(1236) High-Volume Nasal Irrigation in Chronic Rhinosinusitis: Clinical Benefit Without Evidence-Based Device Selection

Introduction: This systematic review aims to evaluate the clinical efficacy and cost effectiveness of different forms of high-volume nasal irrigation for sinonasal disease. In addition, the extent to which irrigation delivery systems are reported or compared are assessed.

Methods: A systematic search of PubMed and Cochrane CENTRAL was conducted for studies published within the past 10 years. Eligible studies included primary clinical research evaluating high-volume nasal irrigation in adult patients with various sinonasal disorders in outpatient or postoperative settings. Randomized controlled trials (RCT), pragmatic trials, and prospective observational studies were included. Four reviewers independently screened 260 English studies; extracted data included study design, population, irrigation characteristics, device reporting, comparators, clinical outcomes, and cost or utilization measures.

Results: Five studies met inclusion criteria: two RCTs, one pragmatic primary care trial, one postoperative comparative study, and one prospective observational study. High-volume nasal irrigation was associated with improved symptom scores, reduced patient-reported discomfort, and increased health utility across outpatient and postoperative CRS populations. Only one study explicitly identified a gravity-based Neti pot, while others did not specify device type, pressure, or volume. No study directly compared irrigation delivery systems. Cost-related outcomes were measured indirectly, with no formal cost-effectiveness analyses reported.

Conclusions: High-volume nasal irrigation is associated with improved clinical outcomes in various sinonasal disorders. However, the current evidence does not specify the device utilized and does not provide cost-effective analyses. Despite widespread clinical recommendations for specific irrigation systems, the current literature does not support evidence-based differentiation between delivery methods. Standardized reporting and prospective comparative studies are needed to inform cost-conscious, evidence-based otolaryngology practice.