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Abstract

The nasal mucosa, a critical defense against airborne pathogens, relies on effective Mucociliary Clearance (MCC). Nasal Saline Irrigation (NSI) is a simple procedure for cleansing and moisturizing nasal passages. It mechanically washes out mucus, secretory aggregation, inhaled agents, and inflammatory mediators from the nose, thus promoting MCC and helping reduce mucosal edema. NSI, recommended as an adjunct therapy for sinonasal diseases and after endoscopic sinus surgery, is typically performed with isotonic or hypertonic solutions. Several clinical studies have proven the superiority of hypertonic solutions based on their osmotic decongestion and mechanical cleansing actions. In particular, hypertonic seawater solutions of 2.3% NaCl (2.3%HSS), have extensively been validated in clinical trials involving healthy subjects, patients with ENT diseases or at the postoperative setting. In healthy individuals, these solutions resulted in increased MCC. In ENT disease management, 2.3%HSS, alone or enriched with additional natural ingredients, offered sinonasal symptom relief both as a stand-alone therapy or adjunctively, in combination with standard treatments, across different age groups. In patients with upper respiratory infections, these solutions reduced viral load and were more effective than isotonic solutions. Finally, when used in combination with medication, they have demonstrated quicker symptom relief versus medication alone, while resulting in reduced medication intake. In the post-surgery setting, 2.3%HSS with or without natural extracts, demonstrated superior efficacy over isotonic solutions, while offering accelerated postoperative recovery, and reduced symptoms. These data support the use of 2.3%HSS in nasal symptom management in ENT diseases.