Despite a relative lack of evidence, saline nasal irrigation is often used as an adjunct treatment for acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis. A new review published in the Cochrane Library evaluated published randomized controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.
Five RCTs on 544 children (three studies) and 205 adults (two studies) diagnosed with acute URTIs were identified, all comparing nasal saline irrigation to routine care or other nasal sprays (none comparing nasal irrigation to placebo). Types of acute URTIs included rhinosinusitis, pharyngitis, otitis media, tonsillitis, common cold, and influenza. The primary outcome was change in severity of acuteURTI-related symptoms over periods up to 28 days and secondary outcomes were adverse events associated with treatment, days off from work or school, and antibiotic and URTI medication use.
All five studies provided limited evidence that nasal saline treatment is effective for symptoms of acute URTIs, as nasal symptom scores were statistically similar between treatment and control groups. Two trials reported a reduction in the outcomes of time to resolution of symptoms, but this was not significant. The largest trial did indicate statistically significant outcomes for the nasal saline group at follow-up in reduction of sore throat, nasal secretion and secretion type, and nasal breathing score, yet the study had a high risk of bias. One study found a trend towards reduced antibiotic use and a statistically significant reduction in the use of adjunct nasal decongestant treatment with nasal saline irrigation vs. control. No serious adverse effects were reported in the trials, but minor adverse events were not uncommon.
This limited data suggests that while nasal saline treatment may be mildly beneficial for patients with acute URTIs and is generally considered to be a safe treatment, existing evidence does not support recommendations for or against its role as a standard intervention.