This article was originally posted in the Montreal Gazette.
A friend of mine recently asked me if nasal irrigation was useful or effective for treating kids who get a cold. Apparently, the idea has become popular of late and there is much discussion about whether parents should try it when their kids get sick and whether the benefits of the procedure are worth the wrestling match with a squirming, unco-operative child.
Rinsing your nasal cavity with a sterile saline solution makes a certain intuitive sense. Rinsing out the inside of your nose should logically clear excess mucus, reduce nasal congestion and improve breathing. It is generally recommended for people with sinus issues because it is a low tech, low cost and essentially risk free procedure with little downside. The only major concern is the possibility of contaminated water being a source of infection, hence the general recommendation to use a sterile salt solution to avoid that potential risk. Nasal rinses are often recommended for people with chronic sinusitis or allergic rhinitis as a cheap and easy therapy.
But the question was specifically about treating cold symptoms in children, which is inherently harder to answer. There is usually less research data available for children. Recruitment is harder and more complicated, and studies tend to be smaller. Also, blinding is impossible in these types of studies, so patients know which treatment they are getting, which may influence whether they feel better or not. Also, when judging something that is inherently subjective, like whether you feel less congested, you often have to rely on parents to report back any change or improvement, especially with younger children. Getting this information from an intermediary rather than directly from the source can always introduce some error. All of these issues make it difficult to be definitive when it comes to something as fundamentally vague like whether you feel better during a cold.
There is not a lot of research on the issue of nasal rinses in children. The Cochrane review on the subject found only three such studies. The results were inconsistent and the studies evaluated different things, making them hard to compare and synthesize. The largest of the studies, which was done in 400 children from the Czech Republic, showed some benefit in some patient-reported symptoms. When asked to rate their nasal congestion, the children who got nasal irrigation reported a mild improvement (again via the intermediary of their parents). However, the improvement was small. On a four-point scale, the treatment group had a 0.3 point improvement in nasal secretion severity and a similar improvement in nasal patency, that is, their noses not being blocked. A 0.3 point improvement on a four-point scale though is hard to interpret clinically and it is tricky to see what this means in a practical way.
More pragmatic outcomes didn’t really show a difference, however the small size of the studies and the inherent difficulties of pediatric research might make any benefit hard to see. In adults, days off work are not lessened by nasal rinses, neither is the time it takes to recover completely. There is some suggestion that nasal rinses reduce antibiotic use, but you should not be taking antibiotics for the common cold anyway. Parents who used nasal irrigation on their children were less likely to use other therapies like nasal decongestants, which conveys a benefit in terms of cost savings and the reduction of unnecessary therapies.
In short, the data for nasal rinses is a bit inconclusive and inconsistent. Overall, there may be some subjective benefit, but we have to acknowledge the general uncertainty of the issue. There is obviously little downside to trying it, with the understanding the benefits may be quite subtle. Whether you should persist in doing so in an unco-operative child is more questionable. In parenting, much like in warfare, you have to learn to pick your battles.
