A prospective randomized study was designed to compare the effect of different irrigation solutions on mucociliary clearance and nasal patency and to compare the limitations of the used solutions, such as nasal burning by a visual analog scale. Forty-five patients who underwent septoplasty were divided into three groups postoperatively. Each group was administered with 2.3% buffered hypertonic seawater, buffered isotonic saline solution and non-buffered isotonic saline, respectively, as irrigation fluid. Saccharine test and acoustic rhinometer were used to determine mucociliary activity and nasal patency. Patients were asked about the burning sensation using a 10-cm visual analog scale. There was no significant difference in saccharine clearance time (SCT) on the 5th postoperative day between the three groups (P = 0.07). On the 20th day, there was a significant difference in SCT between the hypertonic buffered seawater group and non-buffered isotonic saline (P = 0.003). Buffered hypertonic seawater improved nasal airway patency more than the buffered isotonic saline (P = 0.004). Buffered hypertonic solutions used after endonasal surgery have been advantageous for both mucociliary clearance and postoperative decongestion.