Araya Satdhabudha,1 Orapan Poachanukoon,1,3 Sumalee Kondo,2 Paskorn Sritipsukho,1,3 Sira Nanthapisal,1,3 Natnicha Ingviya4

1 Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
2 Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
3 Center of Excellence in Applied Epidemiology, Thammasat University, Pathum Thani, Thailand
4 Department of Pathology, Prince of Songkla University, Faculty of Medicine, Songkhla, Thailand

Abstract

Background: Nasal irrigation is an effective component of sino-nasal disease management. Nonetheless, bacterial contamination is worrisome.
Objective: To study bacterial colonization incidence using squeeze-bottle nasal irrigation devices, after disinfection with soap or soap-plus-microwave technique, in pediatric acute rhinosinusitis.
Methods: A randomized, prospective, controlled study was conducted on acute rhinosinusitis children, aged 2-15 years. Each participant was randomized into a soap-cleaning or soap-plus- microwave group. For a two-week period, participants irrigated their nostrils with NSS twice daily and cleaned the bottle after each use. In the end, bottles were sent to a microbiological laboratory for bacterial identification.
Results: The mean 5S Score and satisfaction score gradually improved in both groups with no significant differences between groups. Bacterial identification frequency in the soap group was slightly higher than in the soap-plus-microwave one, without statistical significance. For safety and tolerability, all participants reported 100% adherence to nasal irrigation. The soap-plus-microwave group reported more minor adverse outcomes than the soap-cleaning one. No thermal deformation of irrigation bottles was observed.
Conclusion: Regular cleaning of nasal irrigation devices is needed to minimize bacterial contamination. Only soap or soap plus microwave disinfection appeared simple and safe for disinfection. Both techniques can equally minimize the rate of bacterial contamination. Although no gross thermal deformation at optimal power and duration, chemical irritants after high power or long microwave durations may be a concern.
Key words: acute rhinosinusitis, bacterial contamination, microwave disinfection, nasal irrigation device, pediatric rhinosinusitis