“There is great confusion”

Smaller syringes, softened pressure, new position of the child; the CHU Sainte-Justine is revising its famous nasal hygiene method, suspected of contributing to recurrent ear infections, we have learned The Press. New documents are being printed and the authoritative videos on the mother-child establishment website will be replaced.

“The new guidelines from CHU Sainte-Justine regarding nasal hygiene will be published in the coming weeks,” explains the establishment by email. “In light of new evidence, it is now recommended that children’s noses be cleaned as needed, using less water and applying lighter pressure. »

As the cold and ear infection season approaches, groups of parents are arguing on social networks: to apply or not the traditional “Sainte-Justine method”, hammered out for more than a decade by many doctors? This nasal irrigation technique using a saline solution would reduce the frequency and duration of several viral infections. Some assure that their otorhinolaryngologist (ENT) swears by it; the others are told by their specialist doctor to put a stop to it.

“There is a lot of confusion and significant differences of opinion that have arisen over the years,” admits the DD Annie Lapointe, pediatric ENT at CHU Sainte-Justine and member of the board of directors of the Association des ENT du Québec.


The DD Annie Lapointe, pediatric ENT at CHU Sainte-Justine

Who’s telling the truth? When in 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 could be “too aggressive” and “contribute to repeated ear infections”, explains the DD The point.

In the spring, the ENT wrote an email to his colleagues at four other large university hospitals in Quebec to find out their position. She then noted that each establishment made its own recommendations.

For what ? In recent years, health professionals, including those at Sainte-Justine, have observed that liquid was flowing into the ears of young patients whose nostrils were irrigated with 10 ml syringes. This was striking in children who had tubes placed in their eardrums. The pressure of the jet, which we wanted to see enter through one nostril then exit through the other, was visibly too strong.

At the Quebec City University Hospital, many pediatricians and ENT specialists have come to simply advise against the technique promoted by Sainte-Justine. “We do not recommend the syringe method, because these are quite large volumes which can potentially put pressure on the Eustachian tubes which are connected to the middle ear”, specifies the Dr Marc-André Dugas, head of the pediatrics department at the Soleil mother-child center at the CHU de Québec.


At birth, the Eustachian tube is horizontal and slowly, year after year, it becomes oblique and the ear is higher than the nose, around 6-7 years of age. This contributes to repeated ear infections in children, notes the DD Annie Lapointe.

“Our ENT specialists have the impression that it can lead to serous ear infections and fill the ears backwards,” he continues. The other thing is that we have to ask ourselves if we need, for the majority of children, syringes with pressure… Probably not. The aspirator, suction and pressureless hydration solutions may be sufficient for the vast majority of patients. »

A new procedure

At Sainte-Justine, “for two years, patients have been told to perform nasal hygiene more gently, but there were still problems,” notes the D.D The point.

The hospital center will now recommend swapping 10 ml syringes – “the piston is too big” – for 3 ml syringes, similar to the droppers favored when the Sainte-Justine method was implemented some time ago. 25 years old, and abandoned for hygiene reasons.

The new recommended format is reminiscent of the single irrigation vials sold in pharmacies, a choice always recommended, although “less economical and ecological”. The goal is to provide gentle hydration, approximately 1 ml per second.

Nasal hygiene with doses of 3 ml can be repeated depending on the age and condition of the patient. The recipe for the solution does not change.

The new documentation will also advise parents to perform nasal hygiene while the child is on their back – “in diaper changing position” – and not on their side, to prevent liquid from going down to the ears. “We will want to push the liquid backwards like the plow pushes snow, so that the baby swallows it and his stomach kills the microbes,” explains the DD The point.

The CHU Sainte-Justine did not respond to our question as to whether the establishment intended to issue a mea culpa to the parents of young patients who could have developed repeated ear infections due to overly intense instructions in recent years.

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