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Tag: Saline

Woman holding nasal spray towards nostrils.

Saline Nasal Spray Helps Control Nosebleeds

Epistaxis, popularly known as nosebleed, is a common problem affecting many people. While majority of cases can be easily treated, some can cause significant problems or can even be life-threatening if associated with serious disorders.

Nosebleeds usually occur during cold or dry months and are often associated with various types of cold, hay fever and allergic symptoms that may irritate the delicate nasal tissues.

In most instances, bleeding occurs when the lining of the nose or nasal mucosa becomes dry and irritated causing the blood vessels along the surface of the nasal lining to break or rupture.

Common medications used to control or prevent nosebleeds include decongestants and antihistamines. However, excessive, or prolonged use of these drugs may further aggravate the dryness and increase risk for more nosebleeds.  Keeping the nasal tissues hydrated or moist with the use of saline nasal spray is frequently offered as a simple intervention which may be as effective as drug therapy in controlling nosebleeds. Apart from addressing the underlying condition or factor that causes epistaxis, using saline nasal spray traditionally becomes a practical part of medical management to prevent recurrence of nosebleed. Saline nasal spray becomes handy in humidifying the nasal environment and in moisturizing the nasal mucosa thus preventing future episodes of bleeding.

The 2020 Clinical Practice Guidelines (CPG) for Nosebleed published in the American Academy of Otolaryngology- Head and Neck Surgery authored by Dr. David Tunkel and his team outlined some supportive measures such as nasal saline spray in keeping the nose humid to prevent dry crusts and to facilitate healing.

The authors underscored that nasal saline spray or gel which can help moisturize the tissues inside the nose can reduce or prevent nosebleeds together with the elimination of contributing factors such as digital trauma (nose picking), vigorous nose blowing and proper nasal hygiene.

To prevent additional nosebleeds in patients taking anticoagulants or antiplatelet drugs, who are at increased risk of recurrent epistaxis, the CPG recommended saline lubrication as well as control of comorbidities.

The result of a North American study which was published online in the Journal of American Medical Association (JAMA) in 2016, demonstrated that salt-based spray is as effective as medicated spray in controlling nosebleeds among patients with Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Disease). In Hereditary Hemorrhagic telangiectasia, a condition characterized by abnormal blood vessel formation, patients suffer from frequent episodes of nosebleeds that may occur once a week or several times a day in some patients.

This double-blind, placebo-controlled randomized clinical trial which included 121 patients afflicted with HHT used either a saline spray or sprayed one of three drugs, bevacizumab, a drug for cancer and macular degeneration, a hormone, Estriol and tranexamic acid, a drug that promotes clotting.

The US-based study lead by Dr. Kevin Whitehead, an Associate professor of Cardiovascular Medicine at the University of Utah School of Medicine, said in the news release that none of the drugs proved any better than the saline spray at preventing nosebleed. No drug treatment was significantly different from placebo for epistaxis duration. Participants in the US-based study who are afflicted with HHT revealed that they had significant improvement in Epistaxis Severity Score even if they were solely using the saline spray.

Resources:

1. Clinical Practice Guideline: Nosebleed (Epistaxis)

2. Effect of Topical Intranasal Therapy on Epistaxis Frequency in Patients With Hereditary Hemorrhagic Telangiectasia

Clinical Researchers Investigate the Benefits of Saline Nasal Solutions as an Aid in the Management of COVID-19

Clinical Researchers Investigate the Benefits of Saline Nasal Solutions as an Aid in the Management of COVID-19

The morbidity and mortality associated with the dreadful novel COVID- 19 has seriously affected the whole world, posing a continuing challenge for the clinical researchers to discover ways to treat and prevent the spread of the disease. In the absence of a cure for COVID-19, researchers are prompted to focus their efforts in preventing viral transmission.

In the early stages of COVID-19, it is the nasopharyngeal mucosa which carries high viral loads. This sparked enormous interest to investigate the potential role of saline nasal irrigation solutions in reducing viral load and transmission.

COVID-19 and the Potential of Nasal Saline Irrigation

In an article published in July 2020 in the JAMA Otolaryngology-Head & Neck Surgery, clinical researchers from the Oregon Health & Science University and the Washington University School of Medicine discussed the benefits and safety of nasal saline irrigations for the COVID-19 pandemic. They reviewed the current evidence regarding the association of nasal saline irrigations with viral upper respiratory disease.

The researchers looked into the effect of saline nasal rinses in viral respiratory infections associated with mucus stasis due to the inflammatory reaction induced by the virus. It was explained that saline solutions may be helpful in disrupting and removing the mucus and other invading foreign materials in the mucosal layer. As the nasal lining is hydrated by the saline solution, the inflammatory substances in mucus also gets diluted and the sweeping actions of the cilia, the hair-like structures of nasal cells which helps clears out the mucus, is improved. These effects were seen to be particularly helpful during a viral respiratory infection wherein the movement of mucus has slowed down due to the inflammatory changes such as localized swelling and thickened secretions. The researchers, citing a recent clinical trial on the common cold, shared that rinsing the nose with saline solution may help in reducing the duration of illness, the transmission among household members, and even viral shedding.

The researchers also acknowledged the concern regarding the potential contamination of the nasal rinsing devices leading to increased transmission through contact-induced infections and advised that disinfection of these devices can be done with 75% ethanol, chlorine, UV light or heat. Indeed, good hand hygiene before and after nasal rinsing as well as decontamination of surfaces like the sink remains important.

Clinical Trials on Saline Nasal Rinses are Underway

In May 2020, researchers from the Vanderbilt University Medical Center, have initiated a clinical trial to see whether nasal saline irrigation would be able to reduce the viral load of patients with COVID-19 as well as contribute to their symptom relief. Interestingly, some of studies recently suggested the possible effect of nasal saline irrigations in reducing viral shedding in patients with coronaviruses treated with saline irrigations when compared with the control group.

Another clinical trial on saline nasal rinses for patients with COVID-19 was started in the same month by another group of researchers at the University of Edinburgh. In the ongoing study named the ELVIS (Edinburgh-Lothians Viral Intervention Study) – COVID-19, the researchers are seeking to determine if nasal washing and gargling with salt water would help individuals with COVID-19 get better faster. It also supports their earlier study which found that cells lining the nose can create an antiviral effect by producing hypochlorous acid, a form of bleach, from chloride ions which are in salt (i.e. sodium chloride).

If these saline nasal irrigations have a similar effect on the novel COVID-19 as they do on other viral respiratory infections – is what the clinical investigators and the rest of the world are eager to know.

Currently, clinical trials are actively recruiting participants with results anticipated in a few months.

References:


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.

Kimura K. Impact of Nasal Saline Irrigations on Viral Load in Patients with COVID-19.

University of Edinburgh. Hypertonic Saline Nasal Irrigation and Gargling in Suspected or Confirmed COVID-19 (ELVIS COVID-19).