Nasal irrigation
Encyclopedia
Nasal irrigation or nasal lavage or nose douche is the personal hygiene
practice in which the nasal cavity
is washed to flush out excess mucus
and debris from the nose
and sinuses. The practice is well-tolerated and beneficial with only minor side effects. Nasal irrigation in a wider sense can also refer to the use of saline nasal spray or nebulizer
s to moisten the mucus membranes.
The saline solution irrigation promotes good nasal health, and patients with chronic sinusitis including symptoms of facial pain, headache, halitosis
, cough, anterior rhinorrhea
(watery discharge) and nasal congestion often find nasal irrigation to provide effective relief. In published studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis", and irrigation is recommended as an "effective adjunctive treatment of chronic sinonasal symptoms".
Further evidence suggests that nasal irrigation causes relief for both hay-fever and the common cold.
Daily nasal irrigation with salt water solution (a mixture of 0.9% non-iodized sodium chloride
and either purified or tap water warmed to around 98 degrees F / 37 degrees C, with or without inclusion of a buffering agent such as sodium bicarbonate) is recommended as both an adjunctive and primary treatment in such cases and is preferable to the use of corticosteroids except in the most serious cases of acute bacterial sinusitis which should be immediately referred to an otolaryngologist. Irrigation should be used with caution in infants, as nasal drops are not widely tolerated.
Flushing the nasal cavity with salt water has been claimed to promote mucociliary clearance
by moisturizing the nasal cavity and by removing encrusted material, although there is no clear evidence to support this. In proper proportion, nasal salt water solution with slight acidic pH functions as an anti-bacterial irrigant. The flow of salt water through the nasal passage flushes the dirt, airborne allergens (dust and pollen), pollutants and bacteria-filled mucus.
Salt water flushing also loosens and thins the mucus, making it easier to expel. Without this build up of mucus, the tiny cilia, or hairs in the nasal passage are able to function more efficiently, pushing excess mucus either to the back of the throat or to the nose to be expelled.
Potential allergens (such as iodine) or contaminants (algae, etc.) are to be avoided in the sodium chloride, water, or buffering ingredients. Premanufactured dosages of salt water flushing solutions can be purchased, or the user can mix non-iodized 'kosher' salt, with or without a buffering agent such as sodium bicarbonate or baking soda (table salt frequently is iodized, while sea salt may contain algae or other contaminants). Proponents of nasal irrigation include many allergy and sinus sufferers, some of whom have claimed anecdotally to rely less on other medications and/or fewer doctor visits. 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.
A conference abstract presented in November 2009 indicated that long-term nasal irrigation led to higher rates of sinus infections, which the principal researcher theorized was due to alterations in nasal immunological chemistry brought on by flushing out the protective elements of the mucous membrane of the nose. Note that this study has not been published in any peer-reviewed journal, and that the results may have been affected by the method of selection of test subjects and by the neti pot methods followed by the subjects. No such results were observed for short term use. However, it is of note that efficacy studies in general have not been conducted on groups utilizing this specific treatment, and that claims regarding the efficacy
of the technique rely largely on anecdotal evidence
.
While nasal irrigation is generally well-tolerated, one death has been reported from the improper use of a neti pot, when amoebae infected a young man. This sort of infection is extremely rare, and can only occur when using water that is not distilled or otherwise purified (for example, by boiling)
.
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 for washing away debris although it may suffice for simple rehydration of mucous and tissues.
A simple yet effective technique is to pour salt water solution into one nostril and let it run out through the other while the mouth is kept open to breathe, using gravity as an aid. This is an old yogic technique known as jala neti, and 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, and rely on gravity alone, along with head positioning and repeated practice in order to rinse the outer sinus cavities. Some users are able to use neti pots without problems, while the sideways positioning of the head can induce vertigo in others. A more advanced variation of the technique (known in yoga as "Vyutkrama Kapalaneti") involves pouring the same salt water solution into one nostril while the other is held closed, so that the solution runs out of the mouth. It is more challenging than the basic version (care must be taken to keep the saline solution out of the throat and to suppress possible vomiting reflex), but it can allow more thorough irrigation of the nasal cavity and the sinuses. Yet another technique (known in yoga "Seethkrama Kapalaneti") is to take the saline into the mouth and - leaning forward - force it out of the nostrils.
