It begins with a slight stinging sensation in the back of the throat.
Then a sneeze.
Then cough, runny nose and severe nasal congestion, with or without fever, for a few excruciating days.
Viral infections of the upper respiratory tract, also known as the common cold, affect everyone, usually three times a year, and last, on average, nine days.
Colds do not respond to antibiotics, and most over-the-counter medications offer modest results at best.
In recent years, research has emerged demonstrating the effectiveness of the ancient practice of saline nasal irrigation in combating the common cold in both adults and children.
Saline nasal irrigation not only reduces the duration of illness, but also decreases viral transmission to others, minimizes the need for antibiotics, and may even reduce the patient’s risk of hospitalization. And best of all, it is very economical and does not require a prescription.
I am an associate professor of medicine and a practicing physician. As a family doctor, I see common colds every day. My patients are often skeptical when I first recommend saline nasal irrigation. However, they often come back to tell me that this practice has changed their lives. Not only does it help with upper respiratory viruses, but it also helps manage allergies, chronic congestion, postnasal drip, and recurrent sinus infections.
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What is saline nasal irrigation?
Saline nasal irrigation is a process by which the nasal cavity is bathed with a salt water solution. In some studies, this is done using a pump sprayer.
In other cases, participants used a traditional neti pot, which is a teapot-like container.
This nasal irrigation practice has its origins in the Ayurvedic tradition, an alternative medicine system from India that is more than 5,000 years old.
The use of nasal burbot dates back to the 15th century. It achieved great popularity in the United States in 2012, after Dr. Oz demonstrated it on the Oprah Winfrey show. However, it is not the only device that has historically been used for this purpose. Doctors in ancient Greece and Rome already had their own tools for nasal washing. These practices were even mentioned in medical journals such as The Lancet more than a century ago, in 1902.
How does saline nasal irrigation work?
Nasal saline has several key benefits. First, it physically removes waste from the nasal passages. This includes not only mucus and scabs, but also the virus itself, along with allergens and other environmental contaminants.
Second, salt water has a slightly lower pH than fresh water. Its acidity creates an inhospitable environment for viruses and makes it difficult for them to replicate.
Third, nasal saline helps restore function of part of our natural defense system, made up of microscopic hair-like projections called cilia, which line the surface of the nasal passages. These cilia move in a coordinated manner, acting like an escalator that expels viruses and other foreign particles from the body. Nasal irrigation with saline solution helps this system work effectively.
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What the research shows
A study of more than 11,000 participants, published in The Lancet in 2024, showed that nasal irrigation with saline, started at the first symptoms and performed up to six times a day, reduced the duration of symptomatic illness by approximately two days. On the other hand, smaller studies have reported that the reduction in the duration of the disease could be up to four days.
Research has also shown that nasal irrigation with saline solution can help prevent the spread of disease. A study in hospitalized patients showed that after detection of COVID-19 by nasal swab, nasal saline irrigation performed every four hours for a 16-hour period reduced COVID-19 viral load by 8.9%. Meanwhile, the viral load in the control group continued to increase during that time.
The benefits of saline nasal irrigation go beyond acute infectious diseases. A meta-analysis of 10 randomized controlled trials showed that, when performed regularly in patients with allergic rhinitis (also known as hay fever), nasal saline irrigation can reduce the use of allergy medications by 62%. It is also effective for chronic congestion, postnasal drip, and recurrent sinus infections.
Why is it important
In addition to helping patients feel better faster, one of the most valuable benefits of saline nasal irrigation is that its use can help decrease unnecessary antibiotic prescriptions, which are a major factor in antibiotic resistance.
It has been shown that antibiotics do not shorten the duration or reduce the severity of respiratory infections. Despite this, some studies have shown that patients feel more satisfied when they leave the doctor’s office with a prescription for antibiotics.
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This could explain why 10 million antibiotics are inappropriately prescribed for viral respiratory infections each year. In a study of more than 49,000 visits for respiratory infections, antibiotics were unnecessarily prescribed to 42.4% of patients.
One of the reasons patients with viral upper respiratory infections often feel better initially with antibiotics is because of their anti-inflammatory properties, even though they are not the primary goal of treatment. However, this benefit may be best achieved with anti-inflammatory medications such as ibuprofen or naproxen, which can be taken along with saline nasal irrigation.
In summary, saline nasal irrigation is an affordable, effective, evidence-based alternative that will not only shorten the duration of the disease, but also prevent its spread, minimize the need for unnecessary antibiotics, and prevent people from being hospitalized.
How to do it
For those who want to try it, nothing fancy is needed. You don’t even need a nasal irrigator. Many pharmacies sell salt water in a container with a spout and even spray bottles that can be refilled with homemade saline solution.
Mix about half a teaspoon of non-iodized salt with a cup of water. For your safety, it is important that the water be distilled or boiled for at least five minutes and then cooled to eliminate any harmful bacteria. You can also add a pinch of baking soda to reduce the possible burning sensation.
It should be noted that saltier solutions are not more effective. However, some studies suggest that natural seawater, due to its additional minerals such as magnesium, potassium and calcium, could offer even greater benefits. Salt water solutions are also available commercially, which could be an option for those who do not get a sufficient response to saline alone.
You can perform saline nasal irrigations after any possible exposure to an infectious disease. For best results, begin irrigating the nasal passages at the first sign of infection. You can repeat the rinses throughout the day, as many times as necessary, as long as the illness lasts. At a minimum, it is recommended to irrigate the nasal passages in the morning and evening. You may also consider gargling with salt water as a complementary therapy.
About the author:
Mary J. Scourboutakos is Associate Professor of Family and Community Medicine, Macon & Joan Brock Virginia College of Health Sciences at Old Dominion University.
This text was originally published on The Conversation.
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