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Otolaryngology

Benefits and Safety of Nasal Saline Irrigations in a Pandemic—Washing COVID-19 Away

Educational Objective
To understand the benefits of using Nasal Saline Irrigations in a Pandemic

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: July 23, 2020

Viewpoint

Article Information and Disclosures

Nyssa F. Farrell, MD¹;

Cristine Klatt-Cromwell, MD²;

John S. Schneider, MD, MA²

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
²Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri

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The coronavirus disease 2019 (COVID-19) pandemic has ignited interest in viral transmission and prevention owing to the significant morbidity and mortality associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Investigations into SARS-CoV-2 pathophysiology suggest that, similar to other viral upper respiratory infections, infection occurs primarily in the nasal and nasopharyngeal mucosa with high viral loads early in disease.¹ Within the otolaryngology–head and neck surgery community, recent reports of viral transmission through endoscopic endonasal surgical procedures have caused increased concern regarding how nasal biology affects viral transmission. Further questions have arisen on the possible therapeutic role of commonly used topical nasal therapies. Nasal irrigations may play a role in reducing viral severity and further transmission. However, it is not yet clear whether topical nasal saline irrigations provide viral mitigation effects or conversely have a potentiating effect on viral transmission. Additionally, there are concerns about the consequences of topical adjuncts, such as nasal corticosteroids, for viral nasal infections. In this Viewpoint, we have briefly reviewed the current evidence regarding the association of nasal saline irrigations and their adjuncts with viral upper respiratory illnesses.

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Article Information

Corresponding Author: John S. Schneider, MD, MA, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8115, St Louis, MO 63110 (jsschnei@wustl.edu).

Published Online: July 23, 2020. doi:10.1001/jamaoto.2020.1622

Conflict of Interest Disclosures: Dr Klatt-Cromwell reported being a consultant for Medtronic outside the submitted work. Dr Schneider reported receiving personal fees from Optinose outside the submitted work. No other disclosures were reported.

References

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Panchmatia R , Payandeh J , Al-Salman R , et al. The efficacy of diluted topical povidone-iodine rinses in the management of recalcitrant chronic rhinosinusitis: a prospective cohort study. Eur Arch Otorhinolaryngol. 2019;276(12):3373-3381. doi:10.1007/s00405-019-05628-w PubMed Google Scholar Crossref

Lee SB , Yi JS , Lee BJ , et al. Human rhinovirus serotypes in the nasal washes and mucosa of patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2015;5(3):197-203. doi:10.1002/alr.21472 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.