Hypertonic Saline Improves Nasal Symptoms and Ciliary Movement Compared to Isotonic Saline in Chronic Rhinosinusitis
Introduction
Nasal irrigation has been an effective adjunct therapy for the treatment of rhinosinusitis, allergic rhinitis and other sinonasal diseases. Many prospective studies have evaluated the efficacies of different saline concentrations in the treatment of chronic rhinosinusitis (CRS). However, there is lack of sufficient systematic analyses of the efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis, although many otolaryngologists have found efficacy of hypertonic saline superior to isotonic saline.
Aim
This meta-analysis compares the efficacy and safety of hypertonic saline and isotonic saline in the clinical management of CRS in order to provide more reliable clinical evidence.
Methods
Study Design
- Systematic review and meta-analysis.
Treatment Strategy
- Studies that compared the outcomes of hypertonic saline with isotonic saline were included.
- The subjects comprised adults with clinical diagnosis of CRS
- Extensive search of Medline, Cochrane library, EMBASE, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wan fang database, and other databases were carried out.
- The included studies were assessed for quality, and data were extracted for meta-analysis using Review Manager (RevMan) version 5.3.
Endpoints
- Nose symptom score
- Mucociliary clearance time
- Imaging scores
- Improvement in smell
Results
- A total of 7 randomized controlled trials with 454 participants were included.
- The nasal secretion was greatly reduced in the hypertonic saline nasal irrigation (HSNI) group as compared to isotonic saline nasal irrigation (ISNI) group (SMD=1.52; p<0.01).
- The HSNI group showed significant reduction in nasal congestion (SMD=1.52; p=0.01)
- Headache was remarkably reduced in HSNI group (SMD=0.82; p<0.01)
- HSNI group had greater improvements in the overall symptomatic relief (SMD=1.63; p<0.01).
- However, there was no difference in smell improvement in the groups (SMD=0.47; p=0.41).
- There was no significant difference in radiologic scores between the groups (SMD=2.44; p<0.01).
- The mucociliary clearance time scores were better in HSNI group (SMD=1.19; p<0.01).
- Hypertonic saline was associated with a higher risk of developing minor adverse effects as compared to ISNI group, nasal irritation and burning sensation being the most common.
- Other mild side effects were tearing, nosebleeds, headache or nasal drainage.
Conclusion
- Hypertonic saline nasal irrigation is associated with mild side effects and a superior clinical efficacy as compared to isotonic saline nasal irrigation in the treatment of chronic rhinosinusitis.
- Hypertonic saline nasal irrigation significantly improved the nasal symptoms and ciliary movement, but demonstrated no significant difference in imaging findings and smell improvement.
Braz J Otorhinolaryngol. 2020 Sep-Oct; 86(5):639-46. Doi: 10.1016/j.bjorl.2020.03.008.
