Washing Illness Away: A Systematic Review of the Impact of Nasal Irrigation and Spray on COVID‐19
MD Karan Gandhi, BHSc Freeman Paczkowski, MD, MHM, FRCSC Leigh J Sowerby
The Laryngoscope, doi:10.1002/lary.31761
Objective: Nasal irrigation is a common treatment for sinonasal disorders; however, it is unknown if it can reduce SARS-CoV-2 nasopharyngeal viral load (NVL). This systematic review investigated the efficacy of nasal irrigation with saline, povidone iodine (PVP-I), and intranasal corticosteroids (INCS) at reducing SARS-CoV-2 NVL and transmissibility.
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'abstract': '<jats:sec><jats:title>Objective</jats:title><jats:p>Nasal irrigation is a common treatment '
'for sinonasal disorders; however, it is unknown if it can reduce SARS‐CoV‐2 nasopharyngeal '
'viral load (NVL). This systematic review investigated the efficacy of nasal irrigation with '
'saline, povidone iodine (PVP‐I), and intranasal corticosteroids (INCS) at reducing SARS‐CoV‐2 '
'NVL and transmissibility.</jats:p></jats:sec><jats:sec><jats:title>Data '
'Sources</jats:title><jats:p>Databases including Embase, MEDLINE, Web of Science, and '
'ClinicalTrials.gov.</jats:p></jats:sec><jats:sec><jats:title>Review '
'Methods</jats:title><jats:p>A systematic review was completed with pre‐defined search '
'criteria using keywords related to nasal irrigation and COVID‐19 from 1946 through January '
'2024. This review followed PRISMA reporting guidelines and was registered on PROSPERO. Only '
'in‐vivo studies testing nasal irrigation with either saline, PVP‐I, or INCS for reducing NVL '
'were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Nine out '
'of ten studies on saline‐based solutions reported positive effects in reducing NVL, with '
'benefits noted in earlier time to negative nasopharyngeal PCR and a greater decline in NVL '
'during early study time points, compared with controls. Isotonic and hypertonic saline '
'mediums were found to be effective with three studies demonstrating enhanced efficacy with '
'additives. Four out of seven studies on PVP‐I showed a positive effect on reducing NVL, but '
'results were heterogenous. Four studies demonstrated reduction of transmission with saline or '
'PVP‐I. No studies were found on '
'INCS.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Saline nasal '
'irrigation showed the best efficacy in reducing SARS‐CoV‐2 NVL. Additives to saline may have '
'a clinical benefit, but further studies are needed to elucidate their isolated impacts on '
'NVL. Data on PVP‐I is inconclusive and further studies are warranted to determine the ideal '
'concentration for irrigation. <jats:italic>Laryngoscope</jats:italic>, '
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