Additional medical therapies are often used in conjunction with antimicrobial agents to decrease sinonasal edema and reestablish a more normal functioning nasal environment. No controlled studies have been performed to document their efficacy in chronic pediatric rhinosinusitis. Investigators report that buffered hypertonic nasal irrigation provides rapid and effective cleansing of nasal debris, decreases mucosal edema, and may improve mucociliary flow patterns by decreasing ciliary transit times.7,48 Although frequent nasal irrigation with this solution may allow for a healthier sinonasal tract, the improvement lasts only hours.
For longer-lasting nasal decongestion in children with chronic rhinosinusitis, several Consensus Panel members support intranasal steroid sprays,17 which may be even more effective when used after hypertonic saline irrigation.48 These agents reduce cholinergic receptor sensitivity, reduce the number of basophils and eosinophils in nasal mucosa, and inhibit the
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