Can Hypochlorous Acid Nasal Spray be an Alternative to Saline Nasal Irrigation in CRS Patients Post-FESS?

Table of Content


Although topical therapy is beneficial in treatment of various sinonasal diseases, there is little consensus on the methods of topical therapy such as head position, rinsing volume, pressure, frequency, etc. Nasal saline irrigation (NSI) is currently recommended for postoperative treatment in patients with chronic rhinosinusitis (CRS) without nasal polyps. Hypochlorous acid (HOCl) has been used as a nasal irrigant in the treatment of CRS and is available as a nasal spray in Taiwan.


The efficacy of HOCl nasal spray as an adjuvant therapy after functional endoscopic sinus surgery (FESS) has been assessed in this study.


Study Design

  • Randomized study.

Patient Profile

  • CRS patients who underwent FESS after failed medical treatment

Treatment Strategy

  • The eligible patients were randomized into 2 groups at one month post-surgery.
  • The HOCl group received 0.02% HOCl nasal spray three times a day for two months.
  • The control group received normal saline (NS) nasal irrigation.
  • The cohort filled in the Taiwanese version of the 22-item Sino-Nasal Outcome Test (TWSNOT-22) questionnaire before FESS and before and after nasal spray or irrigation.
  • The patients underwent endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial cultures were obtained from their middle meatus to assess the outcomes.


  • Change in TWSNOT-22 score
  • Change in endoscopic score


  • The final analysis set comprised 78 patients; out of which 41 received HOCl nasal spray, and 37 received NS irrigation.
  • There was a significant reduction in the endoscopic score from 5.22+1.64 before FESS to 4.34+1.59 after 2-month HOCl nasal spray (p = 0.036).
  • The HOCl nasal spray resulted in decrease in the TWSNOT-22 score too. However, the difference was insignificant (p = 0.285).
  • The NS nasal irrigation significantly reduced the TWSNOT-22 score (p = 0.017) but did not significantly decrease the endoscopic score (p = 0.142).


  • The efficacy of HOCl nasal spray was similar to that of saline nasal irrigation in the patients with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS).
  • HOCl nasal spray was convenient to use and could be an alternative to saline nasal irrigation in the post-FESS care.

Am J Otolaryngol. Jan-Feb 2022;43(1):103264. Doi: 10.1016/j.amjoto.2021.103264.