This Study Aims to Assess the Impact of 50°C Saline Irrigation on the Overall Intraoperative Blood Loss and Surgical Visualization During Endoscopic Sinus Surgery for Rhinosinusitis.

June 2, 2026 updated by: Military Institute of Aviation Medicine

Hot Saline Irrigation on Intraoperative Bleeding and Improving Surgical Field Visibility During Functional Endoscopic Sinus Surgery: a Prospective Clinical Study.

Objectives: Intraoperative bleeding during endoscopic sinus surgery for severe rhinosinusitis may significantly compromise the surgical field. Saline heated to 50°C promotes transient vessel vasodilation and mucosal edema without causing nasal mucosal necrosis. The brief thermal exposure may induce superficial protein denaturation and facilitate local hemostasis, thereby improving endoscopic visibility. This study aims to assess the impact of 50°C saline irrigation on the overall intraoperative blood loss and surgical visualization during endoscopic sinus surgery for rhinosinusitis.

Methods: This prospective randomized controlled trial study is going to assign the patients to three groups. In the interventional hot saline group (HSI), intraoperative irrigation will be performed with heated saline at 50°C. In the room-temperature saline group (RTSI), saline at 22°C will be used; in the third one group (Control), no irrigation will be administered. Intraoperative blood loss will be recorded in milliliters and milliliters per minute of operative time, and the surgical field will be evaluated using the Boezaart scale.

HSI is hypothesized to be more effective than RTSI in minimizing intraoperative bleeding during FESS.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Introduction Chronic rhinosinusitis (CRS) affects approximately 5-15% of the European population and significantly reduces quality of life. While pharmacological treatment, including intranasal corticosteroids, nasal irrigation, and antibiotics, may be effective in many cases, some patients will require functional endoscopic sinus surgery (FESS). Compared with traditional surgery, FESS will provide better visualization, reduced tissue trauma, fewer complications, and shorter hospitalization. However, intraoperative bleeding will remain a major challenge, as even minor bleeding may impair endoscopic visibility and increase the risk of complications. Various methods, including controlled hypotension, vasoconstrictors, corticosteroids, and reverse Trendelenburg positioning, will be used to reduce bleeding. Heated saline irrigation may also represent a useful supportive technique.

Aim This prospective study will evaluate the effect of intraoperative hot saline irrigation (HSI) on blood loss and surgical field visibility during FESS compared with room-temperature saline irrigation (RTSI) and no irrigation.

Materials and Methods Adult patients with CRS meeting EPOS 2020 criteria and requiring FESS after unsuccessful conservative treatment will be included in this randomized, patient-blinded study. Patients with fungal disease, immunodeficiency, coagulation disorders, neoplastic or autoimmune disease, or preoperative systemic steroid use will be excluded.

Participants will be randomized into three groups: HSI (0.9% NaCl at 50°C), RTSI (0.9% NaCl at 22°C), and control (no irrigation) using coin-toss allocation. Randomization will be conducted by an independent researcher not involved in surgery or postoperative assessment. Separation of responsibilities and independent surgical scheduling will be applied to reduce the risk of selection bias.

Surgical Procedure Surgical procedures will include middle meatal antrostomy, anterior and posterior ethmoidectomy, Draf I-IIa procedure, and bilateral sphenoidectomy performed without preoperative topical decongestants. A 2.7-mm Hopkins nasal endoscope (0°, 30°, 45°, or 70°; Karl Storz) and a microdebrider will be used during all procedures.

Anesthesia General anesthesia will be administered according to a standardized protocol. Anesthesia induction will be achieved with propofol, analgesia with fentanyl or remifentanil, maintenance with sevoflurane or desflurane, neuromuscular blockade with rocuronium bromide, and reversal with atropine plus neostigmine or sugammadex, depending on individual patient requirements.

Study Procedure Nasal irrigation will be performed using 0.9% NaCl at either 22°C or 50°C at least three times during surgery at 10-minute intervals. The 50°C saline solution will be stored in a laboratory incubator, while the 22°C solution will be maintained at room temperature. Irrigation will be delivered through a metal cannula connected to a syringe and inserted into the middle nasal meatus over approximately 5 seconds.

Following each irrigation, the surgical field will be evaluated using the 6-point Boezaart scale after suctioning the irrigation fluid mixed with blood from the nasopharynx. In the control group, surgical field visibility will be assessed every 10 minutes. Total blood loss will be calculated as the difference between the irrigation volume and the total suctioned fluid volume, and mean blood loss per minute will also be recorded.

