Role of Xylitol Nasal Irrigation in the Management of Chronic Sinusitis: A Systematic Review and Meta-Analysis

Objectives: Xylitol, a low-permeability sugar alcohol, is recommended for treating chronic rhinosinusitis (CRS) due to its ability to decrease liquid salt concentration at the airway surface. This study investigated the efficacy of xylitol nasal irrigation for the management of CRS and its postoperative care. Methods: We analysed 7 studies with 263 participants after reviewing the studies that were retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to December 2024. Those comparing changes in endoscopic score, Sinonasal Outcome Test (SNOT), Nasal Obstruction Symptom Evaluation (NOSE), olfactory dysfunction, and CRS-related visual analogue scale from baseline to post-treatment between xylitol and normal saline nasal irrigation groups were analysed. Results: Nasal irrigation with xylitol significantly improved sinonasal well-being in CRS patients compared to irrigation with saline (SMD 0.6253, 95% CI [0.0067; 1.2438]; I² = 0.0%). Patients who underwent endoscopic sinus surgery showed substantial SNOT improvement (SMD 3.1284, 95% CI [0.5229; 5.7338]; I² = 86.1%), while no significant changes were observed in non-ESS patients (SMD 0.2571, 95% CI [−0.4872; 1.0014]). The xylitol group also showed significant improvements in NOSE (SMD 0.5976, 95% CI [0.2297; 0.9656]; I² = 49.3%) and SNOT scores (SMD 0.3608, 95% CI [0.0724; 0.6493]; I² = 49.1%). However, there were no significant changes in endoscopic scoring (SMD 0.1309, 95% CI [−0.1777; 0.4396]; I² = 0.0%), olfaction (SMD −0.0292, 95% CI [−0.3633; 0.3050]; I² = 0.0%), or saccharine clearance time (SMD 0.3816, 95% CI [−0.3816; 1.1449]; I² = 61.6%). Xylitol irrigation was well tolerated, with minimal, transient side effects and no significant adverse events. Conclusion: Nasal irrigation with xylitol significantly improves the subjective management of CRS and postoperative care compared to saline irrigation but does not alter objective outcomes.