Saline Nasal Irrigation: An Evidence-Based Review and Practical Recommendations for Clinical Practice
Main Article Content
Abstract
Saline nasal irrigation (SNI) is an adjunctive therapy used in the management of allergic rhinitis, rhinosinusitis, and postoperative care following endoscopic sinus surgery (ESS). Evidence accumulated over the past two decades has demonstrated that SNI can help enhance mucociliary clearance, promote the removal of nasal secretions, alleviate nasal symptoms, and, in some conditions, improve patients’ quality of life. This review aims to summarize the current evidence regarding the mechanisms of action, clinical indications, precautions, and the appropriate characteristics of SNI, including solution type, irrigation volume, delivery pressure, and solution temperature. Based on the available evidence, practical recommendations are provided to guide both primary care physicians and otorhinolaryngologists in the appropriate application of SNI in routine clinical practice.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the Royal Thai Army Medical Department and published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.
may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.
Use or modification of the articles is prohibited without permission.
Statements expressed in the articles are solely the opinions of the authors.
Authors are fully responsible for the content and accuracy of their articles.
Any other republication of the articles requires permission from the journal.
References
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. doi:10.4193/Rhin20.600.
Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213-739. doi:10.1002/alr.22741.
Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, et al. International consensus statement on allergy and rhinology: allergic rhinitis—2023. Int Forum Allergy Rhinol. 2023;13(4):293-859. doi:10.1002/alr.23090.
Thai Rhinologic Society. Clinical practice guidelines for allergic rhinitis in Thailand (2022 revision). Thai Journal of Otolaryngology Head and Neck Surgery [Online]. 2022;23(1):53-310. Available from: https://he02.tci-thaijo.org/index.php/rcotJ/issue/view/17891/4983. Thai
Rabago D, Zgierska A. Saline nasal irrigation for upper respiratory conditions. Am Fam Physician. 2009;80(10):1117-9.
Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007;(3):CD006394. doi:10.1002/14651858.CD006394.pub2.
Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;110(7):1189-93. doi:10.1097/00005537-200007000-00023.
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):815-21. doi:10.1016/j.otohns.2007.07.034.
Chusakul S, Warathanasin S, Suksangpanya N, Phannaso C, Ruxrungtham S, Snidvongs K, et al. Comparison of buffered and nonbuffered nasal saline irrigations in treating allergic rhinitis. Laryngoscope. 2013;123(1):53-6. doi:10.1002/lary.23617.
Nimsakul S, Ruxrungtham S, Chusakul S, Kanjanaumporn J, Aeumjaturapat S, Snidvongs K. Does heating up saline for nasal irrigation improve mucociliary function in chronic rhinosinusitis? Am J Rhinol Allergy. 2018;32(2):106-11. doi:10.1177/1945892418762872.
Chitsuthipakorn W, Thanaphiphatsatja A, Doungbuppha P, Lawpoolsri S, Seresirikachorn K, Snidvongs K. Effects of large volume, isotonic nasal saline irrigation for acute rhinosinusitis: a randomized controlled study. Int Forum Allergy Rhinol. 2021;11(10):1424-35. doi:10.1002/alr.22807.
Audag N, Cnockaert P, Reychler G, Poncin W. Consensus on nasal irrigation in infants: a Delphi study. Ann Otol Rhinol Laryngol. 2023;132(6):674-83. doi:10.1177/00034894221112514.
Keojampa BK, Nguyen MH, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004;131(5):679-82. doi:10.1016/j.otohns.2004.05.026.
Kulasek M, Mercier E, Bergeron M. Assessing the role of nasal irrigation in chronic otorrhea in children with tympanostomy tubes. J Otolaryngol Head Neck Surg. 2025;54:19160216251315055. doi:10.1177/19160216251315055.
Psaltis AJ, Foreman A, Wormald PJ, Schlosser RJ. Contamination of sinus irrigation devices: a review of the evidence and clinical relevance. Am J Rhinol Allergy. 2012;26(3):201-3. doi:10.2500/ajra.2012.26.3747.
