Speaking from experience, both as an ENT specialist AND as a former CRS patient who received a successful operation two years ago. I routinely advise my patients to do nasal douching. I never advise them to use hypertonic saline, as it is irritating. It really hurts!

On the other hand, normal saline or any other isotonic solution provides clearence of mucus and temporary improvement in nasal obstruction.

Moreover, the most helpful device I have used is the SinusRInse bottle. It is easy to use and is based on the principle "high volume of saline with low pressure", contrary to other similar devices.

I recommend my CRS patients to use saline irrigation during exacerbation episodes but not necessarily daily during milder phases of the disease. Some of my patients have had persistent crusting and secretion problems which have stopped after quitting daily saline irrigation. This might be due to contaminated rinsing devices or mechanical irritation of the mucosa. Anyway, I think it's a good method to maintain the disease but some patients take it too far and rinse too much and too often. Sometimes those patients benefit if they stop the irrigation for a while. 

There is good evidence to support the use of isotonic irrigation, and anecdotally my patients almost all love it. I encourage them to irrigate daily at the start of treatment, using a high volume rinse bottle, and once symptoms are controlled, on a prn basis. there is not good evidence to support the use of hypertonic over isotonic saline, and the increased incidence of nasal irritation means that patients are less likely to be compliant, so I dont recommend that.

Isotonic saline irrigation is very helpful in cases with excessive crustations an dryness, as it improves the mucociliary clearence and decrease nasal and postnasal discharge

hypertonic saline is useful in cases with resistant nasal obstrucion not responding to topical decongestents and steroids. We do not recommend long term use of this hypertonic solutions

Since many years we have been prescribing nasal irrigation in all our patients sufferring of chronic inflammation of the nose and sinuses from allergy to CRS with and without polyps. Our experience is that hypertonic solutions (22g of NACl/l buffered to the pH of the inflammed nasal mucosa) is indicated in acute cases and immediate post-op. For daily use and in patients who earlier underwent surgery we prefer light hypertonic solutions (11g of NaCl/l buffered with bicarbonate). The use of mechanical devices makes irrigations more efective, easy and fast. Patients becomes addicted to this practice.

We sugget our patients a device that is sold in Europe from a small company and that sales through its internet site and Amazon. This company, named sinh2ox, also produces sackets of salts easy to prepare our preferred recipies.

We never use isotonic solutions based to the fact that the nasal mucosa is not isotonic and that the thick mucus usually found in chronic patients is better dissolved by hiypertonic solutions. To avoid discomfort for the patients or pain is mandatory to irrigate the nose with warm solutions (this also avoid osteomatosis) and to direct the flow toward the rhinopharynx.

The daily use of nasal irrigations associated with topical steroids has dramatically reduced the rate of recurrences in our surgical patients and helps our allergics to reduce the amount of sistemic medications