published in February 2016, indicated that highvolume nasal saline irrigation was

strongly recommended as an adjunct to other medical therapies for CRS. A systematic review
performed in 2011 gave a “Strong recommendation/ recommendation” for use of high-volume
normal saline irrigations between 24 and 48 hours after FESS ( Orlandi RR et al, 2016).
Saline nasal irrigation in chronic rhinosinusitis after FESS had been proved to clean the
nasal cavity and promote the restoration of mucosal function, and was widely used (Sanan A et
al, 2017). A number of studies had verified the efficacy of nasal irrigation with various solutions
(Li N, Peters AT, 2015). However, the value of various solutions in nasal irrigation remains
controversial (Adappa ND et al, 2012).
The mechanism of nasal irrigation remains unclear. Saline nasal irrigation may improve
nasal mucosa function through several physiological effects, including: direct cleaning of mucus
(mucus is a potential condition for bacteria to multiply; saline dilutes mucus and helps to clear it
out); removal of antigens, bacterial biofilm or inflammatory mediators (thereby alleviating the
inflammation); and improving mucociliary function (Principi N and Esposito S,2017). A
Cochrane review (2007) of nasal saline irrigations for chronic rhinosinusitis concluded that nasal
saline irrigation was better than no irrigation for improving symptoms and quality of life (Harvey
R et al, 2007). Recent studies had shown that nasal irrigation with various topical medications
can provide a high concentration of the drug and achieve better outcomes (Pham V et al, 2014).
1.2 Problem Statement
According to the National Health Interview Survey of 1996, chronic sinusitis was the
second most prevalent chronic health condition, affecting 12.5% of the US population or
approximately 31 million patients each year. According to an analysis of the 2008 National
Health Interview Survey data, rhinosinusitis affected approximately 1 in 7 adults. Because
chronic rhinosinusitis (CRS) was classified solely on symptomatic criteria, CRS prevalence was
likely overestimated in these surveys(Hamilos, 2011).
Despite comprehensive medical therapy, a subgroup of patients with refractory disease often
requires surgical treatment, usually in the form of endoscopic sinus surgery (ESS). The surgical
treatment of CRS had been increasing steadily, with an estimated 250,000 paranasal sinus
surgical procedures performed yearly in the United States. To optimize patient care and manage
finite health care resources,