Table 5.
Studies of Saline Treatment During Postoperative Period After Endoscopic Sinus Surgery: Adults. a
| First Author | Year | Study type | Patients b | Saline type c | Buffered | Devices c | Treatment duration | Outcomes | Main result |
|---|---|---|---|---|---|---|---|---|---|
| Wang 71 | 2020 | RCT | 93: adult, CRSwNP | I: Hypertonic seawater 2.0% (48). II: Isotonic seawater (45) | I: Yes. II: Yes | Spray. 5 spray/nostril | 3 times/d, 24 wk | SNOT-22, symptoms VAS, LKES, STT at 2, 8, 16, and 24 wk | Hypertonic saline improved edema, crusting, STT more than isotonic saline spray at 8 wk |
| Peric 70 | 2019 | RCT | 30: adult, CRSwNP/AERD | I: Hypertonic seawater 2.3% (15). II: Isotonic saline (15) | I: Yes. II: No | Not mentioned. 60 mL (30 mL/nostril) | 3 times/d, 4 wk | Symptom score, endoscopic score at 1, 7, 14, 21, and 28 d | Hypertonic seawater improved symptoms and/or endoscopic score more than isotonic saline at 7-28 d |
| Chen 73 | 2018 | SRMA (3 studies) | 233: adult, CRS | I: Electrolyzed acid water (1.1%), hypertonic saline 2.7%, Ringer lactate solution. II: Isotonic saline | I: No. II: No | Any | 6 wk to 2 mo | SNOT-22, symptoms VAS, endoscopic score, computed tomography score, eosinophil count, adverse events | No difference in symptom or endoscopic scores among various solutions |
| Giotakis 67 | 2016 | RCT | 158: adult, CRSwNP | I: Emser salt solution 1.175% or isotonic mineral salt mixture (110). II: No saline (48) | I: Yes. II: NA | Squeeze bottle. 250 mL | 2 times/d, 12 mo, | Nasal symptom score, general QoL scores, endoscopic score, missed workday at 3, 6, 9, and 12 mo | Saline irrigation improved symptoms but not nasal mucosa vs no-saline group |
| Macdonald 72 | 2015 | RCT | 86: adult, CRS (55 CRSwNP,31 CRSsNP) | Isotonic saline | Yes | I: Squeeze bottle 240 mL (43). II: Spray, 2 spray/nostril (43) | 2 times/d, 1 mo | SNOT-22, NSS, POSE at 1 mo | Both devices showed significant improvement in all outcomes |
| Jiang 66 | 2014 | RCT | 110: adult, CRS | I: Electrolyzed acid water (1.1%) (36). II: Isotonic saline (35). III: No saline (39) | I: No. II: No. III: NA | Pulsatile nasal irrigator. 250 mL | Once daily, 2 mo (during 1-3 mo postoperative) | SNOT-20, ARM, UPSIT, endoscopic score, VAS (comfortable of device), bacterial culture, STT at 3 mo | No difference among 3 groups |
| Low 69 | 2014 | RCT | 63: adult, CRS (31 CRSwNP, 32 CRSsNP) | I: Isotonic saline (22). II: Hypertonic saline 2.7% (21). III: Ringer lactate solution (20) | I: No. II: No. III: No | Squeeze bottle. 240 mL | 3 times/d, 6 wk | SNOT-20, STT, VAS, endoscopic score at 1, 3, and 6 wk | Ringer solution irrigation showed better SNOT-20 and VAS than both saline types. Hypertonic saline reduced polypoid mucosa more than isotonic saline. |
| Salib 68 | 2013 | RCT | 25: adult, CRS (17 CRSwNP, 8 CRSsNP) | I: Isotonic seawater (25). II: Isotonic saline (25). Act as own control | I: Yes. II: No | I: Spray 2 spray/side (25). II: Squeeze bottle 120 mL (25). Use I and II in separate nostril | 3 times/d, 12 wk | SNOT-22, modified LKES at 2, 4, and 12 wk | Squeeze bottle showed significantly better LKES than spray at 2 and 4 wk |
| Liang 65 | 2008 | RCT | 77: adult-children, CRS | I: Isotonic saline (44). II: No saline (33) | I: Yes. II: NA | Pulsatile nasal irrigator. 250 mL/nostril | Once daily, 3 mo | Symptom score, endoscopic score at 2 wk, 1, 2, and 3 mo | Saline irrigation benefited mild CRS |
| Freeman 64 | 2008 | RCT | 17: adult, CRS | I: Isotonic saline on one nostril (17). II: No saline on the other nostril (17) | I: No. II: NA | Atomized douching device. 2 mL into the one side | 3 times/d, 6 wk | Endoscopic finding: adhesions, polyps, crusting, discharge, edema at 3 wk and 3 mo | Saline douching reduced nasal discharge; no difference in long-term endoscopic findings |
| Pinto 63 | 2006 | RCT | 60: adult, CRS | I: Isotonic saline (20). II: Hypertonic saline 3.0% (20). III: No saline (20) | I: No. II: Yes. III: NA | Spray. 2 sprays/nostril | 4 times/d, 5 d | Nasal symptoms, medication used at everyday from 1 to 5 | No difference of saline spray vs no saline |
Abbreviations: AERD, aspirin-exacerbated respiratory disease; ARM, acoustic rhinometry; CRS, chronic rhinosinusitis; CRSsNP, chronic rhinosinusitis without nasal polyp; CRSwNP, chronic rhinosinusitis with nasal polyp; LKES, Lund-Kennedy Endoscopic Score; NA, not applicable; NSS, Nasal and Sinus Symptom Score; POSE, perioperative sinus endoscopy; QoL, quality of life; RCT, randomized controlled trial; SNOT, Sino-nasal Outcome Test; STT, saccharin transit time; UPSIT, University of Pennsylvania Smell Identification Test; 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.