Smaller injections, milder pressure, new position of the child; CHU Sainte-Justine is overhauling its famous nasal hygiene method, which is suspected of contributing to recurring ear infections, La Presse has learned. New documents will be printed and the relevant videos on the mother and child facility website will be replaced.
Posted at 5:00 am.
“CHU Sainte-Justine’s new guidelines on nasal hygiene will be published in the coming weeks,” the facility explains via email. “In light of new evidence, it is now recommended that children clean their noses as needed, using less water and applying less pressure. »
As cold and ear infection season approaches, parenting groups are arguing on social media: Should the traditional “Sainte Justine Method,” which many doctors have been working on for more than a decade, be used or not? This saline nasal rinsing technique would reduce the frequency and duration of multiple viral infections. Some assure that their ENT doctor swears by it; The others are instructed by their specialist to put an end to it.
“Over the years there has been a lot of confusion and considerable disagreement,” says Dr. Annie Lapointe, pediatric ENT at CHU Sainte-Justine and board member of the Association of ENT of Quebec.
PHOTO ALAIN ROBERGE, LA PRESS ARCHIVE
Dr. Annie Lapointe, pediatric ENT at CHU Sainte-Justine
Who tells the truth? In case of doubt, due to a lack of sufficient scientific literature in pediatrics, the CHU Sainte-Justine takes it easy and revises its instructions. Although nasal hygiene remains beneficial, the currently recommended technique may be “too aggressive” and “contribute to recurrent ear infections,” explains Dr. Lapointe.
In the spring, the otolaryngologist wrote an email to his colleagues at four other major university hospitals in Quebec to find out their position. She then found that each facility made its own recommendations.
For what ? In recent years, health experts, including those at Sainte-Justine, have observed fluid flowing into the ears of young patients whose nostrils were flushed with 10 ml syringes. This was noticeable in children who had tubes inserted into their eardrums. The pressure of the jet, which we wanted to see enter through one nostril and exit through the other, was visibly too strong.
Many pediatricians and otolaryngologists have come to the Quebec City University Hospital simply to advise against the technique advocated by Sainte-Justine. “We do not recommend the syringe method as these involve quite large volumes that can potentially put pressure on the Eustachian tubes that connect to the middle ear,” explains Dr. Marc-André Dugas, head of pediatrics at the Mother-Child Center of Soleil. Children’s Center at the CHU de Québec.
ILLUSTRATION FROM ADAM HEALTH WEBSITE
At birth the Eustachian tube is horizontal and slow, year after year it becomes oblique and the ear is higher than the nose, around the age of 6-7 years. This contributes to recurrent ear infections in children, notes Dr. Annie Lapointe.
“Our ENT doctors feel that serous ear infections can occur and block the ears backwards,” he continues. The other thing is that we have to ask ourselves if we need pressurized syringes for most children… Probably not. For the vast majority of patients, suction, suction, and non-pressure fluid solutions may be sufficient. »
A new procedure
In Sainte-Justine, “patients were told for two years to be gentler on nasal hygiene, but there were still problems,” notes Dr. Lapointe.
The hospital center will now recommend swapping 10ml syringes – “the plunger is too big” – for 3ml syringes, similar to the droppers favored when the Sainte-Justine method was introduced some time ago. 25 years old and abandoned for hygiene reasons.
The new recommended format is reminiscent of the single-rinse bottles sold in pharmacies, a choice that is always recommended, although “less economical and ecological”. The goal is gentle hydration, about 1 ml per second.
Nasal hygiene with doses of 3 ml can be repeated depending on the patient’s age and condition. The recipe for the solution does not change.
The new documentation will also advise parents to perform nasal hygiene while the child is lying on their back – “in the diaper changing position” – rather than on their side, to prevent fluid from entering the ears. “We want to push the liquid backwards, like a plow pushes snow, so the baby swallows it and his stomach kills the microbes,” explains Dr. Lapointe.
The CHU Sainte-Justine did not respond to our question whether the institution intended to issue a mea culpa to the parents of young patients who could have developed repeated ear infections in recent years due to excessively intensive instructions.