Saline irrigation for chronic rhinosinusitis

Chong LY

Published in Cochrane Database of Systematic Reviews

Methodology

Cochrane systematic review and meta-analysis of randomised controlled trials of nasal saline irrigation in adults with chronic rhinosinusitis, using GRADE certainty assessment and disease-specific quality-of-life primary outcomes.

Key Findings

Cochrane review of saline irrigation in chronic rhinosinusitis found low-quality evidence that high-volume hypertonic saline improved disease-specific quality of life at three months versus no treatment (SNOT-20 improvement of about 1.4 points on a 5-point scale), with no clear benefit over intranasal steroids and no serious adverse effects; evidence comparing saline types was insufficient.

Conclusions

Large-volume saline irrigation is a safe, low-cost adjunct that may modestly improve chronic rhinosinusitis symptoms, but the evidence is low certainty and it does not outperform intranasal steroids.

Limitations

Only two eligible trials with 116 participants total; both at high risk of bias and unblinded; short follow-up; heterogeneous saline volumes, tonicities and delivery devices; certainty rated low to very low.