The second method of nasal irrigation is to introduce some form of positive pressure to the water introduced into the sinuses and nasal cavities in order to provide a more complete rinsing without resort to special techniques, such as holding the head to one side. Some products available from pharmacist supply retailers are essentially bottles made of flexible plastic with special tips to fit the nostril. These bottles, when filled with warm salt water solution, can be squeezed to exert positive pressure of the water flowing through the sinuses while the mouth is kept open at all times in order to breathe and prevent snorting the liquid down the throat. Even ordinary plastic water bottles can and have been used, as long as the nozzle will adequately fit a person's nostril. However, neither squeeze bottles nor bulb syringe
s provide the user with any genuine control over the pressure/volume of solution introduced. You need to make sure the pressure cannot be too high to prevent ear pressure or ear infection. The diameter of the hole in the center of the nostril fitting cannot be larger than 3 mm. If too large, a big wave of liquid can be forced to enter any where, such as middle ear, to cause ear pain or even ear infection.
Yet another type of product, the Nasaline irrigator, utilizes an oversized syringe with an injector-type plunger in place of the bulb. Invented by a group of Swedish ENT specialists, the Nasaline contains a specially designed tip intended to better atomize the salt water through a swirling action at a predetermined, nonadjustable velocity as it is forced through the sinuses by the injector's plunger.
Irrigation machines that utilize electric motor-driven pumps are also available. These irrigation devices pump salt water solution through a tube, in connection with a nasal adapter tip designed to seal against the nostril. Some of these machines allow adjustment of water volume/speed by use of an adjustment dial which regulates pump speed and volume per minute. Most of these motorized machines use a pulsatile or pulsating water pumping action at a relatively low, predetermined fixed pulse cyclic rate, designed to match the normal wave rate of healthy, unobstructed nasal cilia. This matched pulse rate is claimed to stimulate the nasal cilia hairs and promote better sinus health, while reducing the severity of allergic reactions. More sophisticated motorized irrigators have two or more pulse cycle settings that adjust the actual pulse cycle (as opposed to a simple volume/speed control, which does not alter the pulse cyclic rate). This design affords the user the option of using a higher pulse cyclic rate when suffering from partially closed sinuses, as in a typical case of acute sinusitis. The efficacy of all motorized pump irrigators has not yet been tested compared to simpler non-motorized mechanical pressure nasal irrigation methods.
as a buffering agent
.
Nasal irrigation can be carried out using ordinary tap water, but this is generally felt to be uncomfortable because it irritates the mucous membranes. Therefore an isotonic or hypertonic salt water solution
is normally used, i.e. water with enough salt
to at least match the tonicity
of the body cells and blood. Normal saline is essentially isotonic with blood. For the same reason, lukewarm water is preferred over cold water, which in addition to irritating nasal membranes can also exaggerate the gag reflex during irrigation. Similarly, a small amount of baking soda is frequently mentioned as an optional buffering ingredient to adjust the pH
value to that of the body.
Many pharmacies stock pre-manufactured sachets of pharmaceutical grade salt and baking soda designed to be used with the volume of water their corresponding device uses. Home recipes for an isotonic solution vary considerably, ranging from 3 tablespoons of non-iodized salt per 1 US gallon of water (roughly one part salt to 86 parts water) to a mere 4 teaspoons of salt per 1 US gallon of water (1/4 teaspoon salt to 1 cup, or roughly 1 part salt to 192 parts water). Other proportions include 1 US pint of water and 1 and 1/8 teaspoons salt or 1 litre of water and 12 millilitres of salt (just less than 2 and a half teaspoons). For a hypertonic solution the amount of salt would be doubled or tripled.
Medical sources generally agree that iodised
table salt is not acceptable, and that pickling salt
(or kosher salt
, though care is needed to ensure no additives and that it dissolved completely) is preferred because it also does not contain any other additives such as anticaking agent
s - 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.
Sometimes manufactured solutions such as lactated Ringer's solution
are used instead of the basic recipe.
Optional additives include xylitol
which is claimed to draw water into the sinus regions and helps displace bacteria. Xylitol is commonly used to prevent acute otitis media in Europe and dental caries
in the United States, but research into xylitol use in the sinus cavities is lacking. Another nasal irrigation additive is aloe extract, which helps to prevent nasal dryness. Sodium citrate and citric acid help not only to balance the pH, also helps to improve the sense of smell.
is an important factor in the development of sinonasal diseases, leading to a stasis of mucus. The numerous proteins found in nasal mucus include inflammatory mediators, defensin
s and many whose function is not understood.
