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Nasal irrigation

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A man flushing his nose with a neti pot

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

Common nose rinse device available at drug stores

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, the sale of over-the-counter medicines for coughs and colds has been banned for infants under the age of two. Nasal irrigation is a useful safe 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.

Pulsating nasal irrigation

Several medical reports indicate pulsatile lavage is more effective than non-pulsating nasal wash products like bulb syringes, neti pots and squeeze bottles which rely simply on gravity and conventional flow at breaking down biofilm, general cleansing and removing bacteria.

Solutions used for nasal irrigation

The normal concentration of saline solution used for medical purposes is 0.9% which can be made by adding 9 grams of salt to one litre of lukewarm water. This concentration is also known as isotonic.

This amounts to 1 tea spoon (5g) of salt disolved in 16 oz of water. A hypertonic solution is 2 or 3 times the concentration depending on whether it is a 2X hypertonic or 3X hypertonic.

Jala neti

Nasal irrigation is an ancient Ayurvedic technique known as jala neti, which literally means nasal cleansing with water in Sanskrit, where the practitioner uses a neti pot to perform the irrigation. Because modern medicine has long supported the use of nasal irrigation to clear sinuses and prevent sinus and nasal conditions, physicians also accept jala neti as simply one type of nasal irrigation, which can be performed using a neti pot or syringe.

A related technique for nasal cleansing in the yogic tradition, is Sutra Neti. One end of a cord, or rubber catheter, is passed from the nose into the back of the throat where it is grabbed by the fingers and pulled out of the mouth. Holding the nose end of the cord with one hand and the mouth end with the other, the cord is gently pulled to and fro.

See also

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. Osguthorpe, JD (1999 Jan). "RHINOSINUSITISCurrent Concepts in Evaluation and Management". Medical Clinics of North America. 83 ((1)): 27–41. PMID: 9927958. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  11. Davidson, TM (2000 Jul). "Clinical study and literature review of nasal irrigation." The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease"". Laryngoscope. 110 ((7)): 1189–93. PMID: 10892694. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  12. Kaliner, MA (1997 June). "Sinusitis: Bench to Bedside "Pulsatile sinus irrigation is recommended as a treatment for sinusitis, and as a supplement to other treatment modalities"". Otolaryngology. 116 Part 2 Study of Sinusitis ((6)). PMID: 9212028. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. Pope, A (1974 Aug). "Pulsation Irrigation: a Simple, Safe Effective Treatment of Many Nasal Complaints". O.R.L. Digest. 15 ((8)): 36–38. PMID: 9927958. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • Neti: Healing Secrets of Yoga and Ayurveda, Dr. David Frawley, Lotus Press, Twin Lakes, WI ISBN 0940985853

External links

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