I appreciate Dr Berry's comments regarding the use of saline spray in the nose and agree that the efficacy of nasal saline spray in the treatment of sinonasal diseases is unknown. To my knowledge, no studies have specifically addressed the effectiveness of nasal saline spray or its mechanism of action. Some studies, however, have examined the role of nasal saline irrigation in the treatment of sinonasal disease without conclusive results. Heatly et al1 evaluated the effects of daily nasal irrigation vs reflexology massage in patients with sinus symptoms and found equal degrees of symptom improvement in both groups. In another study, Tomooka et al2 found that daily use of a water irrigation device (Water Pik) to irrigate the nose resulted in a significant improvement in nasal and allergic symptoms compared with control. Unfortunately, their control group did not have sinonasal disease or symptoms. While these studies did not report any significant adverse effects with the use of nasal saline irrigation during the short duration of treatment (2-6 weeks), both studies used preservative-free saline solutions. As our study points out, preservatives contained within some saline sprays may be detrimental to normal nasal defenses and function.3
Boston M. Negative Side of Nasal Saline Sprays: They Can Be Harmful—Reply. Arch Otolaryngol Head Neck Surg. 2003;129(12):1352. doi:10.1001/archotol.129.12.1352-a
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