Thus hypotheses include that nasal irrigation may decrease inflammation through the removal of mucus, that it may improve mucociliary clearance
, and that it may remove thickened mucus that cannot be handled by the cilia
.
In a study with eight healthy volunteers, solution was transported reliably to ethmoid
and maxillary
sinuses when it was snorted or applied with a squeeze bottle; a nebulizer
was significantly less effective. Sphenoid and frontal
sinuses were rarely reached, and not at all with the nebulizer.
.
The simplest method of nasal irrigation, that is to sniff water from cupped hands and then blowing it out, is also a step in the hygienic practices (Wudu
) of Muslims.
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...
practice in which the nasal cavity
Nasal cavity
The nasal cavity is a large air filled space above and behind the nose in the middle of the face.- Function :The nasal cavity conditions the air to be received by the other areas of the respiratory tract...
is washed to flush out excess mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
and debris from the nose
Human nose
The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
and sinuses. The practice is well-tolerated and beneficial with only minor side effects. Nasal irrigation in a wider sense can also refer to the use of saline nasal spray or nebulizer
Nebulizer
In medicine, a nebulizer is a device used to administer medication in the form of a mist inhaled into the lungs....
s to moisten the mucus membranes.
The saline solution irrigation promotes good nasal health, and patients with chronic sinusitis including symptoms of facial pain, headache, halitosis
Halitosis
Halitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
, cough, anterior rhinorrhea
Rhinorrhea
Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. Rhinorrhea is a common symptom of allergies or certain diseases,...
(watery discharge) and nasal congestion often find nasal irrigation to provide effective relief. In published studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis", and irrigation is recommended as an "effective adjunctive treatment of chronic sinonasal symptoms".
Efficacy and safety
Nasal irrigation is used to treat a wide range of chronic sinus and nasal symptoms; for chronic rhinosinusitis it is an effective adjunctive therapy. 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.
Daily nasal irrigation with salt water solution (a mixture of 0.9% non-iodized sodium chloride
Sodium chloride
Sodium chloride, also known as salt, common salt, table salt or halite, is an inorganic compound with the formula NaCl. Sodium chloride is the salt most responsible for the salinity of the ocean and of the extracellular fluid of many multicellular organisms...
and either purified or tap water warmed to around 98 degrees F / 37 degrees C, with or without inclusion of a buffering agent such as sodium bicarbonate) is recommended as both an adjunctive and primary treatment in such cases and is preferable to the use of corticosteroids except in the most serious cases of acute bacterial sinusitis which should be immediately referred to an otolaryngologist. Irrigation should be used with caution in infants, as nasal drops are not widely tolerated.
Flushing the nasal cavity with salt water has been claimed to promote mucociliary clearance
Mucociliary Clearance
Mucociliary clearance, also referred to as mucociliary apparatus or mucociliar clearance , derived from mucus , cilia and clearance describes the self-clearing mechanism of the bronchi.The main bronchi down to the alveoli are lined with a respiratory epithelium...
by moisturizing the nasal cavity and by removing encrusted material, although there is no clear evidence to support this. In proper proportion, nasal salt water solution with slight acidic pH functions as an anti-bacterial irrigant. The flow of salt water through the nasal passage flushes the dirt, airborne allergens (dust and pollen), pollutants and bacteria-filled mucus.
Salt water flushing also loosens and thins the mucus, making it easier to expel. Without this build up of mucus, the tiny cilia, or hairs in the nasal passage are able to function more efficiently, pushing excess mucus either to the back of the throat or to the nose to be expelled.
Potential allergens (such as iodine) or contaminants (algae, etc.) are to be avoided in the sodium chloride, water, or buffering ingredients. Premanufactured dosages of salt water flushing solutions can be purchased, or the user can mix non-iodized 'kosher' salt, with or without a buffering agent such as sodium bicarbonate or baking soda (table salt frequently is iodized, while sea salt may contain algae or other contaminants). Proponents of nasal irrigation include many allergy and sinus sufferers, some of whom have claimed anecdotally to rely less on other medications and/or fewer doctor visits. 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.
