NASAL SALINE IRRIGATION

What is nasal saline irrigation?

Nasal saline irrigation, often done with a neti pot, is a non-medicated alternative that can be used as an additional treatment to relieve nasal congestion from allergies or upper respiratory tract infections. To perform nasal saline irrigation, wash and completely dry the neti pot or a similar device before use. Prepare the saline rinse with preferably distilled or sterile water. Lean over a sink and tilt your head sideways and downward to keep the saline rinse from flowing into your mouth. Breathe through your mouth while inserting the neti pot into your upper nostril so the saline can drain from the other nostril. Then repeat on the other side.

How can nasal saline help alleviate certain long COVID symptoms?

The primary target of the SARS-CoV-2 virus starts initially in the nasal epithelium and spreads to the throat and airways. It is believed that nasal saline irrigation can help to remove and limit the viral load in the nasal passages and throat. When added to standard-of-care measures, nasal saline irrigation has been shown to clear viral loads faster in more severe or hospitalized COVID patients.¹ In vitro, saline has also been reported to reduce viral replication by 50-98%.¹ Also, earlier studies have shown that nasal saline may even help reduce household transmission of COVID.² Given its ability to clear the nasal passages, nasal saline may help in the reduction of nasal symptoms post-COVID as well as smell or taste dysfunction.

What evidence supports the use of nasal saline for long COVID?

In a study of 140 patients with 68 participants who performed daily nasal saline irrigations for 12 days, there was an average reduction of 24.7% in nasal congestion, a runny nose, and sneezing.³ Smell or taste dysfunction may take 10-40 days to resolve with nasal saline irrigation, and the evidence is somewhat mixed in effectiveness.¹ In the previously mentioned study, lack of smell and taste did not vary significantly between the treatment and control groups.³ However, other studies have found significant differences in loss of smell between patients who used nasal saline irrigation and gargling and those who did not.⁴  Another study found that using nasal saline irrigation in combination with triamcinolone acetonide nasal spray (a topical corticosteroid available over the counter) significantly improved the sense of smell compared to nasal saline irrigation alone.⁵

What should you be aware of when using nasal saline?

Nasal saline irrigation appears to be safe with no reported serious adverse events with proper administration. Remember to thoroughly wash your neti pot before and after each use. Some may experience nasal irritation and stinging. Reducing the amount of salt in the solution or adjusting the temperature of the water may help. It is important to use distilled or sterile water to prevent potential infection from tap water.

References:

1)      Huijghebaert S, Parviz S, Rabago D, Baxter A, Chatterjee U, Khan FR, Fabbris C, Poulas K, Hsu S. Saline nasal irrigation and gargling in COVID-19: a multidisciplinary review of effects on viral load, mucosal dynamics, and patient outcomes. Front Public Health. 2023 Jun 16;11:1161881. doi: 10.3389/fpubh.2023.1161881

2)      Farrell NF, Klatt-Cromwell C, Schneider JS. Benefits and Safety of Nasal Saline Irrigations in a Pandemic-Washing COVID-19 Away. JAMA Otolaryngol Head Neck Surg. 2020 Sep 1;146(9):787-788. doi: 10.1001/jamaoto.2020.1622

3)      Spinato G, Fabbris C, Costantini G, Conte F, Scotton PG, Cinetto F, De Siati R, Matarazzo A, Citterio M, Contro G, De Filippis C, Agostini C, Emanuelli E, Boscolo-Rizzo P, Frezza D. The Effect of Isotonic Saline Nasal Lavages in Improving Symptoms in SARS-CoV-2 Infection: A Case-Control Study. Front Neurol. 2021 Dec 6;12:794471. doi: 10.3389/fneur.2021.794471

4)      Jadhav RB, Patil SS, Deolekar P, Yadav P, Dongerkery K. A comparative study to evaluate the use of nasal saline lavage and gargling in patients with COVID-19 infection. IJPR. 2023;15(3). doi: 10.31838/ijpr/2022.14.01.003

5)      Yildiz E, Koca Yildiz S, Kuzu S, Günebakan Ç, Bucak A, Kahveci OK. Comparison of the Healing Effect of Nasal Saline Irrigation with Triamcinolone Acetonide Versus Nasal Saline Irrigation alone in COVID-19 Related Olfactory Dysfunction: A Randomized Controlled Study. Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):3022-3027. doi: 10.1007/s12070-021-02749-9