Is All Saline the Same?
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Jonathan M. Lee, MD Assistant Professor, Dept. of Otorhinolaryngology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA About the author: Dr. Jonathan Lee is Board Certified in Otolaryngology, Head & Neck Surgery. He received his undergraduate degree in Neurobiology at Harvard University, and he did his medical training at the University of Pennsylvania. His research work has been published in major medical journals and he has lectured at medical conventions throughout the country. He specializes in the medical and surgical management of a wide variety of ear, nose, and throat conditions, with a special focus on sinus disease and obstructive sleep apnea. https://www.pennmedicine.org/providers/profile/jonathan-m-lee |
Although chronic sinusitis is one of the most common conditions seen by primary care physicians, I often see patients that have not received appropriate treatment. A classic scenario is an otherwise healthy middle aged patient who presents with many months of nasal congestion, postnasal drip, and thick nasal discharge. The patient has often been on multiple courses of antibiotics, nasal steroid sprays, and decongestants without significant improvement.
Chronic sinusitis is a complex disease process that is not yet fully understood. We know that is is not only an isolated problem of bacterial infection. The ability of the body to clear allergens, mucous, bacteria, and particulate matter through a process called mucociliary clearance is thought to be particularly important in managing chronic sinusitis.
Nasal saline irrigation has been demonstrated to be a safe and effective treatment for the management of chronic sinusitis, as well as allergic rhinitis. In 2007, the Cochrane Collaboration reviewed an extensive collection of research and concluded that nasal saline irrigation is beneficial for chronic sinusitis, with relatively few side effects, when used alone or in combination with other therapies.
Often primary care physicians recommend nasal saline sprays instead of irrigation, because they think that the spray is easier to use and to tolerate. When nasal saline spray has been compared to nasal saline irrigation in randomized controlled studies, however, the group that used nasal saline irrigation consistently reported less severe and less frequent symptoms such as runny nose, postnasal discharge, and need to blow the nose.
Although saline spray seems to be the same as nasal saline irrigation, I stress to patients that the key difference lies in the delivery of a large volume of liquid at low pressure. This delivery of liquid appears to greatly assist the body’s ability to clear allergens, mucous, bacteria, and other particulate matter. For this reason, I routinely instruct patients who suffer from chronic sinusitis to incorporate nasal saline irrigation into their daily regimen.
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