A conference abstract presented in November 2009 indicated that long-term nasal irrigation led to higher rates of sinus infections, which the principal researcher theorized was due to alterations in nasal immunological chemistry brought on by flushing out the protective elements of the mucous membrane of the nose. Note that this study has not been published in any peer-reviewed journal, and that the results may have been affected by the method of selection of test subjects and by the neti pot methods followed by the subjects. No such results were observed for short term use. However, it is of note that efficacy studies in general have not been conducted on groups utilizing this specific treatment, and that claims regarding the efficacy
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
of the technique rely largely on anecdotal evidence
Anecdotal evidence
The expression anecdotal evidence refers to evidence from anecdotes. Because of the small sample, there is a larger chance that it may be true but unreliable due to cherry-picked or otherwise unrepresentative of typical cases....
.
While nasal irrigation is generally well-tolerated, one death has been reported from the improper use of a neti pot, when amoebae infected a young man. This sort of infection is extremely rare, and can only occur when using water that is not distilled or otherwise purified (for example, by boiling)
Water purification
Water purification is the process of removing undesirable chemicals, materials, and biological contaminants from contaminated water. The goal is to produce water fit for a specific purpose...
.
Methods
Currently, the best nasal irrigation system offers the following features and benefits: The irrigator has the anti-backwash valves, so the dirty solution will not flow back to the nasal cavity. This is particularly important for those people with bacterial or viral infections, such as the common cold or flu. The irrigator should be held up-right, like brushing your teeth. The head should not be tilted sideways. If the head is tilted sideways, the ear on the lower side could have the liquid entering it to cause an ear infection.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 for washing away debris although it may suffice for simple rehydration of mucous and tissues.
A simple yet effective technique is to pour salt water solution into one nostril and let it run out through the other while the mouth is kept open to breathe, using gravity as an aid. This is an old yogic technique known as jala neti, and the container used to administer the saline is called a neti pot
Neti pot
A neti pot is a device used for irrigating the nasal passages. Typically it has a spout attached near the bottom, sometimes with a handle on the opposite side.-Function:...
. (Neti
Neti (Hatha Yoga)
Neti is an important part of Shatkarma , the yogic system of body cleansing techniques. It is intended mainly to the cleaning of the air passageways in the head...
is Sanskrit
Sanskrit
Sanskrit , is a historical Indo-Aryan language and the primary liturgical language of Hinduism, Jainism and Buddhism.Buddhism: besides Pali, see Buddhist Hybrid Sanskrit Today, it is listed as one of the 22 scheduled languages of India and is an official language of the state of Uttarakhand...
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, and rely on gravity alone, along with head positioning and repeated practice in order to rinse the outer sinus cavities. Some users are able to use neti pots without problems, while the sideways positioning of the head can induce vertigo in others. A more advanced variation of the technique (known in yoga as "Vyutkrama Kapalaneti") involves pouring the same salt water solution into one nostril while the other is held closed, so that the solution runs out of the mouth. It is more challenging than the basic version (care must be taken to keep the saline solution out of the throat and to suppress possible vomiting reflex), but it can allow more thorough irrigation of the nasal cavity and the sinuses. Yet another technique (known in yoga "Seethkrama Kapalaneti") is to take the saline into the mouth and - leaning forward - force it out of the nostrils.
The second method of nasal irrigation is to introduce some form of positive pressure to the water introduced into the sinuses and nasal cavities in order to provide a more complete rinsing without resort to special techniques, such as holding the head to one side. Some products available from pharmacist supply retailers are essentially bottles made of flexible plastic with special tips to fit the nostril. These bottles, when filled with warm salt water solution, can be squeezed to exert positive pressure of the water flowing through the sinuses while the mouth is kept open at all times in order to breathe and prevent snorting the liquid down the throat. Even ordinary plastic water bottles can and have been used, as long as the nozzle will adequately fit a person's nostril. However, neither squeeze bottles nor bulb syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
s provide the user with any genuine control over the pressure/volume of solution introduced. You need to make sure the pressure cannot be too high to prevent ear pressure or ear infection. The diameter of the hole in the center of the nostril fitting cannot be larger than 3 mm. If too large, a big wave of liquid can be forced to enter any where, such as middle ear, to cause ear pain or even ear infection.
Yet another type of product, the Nasaline irrigator, utilizes an oversized syringe with an injector-type plunger in place of the bulb. Invented by a group of Swedish ENT specialists, the Nasaline contains a specially designed tip intended to better atomize the salt water through a swirling action at a predetermined, nonadjustable velocity as it is forced through the sinuses by the injector's plunger.
