Table 2.
Studies of Patients With Acute Rhinosinusitis. a
| First Author | Year | Study type | Patients b | Saline type c | Buffered | Devices c | Treatment duration | Outcomes | Main result |
|---|---|---|---|---|---|---|---|---|---|
| Adult | |||||||||
| Chitsuthipakorn 31 | 2021 | RCT | 61: adult, ARS | I: Isotonic saline (30). II: No saline (31) | I: Yes. II: NA | Squeeze bottle. 250 mL. 1 bottle/time | 2 times/d, 2 wk | SNOT-22, rhinologic subscore, symptom VAS, MLKES, % cure rate | No difference between groups in any outcomes. Post hoc analysis showed the benefits of saline irrigation in the viral subgroup. |
| Piromchai 32 | 2021 | RCT (crossover) | 12: adult, ARS | Isotonic saline | Yes | I: Syringe with nasal applicator (12). II: Syringe 10 mL alone (12). | 10 min | Overall effectiveness | The syringe with nasal applicator had better overall effectiveness scores than the syringe alone. |
| Ramalingam 30 | 2019 | RCT | 61: adult, URI | I: Irrigation and gargling with hypertonic seawater 2%-3% (30). II: No irrigation and gargling (31) | I: Yes. II: NA | Not stated. 100 mL | 6 times/d, 2-14 d | Duration of illness, OTC medication used, viral shredding | Duration of illness reduced by 1.9 d and less medication used by 36% in the irrigation/gargling group |
| Chanaseeyotin 33 | 2016 | RCT | 48: adult, ABRS | I: Isotonic saline (25). II: No saline (23) | I: Yes II: NA | Syringe. 20 mL, 5 times/nostril | 2 times/d, 4 wk | Symptom VAS, SNOT-20 | No difference between groups in any outcomes. |
| King 35 | 2015 | SRMA (3 studies) | 542: adult (152), children (390), URI | Isotonic saline or isotonic seawater vs no saline | Any | Spray. 2-3 sprays/nostril | 3-6 times/d, 1-3 wk | Days to resolution, antibiotic usage | No difference between groups |
| Gelardi 29 | 2009 | RCT | 20: adult, ARS | Warm isotonic saline (36 ºC) | No | I: Syringe 10 mL (10). II: Irrigation bag 250 mL (10) | I: 3 times daily. II: 2 times/d, 2 wk | Symptom (VAS), RMM | Irrigation bag improved symptom and nasal resistance better than a syringe |
| Ural 4 | 2009 | RCT | 24: adult, AR/ARS/CRS | I: Hypertonic saline 3% (12). II: Isotonic saline (12) | I: No. II: No | Syringe. 4 mL/side | 2 times/d, 10 d | STT | Isotonic improved STT, but the hypertonic did not |
| Hauptman 34 | 2007 | RCT | 80: adult, ARS | I: Hypertonic saline (40). II: Isotonic saline (40) | I: Yes. II: Yes | Spray. 1 mL/side, 1 time | 10 min | Symptoms, ARM, STT | Not difference between groups for symptom reduction. Hypertonic better improved STT but had worse ARM than isotonic saline. |
| Passàli 28 | 2005 | RCT | 200: adult, ARS | Isotonic saline | No | I: Atomized douche (7-8 mL) (100). II: Syringe 20 mL (100) | 4 times/d, 15 d | GSS, RMM, ARM, STT | Atomized douche improved all outcomes. But the syringe did not |
| Inanli 27 | 2002 | RCT | 60: adult, ARS | I: Hypertonic saline 3.0% (12). II: Isotonic saline (13). III: Nasal steroid spray (14). IV: Oxymetazoline 0.05% (9). V: No saline (12) | I: Yes. II: Yes. III: NA. IV: NA. V: NA | Irrigation 10 mL. | 3 times/d, 3 wk | STT | No difference between groups |
| Adam 26 | 1998 | RCT | 119: adult, ARS | I: Hypertonic saline 1.6% (41). II: Isotonic saline (35). III: no saline (43) | I: Yes. II: No. III: NA | Spray. 2 sprays/nostril | 3 times/d, 1 wk | Third-day nasal symptom score, days to resolution | No difference between groups in any outcomes |
| Children | |||||||||
| Cabaillot 41 | 2020 | SRMA (4 studies) | 489: children, ARS/URI | Hypertonic saline 2.3% or isotonic saline (334) vs no saline (155) | Any | Drop, syringe, spray, jet flow. | 2 d–3 wk | Rhinologic score, health status scores. | Saline irrigation benefited for rhinological symptoms |
| Satdhabudha 40 | 2017 | RCT | 74: children, ARS | Hypertonic saline 1.25% | Yes | I: Squeeze bottle 240 mL (38). II: Syringe 20 mL (36) | 2 times/d, 2 wk | 5S, satisfaction score, medication used | Squeeze bottle improved in 5S and satisfaction scores more than syringe |
| Köksal 39 | 2016 | RCT | 109: children, URI | I: Isotonic saline (38). II: Hypertonic seawater 2.3% (36). III: No saline (35) | I: No. II: Yes. III: NA | Drop | 3 vials daily, 5 d | Nasal symptoms at days 1 and 7, sleep quality | Saline and seawater drop relieved nasal symptoms and improved sleep quality vs no saline |
| Wang 38 | 2009 | RCT | 69: children, ARS | I: Isotonic saline (30). II: No saline (39) | I: No. II: NA | Syringe. 15-20 mL. | 1-3 times/d, 3 wk | TSS, PRQLQ, nPEFR, nasal smear, Water’s film score | Saline irrigation improved TSS, PRQLQ, nPEFR vs no saline |
| Šlapak 37 | 2008 | RCT | 390: children, common cold | I: Isotonic seawater (99). II: Isotonic seawater (95). III: Isotonic seawater (95). IV: No saline (101) | I: Yes. II: Yes. III: Yes. IV: NA | I: Jet flow 9 mL/side. II: Fine spray 3 mL/side. III: dual formula fine spray 3 mL/side. IV: NA | 6 times/d, 3 wk | Nasal symptoms, medication used | Saline group showed faster resolution of some nasal symptoms and less medication used |
| Bollag 36 | 1984 | RCT | 46: children, URI | I: Isotonic saline (15). II: Phenylephrine drop (16). III: No saline (15) | I: No. II: NA. III: NA | Drop. 4 drops/side. | Every 2 h, 2 d | Nasal symptoms, respiratory symptom | No difference between groups |
Abbreviations: 5S, 5 Symptoms Score; ABRS, acute bacterial rhinosinusitis; AR, allergic rhinitis; ARM, acoustic rhinometry; ARS, acute rhinosinusitis; CRS, chronic rhinosinusitis; GSS, Global Symptom Score; MLKES, Modified Lund-Kennedy Endoscopic Score; NA, not applicable; nPEFR, nasal peak expiratory flow rate; OTC, over the counter; PRQLQ, Pediatric Rhinoconjunctivitis Quality of Life Questionnaire; RCT, randomized controlled trial; RMM, rhinomanometry; SNOT, Sino-nasal Outcome Test; SRMA, systematic review and meta-analysis; STT, saccharin transit time; TSS, Total Symptom Score; URI, upper respiratory tract infection; VAS, visual analog scale.
a
Roman numerals indicate patients groups.
b
Patient total number, age group (number per group), and disease.
c
Number per group in parentheses.