Background

Although nasal saline treatments are widely used in treating acute rhinosinusitis (ARS), the evidence in adult patients is inconclusive. Our objective was to assess the add-on benefits of saline treatment in adult with ARS.

Methods

Literature searches were performed (updated May 9th, 2021). Randomized controlled trials studying the effects of nasal saline treatment in adults with ARS were included. Data were pooled for meta-analysis. Outcomes were composite symptoms score (CSS), disease-specific quality of life (DS-QoL) score, individual symptom score, endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events.

Results

Eleven studies (718 patients) were included. Nasal discharge was the only symptom improved [standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.66 to -0.05]. Saline as an add-on treatment brought no benefits in: CSS and DS-QoL score at both time points (3-10 days and at the end of the study). Other outcomes also showed no benefits of saline, including endoscopy score, saccharin transit time, cure rate, days to resolution, and adverse events. Subgroup analyses showed improvement in viral ARS patients in CSS (SMD -0.60, 95% CI -1.12 to -0.08) and DS-QoL score (mean difference -15.90, 95% CI -31.78 to -0.02), and patients using large-volume saline in CSS (SMD -0.42, 95% CI -0.78 to -0.06).

Conclusions

Nasal saline as an add-on treatment improved rhinorrhea. There was no improvement in CSS and DS-QoL except the subgroup of viral ARS when using large-volume saline. There were no differences in adverse events between the saline and non-saline treatments.

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