Irrigation machines that utilize electric motor-driven pumps are also available. These irrigation devices pump salt water solution through a tube, in connection with a nasal adapter tip designed to seal against the nostril. Some of these machines allow adjustment of water volume/speed by use of an adjustment dial which regulates pump speed and volume per minute. Most of these motorized machines use a pulsatile or pulsating water pumping action at a relatively low, predetermined fixed pulse cyclic rate, designed to match the normal wave rate of healthy, unobstructed nasal cilia. This matched pulse rate is claimed to stimulate the nasal cilia hairs and promote better sinus health, while reducing the severity of allergic reactions. More sophisticated motorized irrigators have two or more pulse cycle settings that adjust the actual pulse cycle (as opposed to a simple volume/speed control, which does not alter the pulse cyclic rate). This design affords the user the option of using a higher pulse cyclic rate when suffering from partially closed sinuses, as in a typical case of acute sinusitis. The efficacy of all motorized pump irrigators has not yet been tested compared to simpler non-motorized mechanical pressure nasal irrigation methods.
Solutions used for nasal irrigation
Warm salt water solution is commonly used, often with sodium bicarbonateSodium bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...
as a buffering agent
Buffering agent
A buffering agent is a weak acid or base used to maintain the acidity of a solution at a chosen value. The function of a buffering agent is to prevent a rapid change in pH when acids or bases are added to the solution. Buffering agents have variable properties—some are more soluble than others;...
.
Nasal irrigation can be carried out using ordinary tap water, but this is generally felt to be uncomfortable because it irritates the mucous membranes. Therefore an isotonic or hypertonic salt water solution
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
is normally used, i.e. water with enough salt
Salt
In chemistry, salts are ionic compounds that result from the neutralization reaction of an acid and a base. They are composed of cations and anions so that the product is electrically neutral...
to at least match the tonicity
Tonicity
Tonicity is a measure of the osmotic pressure gradient of two solutions separated by a semipermeable membrane. It is commonly used when describing the response of cells immersed in an external solution...
of the body cells and blood. Normal saline is essentially isotonic with blood. For the same reason, lukewarm water is preferred over cold water, which in addition to irritating nasal membranes can also exaggerate the gag reflex during irrigation. Similarly, a small amount of baking soda is frequently mentioned as an optional buffering ingredient to adjust the pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...
value to that of the body.
Many pharmacies stock pre-manufactured sachets of pharmaceutical grade salt and baking soda designed to be used with the volume of water their corresponding device uses. Home recipes for an isotonic solution vary considerably, ranging from 3 tablespoons of non-iodized salt per 1 US gallon of water (roughly one part salt to 86 parts water) to a mere 4 teaspoons of salt per 1 US gallon of water (1/4 teaspoon salt to 1 cup, or roughly 1 part salt to 192 parts water). Other proportions include 1 US pint of water and 1 and 1/8 teaspoons salt or 1 litre of water and 12 millilitres of salt (just less than 2 and a half teaspoons). For a hypertonic solution the amount of salt would be doubled or tripled.
Medical sources generally agree that iodised
Iodised salt
Iodised salt is table salt mixed with a minute amount of various iodine-containing salts. The ingestion of iodide prevents iodine deficiency. Worldwide, iodine deficiency affects about two billion people and is the leading preventable cause of mental retardation. It also causes thyroid gland...
table salt is not acceptable, and that pickling salt
Pickling salt
Pickling salt is a salt that is used mainly for canning and manufacturing pickles. It is made without iodine or any anticaking products added. If pickles are made with table salt, they will have dark and cloudy juice, due to the iodide in the salt, although the flavour should be about the same...
(or kosher salt
Kosher salt
Koshering salt, usually referred to as kosher salt in the US, is a variety of edible salt with a much larger grain size than some common table salt...
, though care is needed to ensure no additives and that it dissolved completely) is preferred because it also does not contain any other additives such as anticaking agent
Anticaking agent
An anticaking agent is an additive placed in powdered or granulated materials, such as table salt, to prevent the formation of lumps, easing packaging, transport, and consumption....
s - baking powder
Baking powder
Baking powder is a dry chemical leavening agent used to increase the volume and lighten the texture of baked goods such as muffins, cakes, scones and American-style biscuits. Baking powder works by releasing carbon dioxide gas into a batter or dough through an acid-base reaction, causing bubbles in...
is also not an acceptable substitute for baking soda. Most sources advise that tap water should be boiled for several minutes to ensure sterility
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
before it is cooled and used, but it is not clear whether this is really necessary.
