Comparative study of hypertonic saline nasal douching versus normal saline nasal douching in post operative endoscopic sinus surgery patients

Smruti Milan Tripathy, Rakhee Panda


Background: Nasal douching is routinely done in the post operative functional endoscopic sinus surgery (FESS) patients. Douching helps to clear the nasal cavity of crusts, clots and any infected debris and also promotes quicker mucosal healing.

Methods: A total of 60 patients who underwent FESS in the ENT department were selected for the study. Patients were randomly allocated into two groups. Group 1 patients were subjected to nasal douching using hypertonic saline (3%) in the post operative period while the group 2 patients used isotonic saline (0.9%) for nasal douching. Patients were followed up on the 7th, 15th and 30th post operative day and various parameters were compared using nasal endoscopy, saccharine clearance test, sinonasal outcome test questionnaire (SNOT-22) and visual analogue scale (VAS).  

Results: Group 1 patients who used hypertonic saline for nasal douching had a better symptom score on 30th post operative day in SNOT-22 and VAS (p<0.05 in both) as compared with the group 2 patients who used isotonic saline for nasal douching. More patients in group 1 had a healthy and normal appearance of nasal mucosa on endoscopic examination as compared with group 2. There was not much significant difference in the mucocilliary clearance test (MCT) scores of both the group patients.

Conclusions: Patients who used hypertonic saline for douching in the post operative period were found to have lesser crusting, nasal obstruction as compared to those who used isotonic saline for douching.


Hypertonic saline, Isotonic saline, Nasal douching, Functional endoscopic sinus surgery

Full Text:



Fernandes SV. Postoperative care in functional endoscopic sinus surgery. Laryngoscope. 1999;(6):945-8.

Kumar J, Padiyar BV, Priya M, Arun K. The Effect of Hypertonic Saline Versus Isotonic Saline Irrigation Following Endoscopic Sinus Surgery- A Comparative Study. Glob J Oto. 2018;(5):555-8.

Harvey RJ, Goddard JC, Wise SK, Schlosser RJ. Effects of endo-scopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg. 2008;(1):137-42.

Talbot AR, Herr TM, Parsons D. Mucociliary clearance and buffered hypertonic saline. Laryngoscope. 1997;(4):500-3.

Fokkens WJ, Lund VJ, Mullol J. European position paper on rhinosinusitis and nasal polyps. Rhinology. 2012;(1):1-12.

Boek WM, Keles N, Graamans K. Physiologic and hypertonic saline solutions impair ciliary activity in vitro. Laryngoscope. 1999;(3):396-9.

Wormald PJ, Cain T, Oates L. A comparative study of three methods of nasal irrigation. Laryngoscope. 2004;(12):2224-7.

Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope. 2000;(7):1189-93.

Daviskas E, Anderson SD, Gonda I. Inhalation of hypertonic saline aerosol enhances mucocilliary clearance in asthmatic and healthy subjects. Eur Respir J. 1996;(4):725-32.

Unal M, Seymen HO. Effect of Ringer-Lactate and isotonic saline solutions on mucociliary clearance of tracheal epithelium:an experimental study in rats. J Laryngol Otol. 2002;(7):536-8.

Keojampa KB, Nguyen MH, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004;(5):679-82.

Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg. 2007;(5):815-21.

Salib RJ, Talpallikar S, Uppal S, Nair SB. A prospective ran-domised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products Sterimar TM and Sinus Rinse TM following functional endoscopic sinus surgery. Clin Otolaryngol. 2013;(4):297-305.