrent sinus symptoms in primary care was not effective. A similar strategy to use nasal irrigation was less effective than prior evidence suggested, but it provided some symptomatic benefit.

trial registrationISRCTN, no. 88204146.

Indexed as

Primary Health CareSteamAdultAgedChronic DiseaseCombined Modality TherapyFemaleHumansInhalationMaleMiddle AgedNasal LavageQuality of LifeRecurrenceSinusitisTreatment OutcomeSteam

Identifiers

PMID27431306
PMCPMC5026511
OpenAlexW2476925396

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.