Table 4.
Summary of evidence-based statements
| Statement | Action | Strength |
|---|---|---|
| 1. Nasal saline irrigation | Clinicians should recommend nasal saline irrigation to patients with chronic sinusitis or those who have undergone endoscopic sinus surgery. | Strong recommendation |
| 2. Saline tonicity | Clinicians may recommend using isotonic saline as a nasal irrigation solution for patients considering cost, convenience, and safety. However, it is unclear whether there is a clear difference in the therapeutic effect of hypertonic and isotonic saline solutions. | Option |
| 3. Saline temperature | Clinicians may recommend using room-temperature saline (around 20°C) as a nasal irrigation solution for patients considering effectiveness and convenience. If the patient prefers, then it is also completely acceptable to use a saline solution heated to 40°C. However, it is not recommended to immediately use a solution that has been refrigerated or to use a hot solution that exceeds 40°C for safety reasons. | Option |
| 4. Steroid solution | Clinicians may recommend nasal irrigation with solutions containing steroids to patients with chronic rhinosinusitis who have undergone endoscopic sinus surgery. | Option |
| 5. Antibiotic solution | Clinicians should not routinely recommend nasal irrigation with solutions containing antibiotics for the management of patients with chronic rhinosinusitis or those who have undergone endoscopic sinus surgery. | Recommendation against |
| 6. Antifungal solution | Clinicians should not routinely recommend nasal irrigation with solutions containing antifungal agents for the management of patients with chronic rhinosinusitis or those who have undergone endoscopic sinus surgery. | Recommendation against |
| 7a. Miscellaneous solution–hyaluronate | Clinicians may recommend nasal irrigation with solutions containing sodium hyaluronate to patients with chronic rhinosinusitis. | Option |
| 7b. Miscellaneous solution–xylitol | Clinicians may recommend nasal irrigation with solutions containing xylitol to patients post-endoscopic sinus surgery. | Option |
| 7c. Miscellaneous solution–honey | Clinicians should not routinely recommend nasal irrigation with solutions containing honey for the management of patients with chronic rhinosinusitis or those who have undergone endoscopic sinus surgery. | Recommendation against |
| 8. Irrigation solution preparation | Clinicians should recommend an appropriate irrigation fluid preparation method for patients with chronic rhinosinusitis or those who have undergone endoscopic sinus surgery. For irrigation fluid, bottled or distilled water should preferably be used. If tap water is used, boil it for at least 5 minutes and cool before use or expose it to ultraviolet light for at least 45 seconds. | Recommendation |
| 9. Equipment | Clinicians should recommend nasal irrigation performed by high-volume with low- or high-pressure delivery rather than low-volume with low- or high-pressure delivery in patients with chronic rhinosinusitis. | Recommendation |
| 10. Disinfection | Clinicians should recommend the following techniques for appropriate irrigation equipment care to patients with chronic rhinosinusitis or those who have undergone endoscopic sinus surgery. Irrigation equipment (according to the equipment material and manufacturer’s recommendations, if possible) should be boiled (for more than 2 minutes) or microwaved for 1 minute and 30 seconds regularly before and after use. | Recommendation |
| 11. Posture | Clinicians may recommend the head down-and-forward position as being better for high-volume nasal irrigation, whereas the nose-to-ceiling position is more effective at delivering low-volume nasal irrigation. | Option |