Sometimes manufactured solutions such as lactated Ringer's solution
Lactated Ringer's solution
Lactated Ringer's solution is a solution that is isotonic with blood and intended for intravenous administration. It may also be given subcutaneously....
are used instead of the basic recipe.
Optional additives include xylitol
Xylitol
Xylitol is a sugar alcohol sweetener used as a naturally occurring sugar substitute. It is found in the fibers of many fruits and vegetables, and can be extracted from various berries, oats, and mushrooms, as well as fibrous material such as corn husks and sugar cane bagasse, and birch...
which is claimed to draw water into the sinus regions and helps displace bacteria. Xylitol is commonly used to prevent acute otitis media in Europe and dental caries
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
in the United States, but research into xylitol use in the sinus cavities is lacking. Another nasal irrigation additive is aloe extract, which helps to prevent nasal dryness. Sodium citrate and citric acid help not only to balance the pH, also helps to improve the sense of smell.
Mechanism of action
The precise reasons for the efficacy of nasal irrigation are not well understood, although it is clear that the removal of mucus plays an important role. Damage to the mucociliary transport systemMucociliary Clearance
Mucociliary clearance, also referred to as mucociliary apparatus or mucociliar clearance , derived from mucus , cilia and clearance describes the self-clearing mechanism of the bronchi.The main bronchi down to the alveoli are lined with a respiratory epithelium...
is an important factor in the development of sinonasal diseases, leading to a stasis of mucus. The numerous proteins found in nasal mucus include inflammatory mediators, defensin
Defensin
Defensins are small cysteine-rich cationic proteins found in both vertebrates and invertebrates. They have also been reported in plants. They are, and function as, host defense peptides. They are active against bacteria, fungi and many enveloped and nonenveloped viruses. They consist of 18-45 amino...
s and many whose function is not understood.
Thus hypotheses include that nasal irrigation may decrease inflammation through the removal of mucus, that it may improve mucociliary clearance
Mucociliary Clearance
Mucociliary clearance, also referred to as mucociliary apparatus or mucociliar clearance , derived from mucus , cilia and clearance describes the self-clearing mechanism of the bronchi.The main bronchi down to the alveoli are lined with a respiratory epithelium...
, and that it may remove thickened mucus that cannot be handled by the cilia
Cilium
A cilium is an organelle found in eukaryotic cells. Cilia are slender protuberances that project from the much larger cell body....
.
In a study with eight healthy volunteers, solution was transported reliably to ethmoid
Ethmoid sinus
The ethmoid sinus is each of the two paranasal sinuses within the ethmoid bone, comprising the ethmoidal air cells and filled with air. These are divided into anterior, middle and posterior group. The ethmoidal air cells consist of numerous thin-walled cavities situated in the ethmoidal labyrinth...
and maxillary
Maxillary sinus
The pyramid shaped maxillary sinus is the largest of the paranasal sinuses, and drains into the nose. It is present at birth as rudimentary air cells, and develops throughout childhood.-General characteristics:...
sinuses when it was snorted or applied with a squeeze bottle; a nebulizer
Nebulizer
In medicine, a nebulizer is a device used to administer medication in the form of a mist inhaled into the lungs....
was significantly less effective. Sphenoid and frontal
Frontal sinus
Sinuses are mucosa-lined airspaces within the bones of the face and skull. The frontal sinuses, situated behind the superciliary arches, are absent at birth, but are generally fairly well developed between the seventh and eighth years, only reaching their full size after puberty...
sinuses were rarely reached, and not at all with the nebulizer.
Origin of nasal irrigation
The earliest record of nasal irrigation is found in the ancient Hindu practice of Ayurveda whose roots are traced to the VedasVedas
The Vedas are a large body of texts originating in ancient India. Composed in Vedic Sanskrit, the texts constitute the oldest layer of Sanskrit literature and the oldest scriptures of Hinduism....
.
The simplest method of nasal irrigation, that is to sniff water from cupped hands and then blowing it out, is also a step in the hygienic practices (Wudu
Wudu
Wuḍhu is the Islamic procedure for washing parts of the body using water often in preparation for formal prayers...
) of Muslims.