Resident Vanderbilt Department of Otolaryngology - Head and Neck Surgery Nashville, Tennessee
Initial response to the COVID-19 pandemic primarily focused on pharmacologic interventions, including antivirals, convalescent sera, and vaccinations, with each critical in the fight against COVID-19. Given previous studies demonstrating varying efficy of saline irrigations on other viral diseases, we conducted a randomized controlled trial to evaluate the effect of nasal irrigations on upper respiratory symptoms and viral load in patients with COVID-19.
Methods: Randomized control trial conducted May 2020- December 2020. Patients with a positive reverse transcriptase polymerase chain reaction SARS-CoV-2 test were enrolled within 24 hours of testing and given swabs, viral preservation media, and a symptom diary incorporating a modified version of the validated Wisconsin Upper Respiratory Symptom–21 Survey. Patients were randomized to 1 of 3 treatment arms: (1) twice-daily irrigations with hypertonic saline, (2) twice-daily irrigation with hypertonic saline with 1% surfactant, and (3) a non-intervention group. Participants performed scheduled mid-turbinate swabs and recorded daily temperatures and symptom scores over the 21-day study duration.
Our hypothesis, that saline irrigations would decrease viral load and improve symptoms in patients with COVID-19, was ultimately not supported by this study. There was no significant difference between the intervention groups and the control group when analyzing viral load and symptomatology. Although essentially a negative study, this is the most comprehensive study evaluating efficy of saline irrigations in COVID-19 and implies that saline irrigations are unlikely to significantly affect patients in the setting of COVID-19.