ObjectiveTo indirectly compare the efficacy of different concentrations of saline irrigation in treatment of chronic rhinosinusitis by network meta-analysis. MethodsThe CNKI, WanFang Data, CBM, VIP, Embase, PubMed and Cochrane Library databases were electronically searched to collect randomized controlled trials on different concentrations of saline irrigation in treatment of chronic rhinosinusitis from inception to March 1, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The network meta-analysis was performed by using RevMan 5.4 and Stata 17.0 software. ResultsIn total, 935 patients were enrolled in 15 study. The results of network meta-analysis showed that visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore of hypertonic saline irrigation group were superior to isotonic saline irrigation group. 2.5% hypertonic saline irrigation has best efficacy in terms of visual analogue scale sore, while 3% hypertonic saline irrigation has best efficacy in terms of mucosal ciliary transport rate and 3.5% hypertonic saline irrigation has best efficacy in terms of Lund-Kennedy sore. ConclusionCurrent evidence indicates that hypertonic saline irrigation has more advantages in terms of clinical efficacy rate, visual analogue scale sore, nasal mucosal ciliary transport rate and Lund-Kennedy sore, while 2.5% hypertonic saline irrigation has more advantages in terms of balancing efficacy and acceptability. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.