Key Takeaway
Evidence-based clinical guideline recommends nasal saline irrigation as a core treatment for chronic rhinosinusitis, with large-volume isotonic or hypertonic solutions most effective.
Summary
This clinical practice guideline systematically reviewed the evidence on nasal irrigation for chronic rhinosinusitis (CRS) in adults. The guideline development group evaluated studies on irrigation technique, solution tonicity, volume, additives, and device type to formulate evidence-based recommendations.
The guideline strongly recommends nasal saline irrigation as a first-line treatment for CRS, finding that large-volume irrigation (200+ mL) is more effective than low-volume nasal sprays for symptom relief. Both isotonic and hypertonic saline solutions were found effective, with hypertonic solutions offering modest additional benefit for mucociliary clearance.
The authors recommend nasal irrigation both as standalone therapy for mild CRS and as adjunctive treatment alongside intranasal corticosteroids and other medical therapies. The guideline emphasizes that nasal irrigation is safe for long-term use, with proper device hygiene being the primary safety consideration to prevent secondary infections.
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