Aphrodisiac Saline Rinse? David Randall, M.D., Fleet Surgeon
COVID – 19 has left the world scrambling for prevention, mitigation, and treatment options. Debate exists on the optimal means. “Do no harm,” remains the prime directive for good medicine, weighing risks and benefits of any intervention. Nasal saltwater (saline) irrigation remains a trusted friend. We have two types of saline: isotonic (same concentration as our bodily fluid) and hypertonic with increased sodium chloride concentration. We scrub our hands after performing dirty tasks. Logic posits benefit from washing the nose after wood – working (shown to decrease nose and throat irritation), dealing with a dusty environment, or exposure to dander or other allergens. (1) Many consensus statements show benefit from saline irrigation for a variety of sino – nasal conditions. (1) Studies have documented benefit with the common cold in adults and children. (2) Saline irrigation lacks detrimental effects though other ingredients may cause problems. Topical zinc can impair the sense of smell. (3) A study evaluating povidone – iodine rinse and gargle found temporary elevation of thyroid - stimulating hormone. (4) Trial of various cocktails such as salt water of different concentrations or additives like copper failed to show superiority of a particular choice although one small study showed hypertonic nasal rinse and gargling reduced COVID – 19 symptoms by two days. (1,4) The simple lack of studies prevents conclusive establishment of benefit saline irrigation against COVID – 19. (1,5) yet the lack of risk combined with benefit from other sino – nasal conditions offer compelling evidence to suggest its use after the onset of COVID – 19 (and the common cold) – even just for symptom mitigation. (2) Rinsing clears secretions and improves nasal blockage. Hypertonic saline (which some find irritation) further clears the nose by shrinking swollen tissues because it draws water out from them. The plethora of nasal irrigation options testifies to the popularity of this treatment modality. Rinses offer more benefit than saline spray. Some favor devices such as a Neti – Pot. Saline squeeze bottles provide more effective saltwater flow. One can even get powered gadgets as well but make sanitation more difficult. Otolaryngologist favor the squeeze bottle. These should be regularly washed with soap and water and replaced at least every three months. Disinfection
can be accomplished with isopropyl alcohol, vinegar, or a 10% bleach solution. And, short of drowning yourself or poking your eye out – these are risk free!
Standard isotonic saline recipe: 8 oz distilled / boiled water ½ teaspoon salt ¼ teaspoon sodium bicarbonate
1. Bastier PL, Lechot A, Bordenave L, Durand M, de Gabory L. Nasal irrigation: From empiricism to evidence-based medicine. A review. Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Nov;132(5):281-5. doi: 10.1016/j.anorl.2015.08.001. Epub 2015 Sep 3. PMID: 26344138. 2. Panta P, Chatti K, Andhavarapu A. Do saline water gargling and nasal irrigation confer protection against COVID-19? Explore (NY). 2021 Mar-Apr;17(2):127-129. doi: 10.1016/j.explore.2020.09.010. Epub 2020 Oct 1. PMID: 33046408; PMCID: PMC7528968. 3. Radulesco T, Lechien JR, Saussez S, Hopkins C, Michel J. Safety and Impact of Nasal Lavages During Viral Infections Such as SARS-CoV-2. Ear Nose Throat J. 2021 Apr;100(2_suppl):188S-191S. doi: 10.1177/0145561320950491. Epub 2020 Aug 27. PMID: 32853040; PMCID: PMC7453155. 4. Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. Hypertonic saline nasal irrigation and gargling should be considered as a treatment option for COVID-19. J Glob Health. 2020 Jun;10(1):010332. doi: 10.7189/jogh.10.010332. PMID: 32395245; PMCID: PMC7193539. 5. Guenezan J, Garcia M, Strasters D, Jousselin C, Lévêque N, Frasca D, Mimoz O. Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2021 Apr 1;147(4):400-401. doi: 10.1001/jamaoto.2020.5490. PMID: 33538761; PMCID: PMC7863011. 6. Burton MJ, Clarkson JE, Goulao B, Glenny A-M, McBain AJ, Schilder AGM, Webster KE, Worthington HV. Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking aerosol-generating procedures (AGPs) on patients without suspected or confirmed COVID-19 infection. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013628. DOI: 10.1002/14651858.CD013628.pub2.
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