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Adding Budesonide to Nasal Sinus Irrigation Does Not Help In Chronic Sinusitis

Figured I'd post an article discussing a recent study that tested a new chronic sinusitis treatment, since so much of this site is devoted to sinusitis  - both the latest research and treatments. Eh... I wasn't impressed with the study.

Once again research was aimed at treating symptoms, rather than the actual microbial imbalance (dysbiosis) in the sinuses. No wonder it didn't work so well. The researchers added the corticosteroid drug budesonide to daily nasal saline irrigation in one group vs the other group just did daily nasal saline irrigation - both for 30 days. There were no statistically significant differences - both groups basically improved the same. 

The researchers felt that the budesonide group "trended" toward more of an improvement, but statistically there wasn't a difference. The study was nicely done: it was double-blind (no one knew who got what), it had a placebo group (the saline irrigation only group), and people were randomly put into one or the other group. The budesonide (a corticosteroid) was meant as an alternative to, and to see if it was better than using a corticosteroid nasal spray -  which many people with chronic sinusitis try for a while.

For those interested, here is the Sino-Nasal Outcome Test (SNOT-22) that people took before and after the 30 days of nasal irrigation, and which is used in many sinusitis studies.  Note that some of the questions, in my mind, are bizarre as a measure of sinusitis symptoms and totally not appropriate, especially these 3 questions: Sad? Embarrassed? Frustrated/restless/irritable? And some of the questions are too vague. They list "post nasal drip" which is vague.

Where is a question about "mucus dripping down the throat", and even perhaps "gagging on mucus or phlegm" or "constantly clearing throat"? Where is "waking up with a daily sore throat"? How about "constant headaches", or "constantly feeling sick", or "need to sleep semi-sitting up"? These are descriptions people give me again and again. So eh... the test could use improvement.

Bottom line: People with chronic sinusitis have for years been doing nasal saline irrigation to help treat sinusitis symptoms. It helps the symptoms a little, but typically doesn't cure.  From Medscape:

Does Budesonide Improve Outcome of Nasal Irrigation in Chronic Rhinosinusitis?

 In patients with chronic rhinosinusitis (CRS), addition of budesonide to daily large-volume, low-pressure saline sinus irrigation might lead to improved outcome, but the findings are not clear-cut. 

"In this study, we found that patients in both the nasal-saline-alone and nasal-saline-with-budesonide groups improved, but patients in the budesonide group experienced a greater improvement," Dr. Jay F. Piccirillo of Washington University School of Medicine in St. Louis, Missouri, told Reuters Health by email.

In a paper online June 7 in JAMA Otolaryngology-Head & Neck Surgery, Dr. Piccirillo and colleagues report on a study in which they randomly assigned 74 patients to receive a sinus-rinse kit including saline and identical-appearing capsules that contained either budesonide or lactose placebo. The patients were told to dissolve two capsules of the study drug into the sinus-rinse bottle along with the saline, and to irrigate the left and right nasal cavity with one-half of the contents of the nasal rinse once daily for 30 days.

Outcome was measured via patients' response to the Sino-Nasal Outcome Test (SNOT-22). This validated questionnaire captures the physical, functional and emotional consequences of rhinosinusitis. Scoring ranges from 0 to 5 for each of 22 questions covering items such as sneezing, nasal obstruction and fatigue.

There were no adverse events in either group and the average change in SNOT-22 scores was 20.7 points for those in the budesonide group and 13.6 points for controls (mean difference, 7 points; 95% confidence interval, -2 to 16). When excluding one non-compliant patient in the budesonide group, the mean difference in the change in SNOT-22 scores rose to 8.5 (95% CI, -0.6 to 18.0).

A total of 23 participants (79%) in the budesonide group experienced a clinically meaningful reduction in their SNOT-22 scores compared with 19 (59%) in the control group - also not a significant difference. The mean reduction in endoscopic scoring was also in favor of the budesonide group (3.4 points) compared to controls (2.7 points), though again the difference fell short of significance.

14 thoughts on “Adding Budesonide to Nasal Sinus Irrigation Does Not Help In Chronic Sinusitis

  1. Hilary

    Thanks for this review. I was recently advised to try EDTA instead of budesonide-NAC in my neti-pot. Have you heard of this working? I have been using budesnoide-NAC and have found some improvement over the neti-pot alone, but not much. Thanks!

    1. Sima

      I have not heard from anyone that such solutions help in treating sinusitis. These approaches try to treat the symptoms rather than the cause (which is one approach to sinusitis treatment). Another approach is viewing sinusitis as a microbial imbalance problem (dysbiosis), and to try to get beneficial bacteria into the sinuses - with the beneficial bacteria predominating over or suppressing pathogenic bacteria. This approach is discussed in The One Probiotic That Treats Sinusitis.

  2. Ramona

    My laryngologist prescribed budesonide for my post nasal drip. To use with netti pot. I been using it for 1 week and my throat is on fire, nose running and I am miserable. I called Dr this morning, waiting on a call back. I am stopping the budesonide, but will continue using the rinse till I hear back from her.

