Abstract: Objective To study the efficacy of alkaline isotonic saline in laryngopharyngeal reflux symptom-positive or finding-positive patients with chronic rhinosinusitis(CRS)following endoscopic sinus surgery(ESS). Methods Eighty CRS patients who were reflux symptom- or finding score-positive and who had undergone ESS were randomized to receive alkaline isotonic saline(study group; n=40)or normal saline(control group; n=40). All patients were classified by phenotype(high-%EOS or low-%EOS)according to whether the eosinophil proportion in peripheral blood(%EOS)exceeded 4.27%. Follow-up evaluations were conducted at 2 and 6 weeks after surgery. Evaluations included reflux symptom index(RSI), reflux finding score(RFS), sino-nasal outcome test-20(SNOT-20), visual analogue scale(VAS), nasal obstruction symptom evaluation(NOSE), Lund-Kennedy endoscopic score, and adverse events. Results The study group showed better improvement in the VAS score ［3.0(2.0,4.0)］ than the control group ［1.5(0.0,3.0)］ at 2 weeks postoperatively(P=0.016<0.05); the variation in SNOT-20 and VAS scores ［(13.4±10.3)and 3.0(2.0,4.0), respectively］ was significantly reduced in the study group at 6 weeks(P=0.001<0.05). After stratification, patients in the low-%EOS + study subgroup showed a significant improvement in the variation of SNOT-20 and VAS scores at 2 weeks ［13.0(8.0,19.0)and(3.2±1.9), respectively］(P=0.024<0.05,P=0.030<0.05, respectively)and 6 weeks ［(15.7±9.5)and 2.0(2.0,4.0), respectively］ postoperatively(P=0.002<0.05,P=0.005<0.05, respectively). There were no severe side effects among the groups. Conclusions Alkaline isotonic saline has a better clinical efficacy in patients with CRS who are RSI-positive or RFS-positive during the early postoperative care period of CRS, particularly those with a low %EOS.

Key words: Nasal Irrigation, Laryngopharyngeal reflux, Sinusitis, Endoscopy, Endoscopic sinus surgery