Introduction
In medicine, “irrigate” means to rinse out and clean with a liquid. Irrigation of the nose is an ancient technique that is backed up by modern science. A mix of salt and water (“saline”) is used to wash the nasal cavity regularly. This helps to rinse out bacteria, viruses, allergy particles, and other debris. Studies have shown this can lessen inflammation and improve nasal symptoms. When done the right way, nasal rinses are a safe, effective, and affordable way to help treat and prevent sinus problems.
How to Rinse
There are different ways to do nasal saline irrigations, and not all are equally good at reaching the whole nasal cavity. Studies have shown that using larger amounts of saline to rinse the nose is better at improving symptoms. An 8 ounce bottle will do a better job of reaching the entire nasal lining compared to a saline spray or mist. Sinus surgery also helps rinses get into the all of the sinus cavities. High volume irrigation devices also work better than nebulizer machines, which create a mist that is breathed into the airway.
Holding your head in the right way can help nasal irrigations work better. Leaning the head forward and down can help the rinse get to the top of the nose and the forehead (“frontal”) sinus area. Pointing the nose to the ceiling can help the rinse reach the back of the sinuses (“sphenoid”).
Saline Concentration
“Concentration” means how much salt is mixed into the liquid. Most doctors recommend using nasal irrigations with the same amount of salt as normal body fluids. This is called “isotonic” saline. Some studies have recommended higher saline concentrations (“hypertonic saline”), but this can cause side effects like irritation and congestion in the nose. Many companies offer premixed salt packets which are easy to use and relatively cheap. Some patients may choose to make their own saline irrigation at home, however. A common recipe is 2-3 teaspoons of iodine free salt, 1/4-1/2 teaspoons of baking soda, and 1 liter of sterile water.
Bottle Contamination
Because nasal irrigations are often used to treat infection, keeping the rinse bottle clean is very important. Bottles can carry bacteria into the nose if not cleaned the right way. Fortunately, microwave safe irrigation bottles are easy to find and not expensive. Regularly switching out for a new bottle is also a good idea.
Water Source
There have been a few cases in the news of patients dying from a serious brain infection after using nasal rinses made with tap water. The cause is a tiny amoeba called Naegleria fowleri, which is common in rivers and lakes (this is why infection has also been reported after fresh-water swimming). Naegleria can rarely get into the water supply, and to be safe tap water should not be used for nasal saline irrigations unless it is first boiled and allowed to cool. Using distilled water is another safe option.
Medicated Irrigations
Nasal irrigations can also be used as a way to get medicines like steroids or antibiotics directly to the sinuses. Studies have shown that adding a steroid medicine to high-volume saline rinses is well tolerated and can help to improve sinus symptoms in many patients. Research continues to better understand the best way to use topical antibiotic and steroid rinses in sinusitis.
Summary
High-volume nasal saline irrigations, when done correctly, are safe and help to improve sinus symptoms. Proper cleaning and choosing the right water source are critical to preventing contamination. Placing medications into saline irrigations may be an effective way of treating some patients with sinusitis.