Ideally, patients are supervised in the douching technique before they are discharged. It is well worth spending some time with the patient to make sure they know how to douche, both to see that they are doing it properly and to help them through the first time they do it (Fig. 13.2a, b). This will greatly help compliance. Most patients are advised to douche at least twice daily for 2 weeks and particularly before taking any topical medication (see instruction sheet for the patient on page 285-286). Often patients are advised to douche four times a day in the first week if the mucosa is very unhealthy. In patients with severe polyposis, or those who have had a long history of infective rhinosinusitis, it may take weeks or months for the cilia to recover and protracted douching over this period may be required (Fig. 13.3). In patients who have ciliary dysmotility or cystic fibro-sis, douching is needed in the long term. Some studies have shown that adding antibiotics such as to-

bramycin to the douching can help patients with cystic fibrosis.

It is interesting that studies have shown that douching, in its own right, helps relieve the symptoms of rhi-nosinusitis and the endoscopic appearance of mucosa (Taccariello et al., 1999; Heatley et al., 2001).

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