Common Cold Symptoms Not Washed Away by Nose Irrigation

Washing out your nose with a spray or spout of salt water is safe and might even get you back to work sooner after a cold or acute sinus infection. However, there is not enough evidence to show that it can reduce your symptoms significantly, according to a new research review.

The three studies in the review included small numbers of patients and varied widely in their details, “which means small beneficial effects may be missed,” said lead author David King, MD, of the University of Queensland, in Australia.

One study found that people were more likely to return to work sooner after using the nose washes, and there was some intriguing evidence that nasal washes might reduce antibiotic prescriptions among those who seek the saltwater treatment.

“Nasal irrigation with saline is a safe treatment that may be mildly beneficial to some patients, though the existing evidence is too limited to recommend it as a standard treatment,” King said.

“It is quite amazing that such a common treatment for a very common illness does not have a large body of evidence to support for or against its use,” he added.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Saltwater washes have long been a part of ayurvedic care, a traditional medicine used on the Indian subcontinent. Now saline sprays and nose “irrigators” like the neti pot − a small spouted pot used to pour water through the nostrils − have been showing up more often in Western culture, appearing everywhere from “Oprah” to the Mayo Clinic.

Saline nasal washes could flush out excessive mucus and infectious material, and might strengthen the nose’s own filtration system of waving, hair-like cilia, some studies have suggested.

If saline washes work, said the Cochrane reviewers, they could reduce the amount of decongestants, painkillers and improperly prescribed antibiotics used to treat upper respiratory tract infections, while reducing downtime from these illnesses.

“The economic impact of the common cold alone on workplace absenteeism is estimated to be billions of dollars,” they said.

The studies reviewed by the Cochrane team included 618 participants in the United States and Czech Republic, including children and babies. Many of the participants complained that the nasal wash felt uncomfortable, but the researchers did not find any serious adverse effects in the studies.

Other studies have shown that people with chronic sinus symptoms, and perhaps some allergy sufferers, might be able to prevent flare-ups with regular saline washes, according to David Rabago, M.D., an assistant professor of family medicine at the University of Wisconsin., who had provided feedback on the review draft to the authors.

Some key information about nasal irrigation is still missing, he said: What is the best way to wash?

“No head-to-head comparisons have been made of volume, salinity, temperature, pH or delivery vehicle — do you use a squeeze bottle or a neti pot, for example?” Rabago said.

He said most washes, which use lukewarm water and a 0.9 percent to 3 percent saline solution, “are able to do something good.”