Nasal irrigation
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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 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 technique may be as simple as snorting water from cupped hands but more elaborate methods use a pot, squeeze bottle, or syringe to pour or squirt the water into a nostril. The water then either runs out of the other nostril or goes through the sinuses to the back of the throat from where it may be spat out.
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 more salty than the nasal fluids are favoured and one study indicated that salt from the Dead Sea was especially efficacious.[3]
Benefits and uses
Nasal irrigation is appropriate for many sinonasal conditions and symptoms including, but not limited to:
- Acute bacterial rhinosinusitis[4]
- Aging rhinitis[5]
- Allergic rhinitis - hay fever[5]
- Atrophic rhinitis - ozaena[6]
- Common cold[5]
- Empty nose syndrome[citation needed]
- Facial pain or headache associated with sinusitis[7][8]
- Halitosis - bad breath[7]
- Nasal congestion[7][8]
- Nasal dryness[citation needed]
- Phantosmia - phantom smells[citation needed]
- Post-nasal drip[7]
- Rhinitis medicamentosa - rebound nasal congestion[6]
- Rhinorrhea - runny nose[7][unreliable source?]
- Rhinosinusitis - inflammation of the nose and sinuses[5]
- Sinusitis - inflammation of the sinuses (including chronic sinusitis)[9][2]
The benefits of the treatment include:
- Clearer vision due to cleaning of the tear ducts[citation needed]
- Decreased use of medication[2]
- Deeper, more relaxed breathing[citation needed]
- Improved sense of smell and taste[citation needed]
- Improved sinus-related quality of life[2]
- Reduction of symptoms[2]
Daily nasal irrigation with salt water is therefore recommended as both an adjunctive[10] and primary treatment[9] 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.[11] In several countries, the sale of over-the-counter medicines for coughs and colds have been banned for infants under the age of two. Nasal irrigation is a useful safe alternative for relieving the symptoms of such young patients.[12][13]
The use of nasal irrigation for the similar 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.[4]
Saline Nasal Irrigation
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.[14]
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.
Yogic breathing practices known as pranayama are enhanced since many of them involve deep breathing through the nostrils.[citation needed]
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.[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.
 | This article contains weasel words: vague phrasing that often accompanies biased or unverifiable information. |
Pulsating nasal sinus irrigation
Some people use bulb syringes, squirt bottles, and neti pots. Others use pulsating irrigation devices that deliver an intermittant pulsing saline rinse to remove bacteria, purulent material, and help restore ciliary function.
Published 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.[15][16][17][18]
The presence of Biofilm has been widely reported and implicated in chronic sinusitis.[19]
A pulsating nasal irrigation device delivers a controlled flow with pressure control that may be adjusted for individual comfort. Medical reports support that both positive and negative pressure irrigation (pulsating irrigation is positive pressure irrigation) retains a larger volume of solution and irrigates the sinuses more consistently than other methods (nebulizer).[20]
See also
References
- ^ 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) - ^ a b c d e 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) - ^ 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) - ^ a b David Rabago (June 1, 2008), "The Use of Saline Nasal Irrigation in Common Upper Respiratory Conditions", US Pharmacist
- ^ a b c d Tomooka LT, Murphy C, Davidson TM (2000). "Clinical study and literature review of nasal irrigation". Laryngoscope. 110 (7): 1189–93. doi:10.1097/00005537-200007000-00023. PMID 10892694.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Rhinitis - non allergic, NHS, 16 January 2008
- ^ a b c d e Sinusitis Treatment: What Is New Is Old., About.com, April 5, 2004
- ^ a b
Allison Aubrey (2007-02-22). "Got a Runny Nose? Flush It Out!". Morning Edition. National Public Radio.
{{cite episode}}: External link in|transcripturl=|transcripturl=ignored (|transcript-url=suggested) (help) - ^ a b Brown CL, Graham SM (2004). "Nasal irrigations: good or bad?". Curr Opin Otolaryngol Head Neck Surg. 12 (1): 9–13. PMID 14712112.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ 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) - ^ 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)
- ^ Tracie Simer (August 4, 2008), FDA ban on children's decongestants not a whim, The Jackson Sun
- ^ Infant Cough And Cold Remedies Taken Off Shelves In UK, Medical News Today, 27 March 2008
- ^ Papsin, B., McTavish, A. (2003). "Saline nasal irrigation: Its role as an adjunct treatment". Canadian Family Physician. 49 (February): 168–173. PMID PMC2214184.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Osguthorpe, JD (1999). "RHINOSINUSITISCurrent Concepts in Evaluation and Management". Medical Clinics of North America. 83 ((1)): 27–41. PMID: 9927958.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Brown, LL (1978). "Evaluation of wound irrigation by pulsatile jet and conventional methods". Ann Surg. 187 ((2)): 170–73. PMID 343735.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Anglen, J (1994). "The efficacy of various irrigation solutions and methods in removing slime-producing staphylococcus". J Orthop Trauma. 8 ((2)): 390–6. PMID 7996321.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help) - ^ Svoboda, SJ (2006). "Comparison of bulb syringe and pulsed lavage irrigation". J Bone Joint Surg Am. 88 ((10)): 2167–74. PMID 17015593.
{{cite journal}}: Text "publisher" ignored (help) - ^ Palmer, JN (2008 May-June). "Prevalence of biofilm-forming bacteria in chronic rhinosinusitis". Am J Rhinol. 22 ((3)): 239–45. PMID: 18588755.
{{cite journal}}: Check date values in:|date=(help); Text "publisher" ignored (help) - ^ Olson, DE (2002). "Radiographic comparison of three methods for nasal saline irrigation". Laryngoscope. 112 ((8 Pt 1)): 1394–98. PMID 12172251.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help)
- Neti: Healing Secrets of Yoga and Ayurveda, Dr. David Frawley, Lotus Press, Twin Lakes, WI ISBN 0940985853