The primary outcome measure will be total intraoperative blood loss. Secondary outcomes will include blood loss per minute of operative time and surgical field quality assessed using the Boezaart scale.

Data collection and analysis:

This is a pilot study; hence the statistical analysis will be completed at the end of the study.

Each participant will receive a unique study identification number to ensure anonymity and prevent the collection of directly identifiable personal data. Study data will be recorded in a Microsoft Excel database and will include demographic characteristics, comorbidities, current pharmacological treatment, Lund-Mackay CT score, CRS phenotype with or without nasal polyps, type of surgery (primary or revision), anesthetic infusion details, mean arterial pressure and pulse rate measured at 15-minute intervals, endoscopic surgical field assessment scores recorded every 10 minutes, intraoperative complications, use of a microdebrider, total intraoperative blood loss, duration of surgery, and total volume of saline irrigation used.

Study Type

Interventional

Enrollment (Actual)

59

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Poland
    • Mazovian
      • Warsaw, Mazovian, Poland, 01-755
        • Military Institute of Aviation Medicine

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Chronic rhinosinusitis diagnosed according to the EPOS 2020 criteria;
  • Confirmed failure of conservative treatment, defined as persistence of CRS symptoms for more than 12 weeks despite optimal pharmacological therapy;
  • Age over 18 years and ability to provide informed consent;
  • Written informed consent to participate in the study;
  • Presence of inflammatory changes on sinus computed tomography scans.

Exclusion Criteria:

  • Lack of patient consent;
  • Disease limited to a single sinus;
  • Conditions associated with ciliary dyskinesia (e.g., cystic fibrosis);
  • Suspected fungal infection or fungal ball;
  • Poor adherence to medical recommendations or noncompliance with treatment;
  • Suspected neoplastic disease;
  • Suspected or confirmed autoimmune disorders, particularly granulomatosis with polyangiitis;
  • - Confirmed or clinically suspected immunodeficiency; Diagnosed coagulation disorders or preoperative hemostasis test results outside laboratory reference ranges; Preoperative systemic glucocorticosteroid therapy.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Hot Saline Irrigation
Participants undergoing functional endoscopic sinus surgery (FESS) will receive intraoperative irrigation with 0.9% sodium chloride solution heated to 50°C at 10-minute intervals during surgery.
Procedure: Hot saline irrigation
Intraoperative irrigation of the sinonasal cavity using 0.9% NaCl heated to 50°C during FESS.
Experimental: Room-Temperature Saline Irrigation
Participants undergoing FESS will receive intraoperative irrigation with 0.9% sodium chloride solution at room temperature (22°C).
Procedure: Room-temperature saline irrigation
Intraoperative irrigation of the sinonasal cavity using 0.9% NaCl at 22°C during FESS.
Other Names:
  • 2
No Intervention: Control Group
Participants undergoing FESS without intraoperative saline irrigation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total intraoperative bleeding
Time Frame: From the beginning until the end of the surgery
The effect of intraoperative irrigation with hot 0.9% NaCl on total intraoperative blood loss during FESS, compared with room-temperature NaCl irrigation and no irrigation, that will be measured in mililiters (ml).
From the beginning until the end of the surgery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Surgical field visibility
Time Frame: From the beginning of the operation until the end.
The effect of intraoperative irrigation with hot 0.9% NaCl on surgical field visibility of operative time during FESS, compared with room-temperature NaCl irrigation and no irrigation. To measure this visibility - Boezaart score (from 0-5) will be used.
From the beginning of the operation until the end.
The effect of intraoperative irrigation with hot 0.9% NaCl surgical field visibility and blood loss per minute of operative time during FESS, compared with room-temperature NaCl irrigation and no irrigation.
Time Frame: From the beginning to the end of surgery.
The effect of intraoperative irrigation with hot 0.9% NaCl on blood loss per minute of operative time during FESS, compared with room-temperature NaCl irrigation and no irrigation. Unit of measure: ml/min.
From the beginning to the end of surgery.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Military Institute of Aviation Medicine

Investigators

  • Principal Investigator: Agnieszka Witkowska-Janik, MD, PhD, Military Institute of Aviation Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 1, 2023

Primary Completion (Actual)

December 1, 2025

Study Completion (Actual)

May 28, 2026

Study Registration Dates

First Submitted

May 27, 2026

First Submitted That Met QC Criteria

June 2, 2026

First Posted (Actual)

June 4, 2026

Study Record Updates

Last Update Posted (Actual)

June 4, 2026

Last Update Submitted That Met QC Criteria

June 2, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Bioethics Comm. MMC (232/22)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data collected during the study will not be made publicly available.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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