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Nasal irrigation or nasal lavage is the personal hygiene practice in which the nasal cavity is washed to flush out excess mucus and debris from the nose and sinuses. It has been practised in India for centuries as one of the disciplines of yoga. Clinical testing has shown that this practice is safe and beneficial with no significant side effects. Nasal irrigation in a wider sense can also refer to the use of saline nasal spray to moisten the mucus membranes.

The simplest technique is to snort water from cupped hands. Spraying the solution into the nostrils is more convenient, but also less effective. The most effective methods ensure that the liquid enters through one nostril and then either runs out of the other nostril or goes through the nasal cavity to the back of the throat from where it may be spat out. The necessary pressure comes from gravity, from condensing a plastic bottle or a syringe, or from an electrical pump.

Warm salt water is commonly used, often with a buffering agent such as sodium bicarbonate. Sometimes xylitol is added to help kill bacteria that have accumulated in the nose. Hypertonic solutions which are saltier than the nasal fluids are favoured and one study indicated that salt from the Dead Sea was especially efficacious.

Benefits and uses

Nasal irrigation is used to treat a wide range of chronic sinus symptoms; for chronic rhinosinusitis it is an effective adjunctive therapy. According to patient self-reports it improves quality of life and reduces use of medication, including antibiotics. It is also an effective measure against chronic sinus symptoms induced by work-place exposure to sawdust. Further evidence suggests that nasal irrigation causes relief for both hay-fever and the common cold. The use of nasal irrigation for the related conditions of asthma, nasal polyposis and rhinitis of pregnancy has not been assessed but the symptoms of these conditions are expected to be alleviated in a similar way.

Daily nasal irrigation with salt water is recommended as both an adjunctive and primary treatment in such cases and is preferable to the use of antibiotics or corticosteroids except in the most serious cases of acute bacterial sinusitis which should be immediately referred to an otolaryngologist. In several countries, over-the-counter medicines for coughs and colds are no longer sold for infants under the age of two. Nasal irrigation is an alternative for relieving the symptoms of such young patients.

Flushing the nasal cavity with salt water is believed to promote mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material, although there is no clear evidence to support this. The procedure has been used safely for both adults and children, and has no documented serious adverse effects. Patients treated with nasal irrigation rely less on other medications and make fewer visits to physicians. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity.

Methods

The simplest method, in that it does not require any equipment, is to snort water from cupped hands. The application of commercially available saline nasal spray is another simple alternative, but it is relatively inefficient.

A simple yet effective technique is to pour saline into one nostril and let it run out through the other. This is an old Ayurvedic technique known as jala neti. The container used to administer the saline is called a neti pot. (neti is Sanskrit for "nasal cleansing". A second neti technique known as sutra neti uses a piece of string instead of water.) Neti pots are traditionally made of metal, glass or ceramic. Some modern variants available from chemists are made of flexible plastic and can be condensed to exert additional pressure. If a bulb syringe is used instead, the user has complete control over the pressure.

It is also possible to use a dental water jet, which pumps the solution through a flexible tube with pulsating pressure, in connection with a nostril adapter. In the United States such devices are available for home use. They have been used in some studies, but their efficacy was not compared to the syringe or neti pot method for nasal irrigation.

Solutions used for nasal irrigation

Nasal irrigation can be carried out using ordinary tap water, but this is generally felt to be uncomfortable because it irritates the mucus. Therefore an isotonic or hypertonic saline solution is normally used, i.e. water with enough salt to at least match the tonicity of the body cells. For the same reason, lukewarm water is preferred over cold water. Similarly, a small amount of baking soda is frequently mentioned as an optional ingredient to adjust the pH value to that of the body. A typical home recipe for an isotonic solution consists of 1⁄2 litre (1 pint) of water, 5 millilitres (1 teaspoon) of salt and optionally another 5 millilitres of baking soda for an isotonic solution. For a hypertonic solution the amount of salt would be doubled or tripled.

Occasionally lactated Ringer's solution is used instead, or further substances are added to the basic recipe, such as antibiotics, antifungal drugs or xylol. Instead of making their own mixture, some patients choose manufactured solutions or sachets containing a powder to be dissolved in a prescribed amount of water.

Medical sources generally agree that iodised table salt is not acceptable, and that pickling salt is preferred because it also does not contain any other additives such as anticaking agents – Dead Sea salt is sometimes recommended as an alternative. Baking powder is also not an acceptable substitute for baking soda. Most sources advise that tap water should be boiled for several minutes to ensure sterility before it is cooled and used, but it is not clear whether this is really necessary.

See also

• Douche
• Enema
• Mouthwash

References

1. ^ Papsin B, McTavish A (2003). "Saline nasal irrigation: Its role as an adjunct treatment". Can Fam Physician. 49: 168–73. PMC 2214184. PMID 12619739. {{cite journal}}: Unknown parameter |month= ignored (help)
2. Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R (2002). "Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial". J Fam Pract. 51 (12): 1049–55. PMID 12540331. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
3. ^ Olson, DE (2002 Aug). "Radiographic comparison of three methods for nasal saline irrigation". Laryngoscope. 112 (8 Pt 1): 1394–98. doi:10.1097/00005537-200208000-00013. PMID 12172251. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
4. Friedman M, Vidyasagar R, Joseph N (2006). "A randomized, prospective, double-blind study on the efficacy of dead sea salt nasal irrigations". Laryngoscope. 116 (6): 878–82. doi:10.1097/01.mlg.0000216798.10007.76. PMID 16735920. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
5. ^ David Rabago (June 1, 2008), "The Use of Saline Nasal Irrigation in Common Upper Respiratory Conditions", US Pharmacist
6. Rabago D, Pasic T, Zgierska A, Mundt M, Barrett B, Maberry R (2005). "The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms". Otolaryngol Head Neck Surg. 133 (1): 3–8. doi:10.1016/j.otohns.2005.03.002. PMID 16025044. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
7. ^ Brown CL, Graham SM (2004). "Nasal irrigations: good or bad?". Curr Opin Otolaryngol Head Neck Surg. 12 (1): 9–13. doi:10.1097/00020840-200402000-00004. PMID 14712112. {{cite journal}}: Unknown parameter |month= ignored (help)
8. Sarah-Anne Schumann, John Hickner (July 2008), "Patients insist on antibiotics for sinusitis? Here is a good reason to say "no"" (PDF), The Journal of Family Practice, 57 (7)
9. Infant Cough And Cold Remedies Taken Off Shelves In UK, Medical News Today, 27 March 2008
10. Fear of overdose; children’s cold medication recalled, canada.com, 2007-10-11.
11. "Clinical study and literature review of nasal irrigation". Laryngoscope. 110 (7): 1189–93. 2000. PMID 10892694. {{cite journal}}: Unknown parameter |authors= ignored (help)

• Neti: Healing Secrets of Yoga and Ayurveda, Dr. David Frawley, Lotus Press, Twin Lakes, WI ISBN 0940985853

External links

• Wikibook about nasal irrigation
• Mayo Clinic instructional video
• University of Wisconsin instructions, study and video

• Hygiene
• Rhinology
• Kriyas
• Ayurveda