Efficacy of nasal irrigation with different concentrations of saline in treatment of chronic rhinosinusitis: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

OU Liangjie ¹ , WU Zhongrui ¹ , ZHANG Chenchang ¹ , ZHANG Kaidi ¹ , ZHANG Jingxuan ¹ , GE Yonggui ² ,  CHEN Wanqiang ²

1. Second Clinical Medicine College, Lanzhou University, Lanzhou 730000, P. R. China;
2. Department of Rehabilitation Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

CHEN Wanqiang, Email: 53155543@qq.com

Keywords：

Saline; Nasal irrigation; Rhinitis; Network-analysis

DOI：

10.7507/1672-2531.202412197

Video：

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Objective To indirectly compare the efficacy of different concentrations of saline irrigation in treatment of chronic rhinosinusitis by network meta-analysis. Methods The CNKI, WanFang Data, CBM, VIP, Embase, PubMed and Cochrane Library databases were electronically searched to collect randomized controlled trials on different concentrations of saline irrigation in treatment of chronic rhinosinusitis from inception to March 1, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The network meta-analysis was performed by using RevMan 5.4 and Stata 17.0 software. Results In total, 935 patients were enrolled in 15 study. The results of network meta-analysis showed that visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore of hypertonic saline irrigation group were superior to isotonic saline irrigation group. 2.5% hypertonic saline irrigation has best efficacy in terms of visual analogue scale sore, while 3% hypertonic saline irrigation has best efficacy in terms of mucosal ciliary transport rate and 3.5% hypertonic saline irrigation has best efficacy in terms of Lund-Kennedy sore. Conclusion Current evidence indicates that hypertonic saline irrigation has more advantages in terms of clinical efficacy rate, visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore, while 2.5% hypertonic saline irrigation has more advantages in terms of balancing efficacy and acceptability. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

