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PRACTICE: Neil K Chadha and Rashmi Chadha 10-minute consultation: sinusitis BMJ 2007; 334: 1165 [Full text]

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Benefit of nasal swabs?

Lester M Baskin   (2 June 2007)

Author's Reply

Neil K Chadha, Rashmi Chadha   (4 June 2007)

Nasal Saline Douching

Kerry J Lang   (4 June 2007)

Benefit of nasal swabs? 2 June 2007
Lester M Baskin, internist 2222 NW Lovejoy, Portland, OR 97210 Send response to journal: Re: Benefit of nasal swabs?	I follow US (and international) guidelines in encouraging patients to wait a week until resorting to antibiotics, as the authors recommend. I do not take swabs, though, nor do any of my primary care colleagues I informally polled. Is this recommendation expert opinion or evidence-based? I appreciated the authors' easy to follow and clear guidance in the article. Warmly Lester Baskin Portland, OR, USA Competing interests: None declared
Author's Reply 4 June 2007
Neil K Chadha, Specialist Registrar in ENT Royal Devon & Exeter Hospital, Rashmi Chadha Send response to journal: Re: Author's Reply	Dear Dr Baskin, Thank you very much for your interest in our article. In reference to your question about taking pus swabs, this is based on expert opinion, current evidence, and the principles of good microbiology practice. A nasal pus swab may be helpful in indicating the aetiology of the sinusitis, and is of particular assistance in guiding appropriate antiobiotic therapy in those who do not respond to empirical treatment. Resistant organisms are becoming an increasing problem in the UK, and I suspect in the US. If antibiotic therapy is initiated and swabs are not concurrently taken, this may jeopordise the microbiologists' ability to interpret growth and sensitivities of subsequent culture swabs. Culture swabs are a cost-effective and easy test to perform in the primary care setting. Several microbiology studies (Evidence Level IIb) have shown a reasonable correlation between specimens taken and pathogens within the sinuses. Further information is available in the "European Position Paper on Rhinosinusitis and Nasal Polyps" linked in our article. regards, Neil K Chadha Rashmi Chadha Competing interests: None declared
Nasal Saline Douching 4 June 2007
Kerry J Lang, Hospital Retainer in ENT North Glasgow Trust, G12 0YN Send response to journal: Re: Nasal Saline Douching	I enjoyed the informative 10-minute consultation on Sinusitis by Chadha and Chadha(1) on diagnosing and treatment / referral for sinusitis. A simple, proven, well tolerated, virtually no side effect treatment option that was not mentioned in the article(2,3,4). This is nasal saline douching. There are many over the counter preparations that can be purchased. A recipe can be made up at home and administered as a much cheaper alternative. The recipe is: 1 pint of boiled, cooled water 1 tablespoon of rock salt 1 teaspoon of bicarbonate of soda These are mixed together and syringed into the nasal cavities by the patient with a basin underneath. Nasal douching can be used as often as required and is a useful adjuvant to other treatments. References 1.Chadha NK, Chadha, R. 10 minute consultation Sinusitis.BMJ 2007;334:1165. 2.Taccariello M, Parikh A, Dardy Y, Scadding G : Nasal saline douching as a valuable adjunct in the management of chronic rhinosinusitis. Rhinology 1999;37:29-32 3.Heatley DG, McConnell KE, Kille TL, Leverson GE. Nasal irrigation for the the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg 2001;125:44-8 4.Rabago D, Zgierska A, Mundt M, et al. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomised control trial. J Family Practice 2002;51:1049-55 Competing interests: None declared