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A Clinical Trial of Hypertonic Saline Nasal Spray
The negative findings of the recently published trial1 on the use of hypertonic saline nasal spray might not be surprising if it is understood that the trial used a protocol that overlooked centuries of medical tradition.
I first learned to perform nasal irrigation, or the "nasal wash," more than 20 years ago from yoga teachers. The nasal wash is one of several internal cleansing practices that may have been in use for the last 1500 years. More fluid is normally used in each dose (4-6 oz [115-172 g]) than the amount used in this trial, less salt is used, and baking soda is not used at all.
In my clinical practice, irrigating the nose with a larger volume of the traditionally formulated solution brings relief to many patients who had not achieved success using regimens similar to that used in this trial. While it is gratifying to see the publication of a clinical investigation of a simple self treatment of a common problem, another study testing the procedure used for many centuries would seem to be justified before drawing any conclusions.
Michael Carlston, MD
San Francisco, Calif
1. Adam P, Stiffman M, Blake R Jr. A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Arch Fam Med. 1998;7:39-43.
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In reply
We appreciate Dr Carlston's interest in our study. His comments highlight the need for more clinical research in the field of family medicine. Nasal washes as Dr Carlston described are one of many remedies that are recommended without published evidence demonstrating their benefit. We tested a locally used regimen and found it to have little value. We agree with Dr Carlston that a clinical trial evaluating the treatment method he describes would be of interest. It would be wonderful to find a simple and effective remedy for upper respiratory tract infections.
Patricia Adam, MD, MSPH;
Michael Stiffman, MD, MSPH;
Robert Blake, MD
Minneapolis, Minn
Arch Fam Med. 1999;8:100.
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