Saline irrigation for chronic rhinosinusitis

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and imprecise results (limited study size for each comparison).

A Cochrane review included 2 studies with a total of 116 adults. One study compared large-volume (150 ml) hypertonic (2%) saline irrigation with usual treatment over a 6-month period at the primary care setting; the other compared 5 ml nebulised saline twice a day with intranasal corticosteroids for 3 months and evaluating them on completion of treatment and 3 months later in a secondary care setting.

• Large-volume, hypertonic nasal saline vs. usual care (one trial, n=76): The patients were with or without polyps. Disease-specific HRQL was reported using the Rhinosinusitis Disability Index (RSDI). At the end of 3 months' treatment, patients in the saline group were better than those in the placebo group (MD 6.3 points, 95% CI 0.89 to 11.71) and at 6 months there was a greater effect (MD 13.5 points, 95% CI 9.63 to 17.37). No adverse effects data were collected in the control group but 23% of participants in the saline group experienced side effects including epistaxis. General HRQL was measured using SF-12, no difference was found after 3 months of treatment, but at 6 months there was a small difference favouring the saline group, which may not be of clinical significance (MD 10.5 points, 95% CI 0.66 to 20.34).
• Low-volume, nebulised saline vs. intranasal corticosteroids (one trial, n=40): All patients had polyps. The primary outcome of disease-specific HRQL was not reported. At the end of treatment (3 months) the patients who had intranasal corticosteroids had less severe symptoms (MD -13.50, 95% CI -14.44 to -12.56); this corresponds to a large effect size.