Hot saline irrigation in comparison to nasal packing after sinus surgery

Abstract

Objectives: Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery.

Methods: Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47°C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon.

Results: Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils.

Conclusions: The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery.

Level of evidence: 1b.

Keywords: chronic rhinosinusitis; endoscopic sinus surgery; hot saline; nonabsorbable packing; postoperative complications.

FIGURE 1

Postoperative complications assessed with VAS. Pain (A), bleeding (B), and other uncomfortable experiences (C) were measured before (N = 27) and after nasal packing removal (N = 25‐26), and 2 weeks post‐surgery (N = 27), comparing PVA nasal packing and HSS irrigation in separate nostrils. Uncomfortable experiences assessed with VAS were measured during (N = 27) nasal packing removal (D). Data are presented as median with IQR. HSS, Hot saline solution; PVA, polyvinyl acetate; VAS, visual analog scale. Significance levels are considered at *P < .05; **P < .01