1.	Chee J, Pang KW, Low T, et al. Epidemiology and aetiology of chronic rhinosinusitis in Asia-A narrative review. Clin Otolaryngol, 2023, 48(2): 305-312.
2.	中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018). 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100.
3.	Fu QL, Ma JX, Ou CQ, et al. Influence of self-reported chronic rhinosinusitis on health-related quality of life: a population-based survey. PLoS One, 2015, 10(5): e0126881.
4.	Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, et al. Hypertonic saline versus isotonic saline nasal irrigation: systematic review and meta-analysis. Am J Rhinol Allergy, 2018, 32(4): 269-279.
5.	Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology, 2020, 58(Suppl S29): 1-464.
6.	Liu L, Pan M, Li Y, et al. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol, 2020, 86(5): 639-646.
7.	Eveloff JL, Warnock DG. Activation of ion transport systems during cell volume regulation. Am J Physiol, 1987, 252(1 Pt 2): F1-10.
8.	Lansley AB, Sanderson MJ, Dirksen ER. Control of the beat cycle of respiratory tract cilia by Ca2+ and cAMP. Am J Physiol, 1992, 263(2 Pt 1): L232-242.
9.	陈明珠, 苏雅能. 3%高渗盐水鼻腔冲洗治疗鼻窦炎患者的临床效果. 中国医药指南, 2023, 21(23): 79-81.
10.	钱坤, 范彬彬, 王郁. 3%氯化钠溶液和0. 9%氯化钠溶液鼻腔冲洗治疗慢性鼻窦炎患者的临床疗效. 当代医学, 2023, 29(7): 79-82.
11.	王增光, 郭德强. 高渗盐水和生理盐水鼻腔冲洗对慢性鼻窦炎的疗效及安全性比较. 中国医学文摘(耳鼻咽喉科学), 2022, 37(1): 77-79.
12.	张萃, 蒋正举. 高渗盐水鼻腔冲洗治疗慢性鼻窦炎的效果及对疼痛程度的影响. 吉林医学, 2022, 43(8): 2094-2096.
13.	杨子璐. 高渗盐水与生理盐水鼻腔冲洗对慢性鼻窦炎的治疗效果比较. 中文科技期刊数据库(文摘版)医药卫生, 2021, (9): 44-46.
14.	董振岩. 高渗盐水冲洗鼻腔在慢性鼻炎、鼻窦炎治疗中的临床有效性. 智慧健康, 2020, 6(29): 60-61.
15.	张卉, 万文锦. 不同鼻腔冲洗液在鼻窦炎鼻内镜手术前应用的效果分析. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(2): 145-148.
16.	唐力行, 高娟, 张亚梅. 布地奈德盐水鼻腔冲洗治疗儿童鼻-鼻窦炎疗效分析. 临床耳鼻咽喉头颈外科杂志, 2016, 30(12): 952-954,959.
17.	Ural A, Oktemer TK, Kizil Y, et al. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol, 2009, 123(5): 517-521.
18.	申娜, 刘吉祥, 张志坚, 等. 等渗和高渗冲洗液对鼻黏液纤毛传输系统的影响. 山东医药, 2009, 49(42): 48-49.
19.	Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg, 2007, 137(5): 815-821.
20.	Kumar RA, Viswanatha B, Krishnamurthy N, et al. Efficacy of hypertonic saline and normal saline in the treatment of chronic sinusitis. Inter J Otolaryngol Head Neck Surg, 2013, 2(3): 90-96.
21.	Shoseyov D, Bibi H, Shai P, et al. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol, 1998, 101(5): 602-605.
22.	Sudhakaran SM, Tharayil U, Kallidanthil SD. Comparison of efficacy of hypertonic saline versus normal saline in the treatment of chronic rhinosinusitis with the help of CT: PNS. J Evol Med Dent Sci, 2016, 5(16): 790-795.
23.	Bachmann G, Hommel G, Michel O. Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease. Eur Arch Otorhinolaryngol, 2000, 257(10): 537-541.
24.	许庚, 李源. 儿童慢性鼻窦炎手术治疗的思考与临床诊疗指引. 中华耳鼻咽喉科杂志, 2003, (4): 4-5.
25.	Zuliani G, Carron M, Gurrola J, et al. Identification of adenoid biofilms in chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol, 2006, 70(9): 1613-1617.
26.	Lusk R. Pediatric chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg, 2006, 14(6): 393-396.
27.	Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg, 2015, 152(2 Suppl): S1-S39.
28.	Michel O. [Nasal irrigation in case of rhinosinusitis]. Laryngorhinootologie, 2006, 85(6): 448-458.
29.	Talbot AR, Herr TM, Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope, 1997, 107(4): 500-503.
30.	Middleton PG, Geddes DM, Alton EW. Effect of amiloride and saline on nasal mucociliary clearance and potential difference in cystic fibrosis and normal subjects. Thorax, 1993, 48(8): 812-816.
31.	Georgitis JW. Local hyperthermia and nasal irrigation for perennial allergic rhinitis: effect on symptoms and nasal airflow. Ann Allergy, 1993, 71(4): 385-389.
32.	Georgitis JW. Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators. Chest, 1994, 106(5): 1487-1492.
33.	Homer JJ, Dowley AC, Condon L, et al. The effect of hypertonicity on nasal mucociliary clearance. Clin Otolaryngol Allied Sci, 2000, 25(6): 558-560.
34.	Luk CK, Dulfano MJ. Effect of pH, viscosity and ionic-strength changes on ciliary beating frequency of human bronchial explants. Clin Sci (Lond), 1983, 64(4): 449-451.
35.	Baraniuk JN, Ali M, Yuta A, et al. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am J Respir Crit Care Med, 1999, 160(2): 655-662.
36.	Sanan A, Rabinowitz M, Rosen M, et al. Topical therapies for refractory chronic rhinosinusitis. Otolaryngol Clin North Am, 2017, 50(1): 129-141.
37.	Baraniuk JN, Ali M, Naranch K. Hypertonic saline nasal provocation and acoustic rhinometry. Clin Exp Allergy, 2002, 32(4): 543-550.

