Nasal Irrigations With Hypertonic Saline For Chronic Sinonasal Symptoms:a Systematic Review And Meta-Analysis

Background:The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations and traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Hypertonic saline nasal irrigation (HSNI) is often recommended as additional nonpharmacologic treatment, having proven its efficacy in chronic rhinosinusitis and for therapy after sinonasal surgery. To date, however, no systematic review or meta-analysis exists showing the influence of hypertoninc saline nasal irrigation on chronic rhinosinusitis (CRS). This study aimed to establish the impact of HSNI on symptoms of CRS in different patient groups.Methods:We conducted a systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science,CNKI, CBMdisc, CMCC, CMAC, VIP databases for literature published from 1950 to 2014 on HSNI in CRS. The date of the last search was December 2014.Randomised controlled trials in which hypertonic saline was evaluated in comparison with either isotonic, no treatment, a placebo, as an adjunct to other treatments or against treatments. Trials were graded for methodological quality using the Cochrane approach. Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis with RevMan 5.3. A narrative overview of the remaining results is presented.Results:Three independent reviewers chose 11 originals that satisfied the inclusion criteria (400 participants total) from 116 relevant trials. HSNI performed regularly over a limited period of up to 7 weeks was observed to have a positive effect on all investigated outcome parameters in adults and children with symptoms of chronic rhinosinusitis. There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology’placebo’. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear.Conclusion:SNI using hypertonic solution could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient’s health or causes unexpected side effects. The beneficial effect of saline appears to outweigh these drawbacks for the majority of patients.