Background The purpose of this study was to objectively determine and compare the efficacy and effectiveness of xylitol solution (Xlear Nasal Sprey (R)) compared with xylometazoline and physiological saline with respect to quality of life (QoL) in patients with nasal congestion. Methods A prospective, randomized study was performed in 42 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. The study population was randomized into 3 groups according to the application of xylometazoline, physiological saline, and xylitol hyperosmolar solution. The efficacy of treatment was evaluated objectively (4-phase rhinomanometry) and subjectively (visual analogue scale VAS.) before and after the application of the nasal solutions. QoL was evaluated by means of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results VAS scores and 4-phase rhinomanometry scores were better in the group treated with xylometazoline compared to those treated with xylitol or saline. The xylitol procedure yielded better results than the saline procedure, but differences were not statistically significant in both objective and subjective evaluation methods. For overall QoL, there was a significant improvement from baseline for the xylometazoline and xylitol groups. However, the improvement in the xylometazoline group was significantly greater than that obtained in the xylitol group. Conclusion Xlear Nasal Spray (R) is an effective modality in the treatment of nasal congestion and has positive effect on the QoL of patients. Further studies are needed in order to plan an ongoing treatment of Xlear Nasal Sprey (R) at certain intervals for continuous relief of symptoms and a better and longstanding QoL.