Efficacy of Nasal Irrigation with Isotonic and Hypertonic Solutions after Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Endoscopic sinus surgery (ESS) is often involved in the treatment of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal irrigation after ESS is recommended to improve healing and nasal symptoms in these patients. This study compared the efficacy of nasal irrigation with either an isotonic solution of 0.9% NaCl or a hypertonic solution of 2.3% NaCl comprising algal extracts. This was a randomized cohort study that included patients with CRSwNP after ESS who used isotonic solution and hypertonic 2.3% solution enriched with algal extracts (<i>Undaria pinnatifida</i> and <i>Spir- ulina platensis</i>). Patients filled out the total nasal symptom score (TNSS) questionnaire on visual analog scale of five symptoms, i.e., nasal obstruction, nasal secretion and/or postnasal discharge, sense of pressure in the face, headache, loss of the sense of smell preoperatively, and on postoperative days 7 and 14. Endo- scopic Lund-Kennedy (LK) score was also recorded. The study included 54 patients with CRSwNP that had undergone ESS, mean age 49.5 years. There were 53.7% of male patients. Thirty (55.56%) patients had other comorbidities such as allergic rhinitis, allergy to food, or/and asthma. Five (9.25%) patients had CRSwNP, asthma and allergy to nonsteroidal anti-inflammatory drugs. TNSS improved after 7 and 14 days in both groups; greater improvement of TNSS and LK score was observed in the group of patients that used hypertonic solution with algae, but it did not reach statistical significance. Improvement in particular symptoms was also recorded in the hypertonic solution group both on postoperative days 7 and 14, especially of sneezing and itching. The results of this study confirmed therapeutic benefits of nasal ir- rigation in CRSwNP patients following ESS. Patients who used hypertonic solution enriched with algae experienced greater improvement in sneezing and itching over the 14-day period.