1. Chee J, Pang KW, Low T, et al. Epidemiology and aetiology of chronic rhinosinusitis in Asia-A narrative review. Clin Otolaryngol, 2023, 48(2): 305-312.
2. 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018). 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100.
3. Fu QL, Ma JX, Ou CQ, et al. Influence of self-reported chronic rhinosinusitis on health-related quality of life: a population-based survey. PLoS One, 2015, 10(5): e0126881.
4. Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, et al. Hypertonic saline versus isotonic saline nasal irrigation: systematic review and meta-analysis. Am J Rhinol Allergy, 2018, 32(4): 269-279.
5. Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology, 2020, 58(Suppl S29): 1-464.
6. Liu L, Pan M, Li Y, et al. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol, 2020, 86(5): 639-646.
7. Eveloff JL, Warnock DG. Activation of ion transport systems during cell volume regulation. Am J Physiol, 1987, 252(1 Pt 2): F1-10.
8. Lansley AB, Sanderson MJ, Dirksen ER. Control of the beat cycle of respiratory tract cilia by Ca2+ and cAMP. Am J Physiol, 1992, 263(2 Pt 1): L232-242.
9. 陈明珠, 苏雅能. 3%高渗盐水鼻腔冲洗治疗鼻窦炎患者的临床效果. 中国医药指南, 2023, 21(23): 79-81.
10. 钱坤, 范彬彬, 王郁. 3%氯化钠溶液和0. 9%氯化钠溶液鼻腔冲洗治疗慢性鼻窦炎患者的临床疗效. 当代医学, 2023, 29(7): 79-82.
11. 王增光, 郭德强. 高渗盐水和生理盐水鼻腔冲洗对慢性鼻窦炎的疗效及安全性比较. 中国医学文摘(耳鼻咽喉科学), 2022, 37(1): 77-79.
12. 张萃, 蒋正举. 高渗盐水鼻腔冲洗治疗慢性鼻窦炎的效果及对疼痛程度的影响. 吉林医学, 2022, 43(8): 2094-2096.
13. 杨子璐. 高渗盐水与生理盐水鼻腔冲洗对慢性鼻窦炎的治疗效果比较. 中文科技期刊数据库(文摘版)医药卫生, 2021, (9): 44-46.
14. 董振岩. 高渗盐水冲洗鼻腔在慢性鼻炎、鼻窦炎治疗中的临床有效性. 智慧健康, 2020, 6(29): 60-61.
15. 张卉, 万文锦. 不同鼻腔冲洗液在鼻窦炎鼻内镜手术前应用的效果分析. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(2): 145-148.
16. 唐力行, 高娟, 张亚梅. 布地奈德盐水鼻腔冲洗治疗儿童鼻-鼻窦炎疗效分析. 临床耳鼻咽喉头颈外科杂志, 2016, 30(12): 952-954,959.
17. Ural A, Oktemer TK, Kizil Y, et al. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol, 2009, 123(5): 517-521.
18. 申娜, 刘吉祥, 张志坚, 等. 等渗和高渗冲洗液对鼻黏液纤毛传输系统的影响. 山东医药, 2009, 49(42): 48-49.
19. Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg, 2007, 137(5): 815-821.
20. Kumar RA, Viswanatha B, Krishnamurthy N, et al. Efficacy of hypertonic saline and normal saline in the treatment of chronic sinusitis. Inter J Otolaryngol Head Neck Surg, 2013, 2(3): 90-96.
21. Shoseyov D, Bibi H, Shai P, et al. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol, 1998, 101(5): 602-605.
22. Sudhakaran SM, Tharayil U, Kallidanthil SD. Comparison of efficacy of hypertonic saline versus normal saline in the treatment of chronic rhinosinusitis with the help of CT: PNS. J Evol Med Dent Sci, 2016, 5(16): 790-795.
23. Bachmann G, Hommel G, Michel O. Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease. Eur Arch Otorhinolaryngol, 2000, 257(10): 537-541.
24. 许庚, 李源. 儿童慢性鼻窦炎手术治疗的思考与临床诊疗指引. 中华耳鼻咽喉科杂志, 2003, (4): 4-5.
25. Zuliani G, Carron M, Gurrola J, et al. Identification of adenoid biofilms in chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol, 2006, 70(9): 1613-1617.
26. Lusk R. Pediatric chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg, 2006, 14(6): 393-396.
27. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg, 2015, 152(2 Suppl): S1-S39.
28. Michel O. [Nasal irrigation in case of rhinosinusitis]. Laryngorhinootologie, 2006, 85(6): 448-458.
29. Talbot AR, Herr TM, Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope, 1997, 107(4): 500-503.
30. Middleton PG, Geddes DM, Alton EW. Effect of amiloride and saline on nasal mucociliary clearance and potential difference in cystic fibrosis and normal subjects. Thorax, 1993, 48(8): 812-816.
31. Georgitis JW. Local hyperthermia and nasal irrigation for perennial allergic rhinitis: effect on symptoms and nasal airflow. Ann Allergy, 1993, 71(4): 385-389.
32. Georgitis JW. Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators. Chest, 1994, 106(5): 1487-1492.
33. Homer JJ, Dowley AC, Condon L, et al. The effect of hypertonicity on nasal mucociliary clearance. Clin Otolaryngol Allied Sci, 2000, 25(6): 558-560.
34. Luk CK, Dulfano MJ. Effect of pH, viscosity and ionic-strength changes on ciliary beating frequency of human bronchial explants. Clin Sci (Lond), 1983, 64(4): 449-451.
35. Baraniuk JN, Ali M, Yuta A, et al. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am J Respir Crit Care Med, 1999, 160(2): 655-662.
36. Sanan A, Rabinowitz M, Rosen M, et al. Topical therapies for refractory chronic rhinosinusitis. Otolaryngol Clin North Am, 2017, 50(1): 129-141.
37. Baraniuk JN, Ali M, Naranch K. Hypertonic saline nasal provocation and acoustic rhinometry. Clin Exp Allergy, 2002, 32(4): 543-550.

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