Nasal irrigation

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Common nose rinse device available at drug stores

Nasal irrigation or nasal lavage is the personal hygiene practice in which the nasal cavity is washed to flush out excess mucus and debris while moistening the mucus membranes of 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.[1][2]

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.[3]

Warm salt water is commonly used 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.[4]


[edit] Benefits and uses

Nasal irrigation is used to treat a wide range of chronic sinus symptoms; for chronic rhinosinusitis it has been found to be 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.[5]

There is also evidence 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.[5]

Daily nasal irrigation with salt water is recommended as both an adjunctive[6] and primary treatment[7] 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.[8] 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.[9][10]

Flushing the nasal cavity with salt water (saline) promotes mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material. 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.[11]

[edit] Pulsating nasal irrigation

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.[12] [13] [14]

[edit] 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.

[edit] Jala neti

Ceramic neti pot; neti pots can also be made from glass, metal, or plastic.

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.[citation needed]

Jala neti, though relatively less known in Western culture, is a common practice in parts of India and other areas in South Asia, performed as routinely as brushing one's teeth using a toothbrush.[citation needed] It is performed daily, usually as the first thing in the morning with other cleansing practices. It may also be performed at the end of the day if one works or lives in a dusty or polluted environment. When dealing with problems of congestion it can be performed up to four times a day.[citation needed]

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.

[edit] See also

[edit] References

  1. ^ Papsin B, McTavish A (February 2003). "Saline nasal irrigation: Its role as an adjunct treatment". Can Fam Physician 49: 168–73. PMID 12619739. PMC: 2214184. 
  2. ^ Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R (December 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. 
  3. ^ Olson, DE; Rasgon BM, Hilsinger, RL Jr. (2002 Aug). "Radiographic comparison of three methods for nasal saline irrigation". Laryngoscope. 112 (8 Pt 1): 1394-98. PMID 12172251. 
  4. ^ Friedman M, Vidyasagar R, Joseph N (June 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. 
  5. ^ a b 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 (July 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. 
  7. ^ Brown CL, Graham SM (February 2004). "Nasal irrigations: good or bad?". Curr Opin Otolaryngol Head Neck Surg 12 (1): 9–13. PMID 14712112. 
  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. ^ Tracie Simer (August 4, 2008), FDA ban on children's decongestants not a whim, The Jackson Sun, 
  10. ^ Infant Cough And Cold Remedies Taken Off Shelves In UK, Medical News Today, 27 March 2008, 
  11. ^ Papsin, B., McTavish, A. (2003). "Saline nasal irrigation: Its role as an adjunct treatment". Canadian Family Physician 49 (February): 168-173. PMID PMC2214184. 
  12. ^ Osguthorpe, JD; Osguthorpe David J MD, Hadley James A. MD, FACS (1999 Jan). "Rhinosinusitis: Current Concepts in Evaluation and Management". Medical Clinics of North America 83 ((1)): 27-41. PMID: 9927958. 
  13. ^ Davidson, TM; Tomooka LT, Murphy C School of Medicine, University of California San Diego, USA. (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.$=citationsensor. 
  14. ^ Kaliner, MA; Osguthorpe JD, Fireman P, Anon J, Georgitis J, Davis ML, Naclerio R, Kennedy D (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. 
  • Neti: Healing Secrets of Yoga and Ayurveda, Dr. David Frawley, Lotus Press, Twin Lakes, WI ISBN 0940985853

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