Table 3.
Studies of Patients With Chronic Rhinosinusitis. a
| First Author | Year | Study type | Patients b | Saline type c | Buffered | Devices | Treatment duration | Outcomes | Main result |
|---|---|---|---|---|---|---|---|---|---|
| Adult | |||||||||
| Liu 55 | 2020 | SRMA (7 studies) | 454: adult, CRS | Hypertonic saline vs isotonic saline | Any | Any | Any | Symptom score, radiologic score, STT | Hypertonic saline improved symptoms and STT more than isotonic saline. |
| Muthubabu 54 | 2020 | RCT | 60: adult, CRS | I: Hypertonic saline 3.5% (30). II: Isotonic saline (30) | I: No. II: No | Squeeze bottle, 100 mL | 3 times/d, 6 wk | SNOT-20 subscores (obstruction, discharge, postnasal drip, ear pain, facial pain) | Hypertonic saline showed significant improvement in symptoms more than isotonic saline. |
| Rachana 52 | 2019 | RCT | 400: adult, CRS | I: Isotonic saline (200). II: No saline (200) | I: Yes. II: NA | Syringe, 20 mL/side | 2 times/d, 4 wk | Nasal symptoms, RSDI | Saline group showed more improvement on symptoms than no saline. |
| Nimsakul 51 | 2018 | RCT | 23: adult, CRS | I: Heated isotonic saline (12). II: Nonheated isotonic saline (11). III: Heated isotonic saline (9 healthy) | I: No. II: No. III: No | Squeeze bottle, 250 mL | One time | Nasal symptom, STT, PNIF, ARM | No difference between heated and nonheated saline |
| Chong 50 | 2016 | SRMA (1 study) | 76: adult, CRS | Saline irrigation vs no saline | Any | Any | Any | HRQL, patient-reported disease severity, endoscopic score, CT score, adverse event | Saline improved QoL and symptoms vs no saline. |
| Nikakhlagh 46 | 2016 | RCT | 185: adult, CRS | I: No saline (not stated). II: Hypertonic saline (not stated). III: Isotonic saline (not stated). IV: Hypotonic saline (not stated) | I: NA. II: No. III: No. IV: No | Not stated | Not stated, 3 wk | Nasal symptoms | Isotonic saline showed better effect than hypertonic saline on nasal congestion. |
| Sudhakaran 56 | 2016 | RCT | 46: adult, CRS | I: Hypertonic saline 3% (23). II: Isotonic saline (23) | I: No. II: No | Drop, 10 drops/nostril | 3 times/d, 4 wk | LM score, symptom VAS | Hypertonic saline was more effective than isotonic saline in symptoms VAS reduction and radiologic score. |
| Kumar 57 | 2013 | RCT | 42: adult, CRS | I: Hypertonic saline 3.5% (21). II: Isotonic saline (21) | I: No. II: No | Drop, 10 drops | 3 times/d, 4 wk | Symptoms, radiologic score | Hypertonic saline was more effective than isotonic saline in symptom reduction and radiologic score. |
| Berjis 49 | 2011 | RCT | 114: adult, CRS | I: Hypertonic saline 3% (57). II: Isotonic saline (57) | I: No. II: No | Drop, 4-5 drops | Frequency, not stated, 1 mo | Symptoms, patient satisfaction | Hypertonic saline irrigation was more effective than isotonic saline in symptom reduction and patient satisfaction |
| Čulig 48 | 2010 | RCT | 60: adult, CRS | I: Hypertonic seawater 2.1% (30). II: Isotonic seawater (30) | I: Yes. II: Yes | Spray, 3 s of continuous spray/side | 3-6 times/d, 2 wk | Nasal symptoms, medication used | Hypertonic seawater improved all symptoms while isotonic seawater improved only congestion and rhinorrhea |
| Ural 4 | 2009 | RCT | 42: adult, AR/ARS/CRS | I: Hypertonic saline 3% (18). II: Isotonic saline (24) | I: No. II: No | Syringe, 4 mL/side | 2 times/d, 10 d | STT | Hypertonic saline improved STT, but isotonic saline did not. |
| Harvey 47 | 2007 | SRMA (6 studies) | 334: adult-children, CRS | Saline vs no treatment, Saline vs placebo, Hypertonic vs isotonic saline | Any | Any | Any | QoL measures, symptom scores, adverse events, radiologic scores, endoscopic score | Saline irrigations improve CRS symptoms vs no-saline irrigation. |
| Friedman 45 | 2006 | RCT | 42: adult, CRS | I: Hypertonic Dead Sea solution 1.8% (22). II: Hypertonic saline 1.8% (20) | I: Yes. II: No | Irrigation (volume not stated) and spray | 2 times/d, 1 mo | Nasal symptoms, RQLQ | Hypertonic Dead Sea solution is more effective in reducing RQLQ and symptom score than the hypertonic saline. |
| Heatley 43 | 2001 | RCT (crossover) | 128: adult, CRS | I: Hypertonic saline 2.7% (43). II: Hypertonic saline 2.7% (39). III: No treatment (reflexology, 46) | I: No. II: No. III: NA | I: Bulb syringe. II: Irrigation pot (volume not stated for both). III: NA | Once daily, 2 wk then crossover between 1 and 2 | RSOM31, SF36, patient satisfaction, medication use | There was no difference between the irrigation groups and reflexology after 2 wk |
| Bachmann 44 | 2000 | RCT | 40: adult, CRS | I: Emser hypertonic saline 1.1% (20). II: Isotonic saline (20) | I: Yes. II: No | Nasal irrigator, 200 mL | 2 times/d, 7 d | Symptoms, endoscopic finding, STT, olfactometry, RMM | No difference between Emser salt hypertonic solution and isotonic irrigation at 7 d |
| Taccariello 42 | 1999 | RCT | 62: adult, CRS | I: Isotonic seawater (21). II: Hypertonic alkaline saline (19). III: No saline (22) | I: Yes. II: Yes. III: NA | I: Spray. II: Douche 60 mL. III: NA | 2 times/d, 8 wk | STT, CBF, endoscopic score, ARM, QoL, nasal score diary card | Both saline groups showed significant improvements in endoscopic score or QoL, while no improvement was found in the control group at 8 wk |
| Children | |||||||||
| Shoseyov 58 | 1998 | RCT | 30: children, CRS | I: Isotonic saline (15). II: Hypertonic saline 3.5% (15) | I: No. II: No | Drop, 10 drops | 3 times/d, 4 wk | Cough/postnasal drip, radiologic score | The hypertonic saline significantly better than normal saline for cough and radiologic score. |
Abbreviations: AR, allergic rhinitis; ARM, acoustic rhinometry; ARS, acute rhinosinusitis; CBF, ciliary beat frequency; CRS, chronic rhinosinusitis; CT, computed tomography; HRQL, health-related quality of life; LM, Lund-Mackay; NA, not applicable; PNIF, peak nasal inspiratory flow; QoL, quality of life; RCT, randomized controlled trial; RMM, rhinomanometry; RQLQ, Rhinoconjunctivitis Quality of Life Questionnaire; RSDI, Rhinosinusitis Disability Index; RSOM31, 31-item Rhinosinusitis Outcome Measure; SF36, 36-item Medical Outcomes Study Short Form; SNOT-20, 20-item Sino-nasal Outcome Test; SRMA, systematic review and meta-analysis; STT, saccharin transit time; VAS, visual analog score.
a
Roman numerals indicate patients groups.
b
Patient total number, age group (number per group), and disease.
c
Number per group in parentheses.