  3. Rick Jimenez

    Could it be possible that adding Budesonide to the nasal irrigation in long term use, could actually lead or cause sinus infections, either bacterial or fungal?

    1. Sima

      I don't know. Budesonide is an anti-inflammatory and not an antibacterial.
      Perhaps if Budesonide is used constantly it could alter the sinus microbiome, which could then bring on symptoms.??
      I do know that no one has reported that Budesonide has helped their sinusitis - everyone said it didn't help at all.

  4. rebecca

    doesnt seem to work for me the actual rinse made me worse and caused throat inflammation and worse upper airway sleep apnea.
    in the nebulizer mask treatment helped at seemed.then seemed to cause inflammation...possible yeast overgrowth.
    in the MAD device got some greenish mucous out first time used then was not effective and casued nerve pain in head and back of head consistent with trigeminal neuralgia..especially in dry high altitude. when tried the MAD device with budesonide even in low alt humid climate was ineffective and bascially came right back out. my situation is getting way out of hand. i have multiple chem sensitivy and react to almost everything in the enviroment. my sleep apnea always comes back bc i cannot keep the sinuses without thick inflammation and mucous. i also can not do sinus rinses as they make me worse and get stuck and it builds up get bacterial infection. have had jaw surgeies and sinus surgeries. have maxillary transverse posterior descrepancy right side (which is where all the problems are) i suspect i have an anotomical defect..born or developed and no amout of surgery or treatment seems to help. i cant live out west where husband is and cant find a rental i dont react to. go from hotel to hotel..which react to also bc of carpet, the cleaning scents and chemicals and if i end up in one with mold i end up severe and have to get out. ive rented places and had to break the lease rt pesticides being sprayed and also tried living near ocean which md they spray overboard aeiral airplane spraying affects extreme.

    1. Sima

      Sounds like you're really suffering.
      Another possible approach is to try to get beneficial bacteria (probiotics) into the sinuses and respiratory system. See The Best Probiotic For Sinus Infections for more about this approach, especially using Lactobacillus sakei. It's self-experimentation, but works for most sinusitis sufferers (according to feedback and personal experiences).

      1. Rebecca

        Found out have immune response to nickel which is in my bilateral tmj artif joints. We think this is the partial cause of the Chronic and very uncomfortable issues wi my sinus and upper airway. As well as the metal screws in maxilla.
        Had dental implants removed. No health insurance and unable to have the screws or tmj joints removed at this time v difficult situation.
        Immunologist doesn’t think I will be well unless it’s all removed and replaced.
        Am now in texas. Finally found place to rent can tolerate.
        Also found out in first jaw surg they trim nasal septum which is prob another reason I have dry sinus as well as I found out that without my knowledge orn discussing or even telling me after worsening problems ent had taken out most of the right inf turbinate in 2016I what i thot was a routine antrectomy so no wonder. What a mess. Didn’t find out until 3 years later that my right inf turbinate was removed. Found out by another ent who wrote it on my post visit notes. I was stunned!

  5. Guy Bodemer

    I disagree I had a cronic condition for years constantly on anti-biotic I started nasal rinse with Budesonide 0.6mg/Ml and salt 120ml twice a day. I went almost two years without a sinus infection,I even stopped my allergy shots & use Allegra 180mg seasonally. The nasal rinse changed my life only issue medicare doesn't cover it

    1. C.G. Lindsey

      I just began using this solution in my Water Pik 2 weeks ago. I have a 4" elbow shaped surgical device that I thread through my sinuses to deliver the Budesonide/saline solution. I have a long history of having to use oral steroids to reduce swelling. I'm well aware of the adverse affects of their use & hope this treatment is effective. I've had 6 sinus surgical procedures since 1994. I received allergy shots for years & didn't benefit much if at all. I also have had asthma since age 2 and am now 66. I am aware that medicine is an art, not an exact science. It is helpful to hear the stories of other people. Thank you.

  6. Ray C

    I am currently on a course of Pulmnicort saline rinse for my chronic sinitus as a last ditch attempt to help me and i must say it has been a miracle in my eyes .Have tried everything under the sun to no affect .Even i thought it would be a waste of time,but how wrong was I...Thankyou

    1. " class="comment-author-name u-url url" rel="ugc external nofollow">Jacqueline

      I did that for 4 weeks before bed every night. After 4 weeks I woke up to burning in my nose very bad. I stopped it. I am so congested in the head all day I'm going to give it another try. Am I doing it at a bad time??

      1. Sima

        Unfortunately, studies find that adding all sorts of products (Budesonide, xylitol, the probiotic L. lactis, etc.) to saline rinses does not work.
        Does not treat sinusitis and does not improve the sinus microbiome.
        So far only the probiotic L. sakei consistently works, and even then not for everyone (because the sinus microbiome is different in everyone).
        It comes down to self-experimentation to see what helps you.
        If you feel worse from something, stop using it. It's not helping.


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