Nasal irrigation
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. While some clinical tests have shown that this practice is safe and beneficial with no significant side effects,[1][2] other more recent studies see a correlation between frequent nasal irrigation and a higher rate of sinus infections - though short term use did not seem to be an issue. [3] Nasal irrigation in a wider sense can also refer to the use of saline nasal spray or nebulizers 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 squeezing a plastic bottle or a syringe, or from an electrical pump.[4]
Warm salt water is commonly used, often with sodium bicarbonate as a buffering agent. Optional additives include xylitol which appears to draw water into the sinus regions and helps displace bacteria.[citation needed]
Benefits and uses
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.[5] 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.[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, over-the-counter medicines for coughs and colds are no longer sold for infants under the age of two.[9][10] Nasal irrigation is an alternative for relieving the symptoms of such young patients.[citation needed]
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.[7] 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.[1]
Methods
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.[4]
A simple yet effective technique is to pour saline into one nostril and let it run out through the other. This is an old Ayurvedic 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. Some modern variants available from pharmacists are made of flexible plastic and can be squeezed to exert additional pressure. If a bulb syringe is used instead, the user has complete control over the pressure.
It is also possible to use an electrical irrigation device, which pumps the solution through a flexible tube, in connection with a nasal adapter. In the United States such devices are available for home use. The more expensive devices that produce a pulsating flow have been used in some studies, but their efficacy was not compared to the nasal irrigation methods that produce a steady flow through constant positive pressure.[11] This is to some degree mechanically similar to simply holding irrigation fluid in the sinus and shaking the head gently before draining.
Another, more advanced variation of this technique, known in yoga as "Vyutkrama Kapalbhati", involves pouring the same saline 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 allows to achieve more thorough irrigation of the nasal cavity and the sinuses. [sounds antedotal or limited to sphenoid, needs citation]
Solutions used for nasal irrigation
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 saline solution is normally used, i.e. water with enough salt to at least match the tonicity of the body cells. For the same reason, lukewarm water is preferred over cold water. Similarly, a small amount of baking soda is frequently mentioned as an optional ingredient to adjust the pH value to that of the body. A typical home recipe for an isotonic solution consists of 1⁄2 litre (1 pint) of water, 5 millilitres (1 teaspoon) of salt and optionally another 5 millilitres of baking soda for an isotonic solution. 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) is preferred because it also does not contain any other additives such as anticaking agents[7] - 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.[7]
Sometimes manufactured solutions such as lactated Ringer's solution are used instead of the basic recipe, or patients dissolve powder from manufactured sachets in a prescribed amount of water. Occasionally further substances are added to the basic recipe, such as antibiotics, antifungal drugs or xylitol.[7]
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.[7] Damage to the mucociliary transport system is an important factor in the development of sinonasal diseases, leading to a stasis of mucus.[11] The numerous proteins found in nasal mucus include inflammatory mediators, defensins and many whose function is not understood.[7] 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.[7][11]
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.[4]
See also
References
- ^ a b 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) - ^ 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) - ^ http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870?userid=227287&impressionId=1257836779807&utm_source=mSpoke&utm_medium=email&utm_campaign=DailyHeadlines&utm_content=GroupD
- ^ a b c Olson, DE (2002). "Radiographic comparison of three methods for nasal saline irrigation" (PDF). Laryngoscope. 112 (8 Pt 1): 1394–98. doi:10.1097/00005537-200208000-00013. PMID 12172251.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ a b David Rabago (June 1, 2008), "The Use of Saline Nasal Irrigation in Common Upper Respiratory Conditions", US Pharmacist
- ^ 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) - ^ a b c d e f g h 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) - ^ 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)
- ^ Infant Cough And Cold Remedies Taken Off Shelves In UK, Medical News Today, 27 March 2008
- ^ Fear of overdose; children’s cold medication recalled, canada.com, 2007-10-11.
- ^ a b c "Clinical study and literature review of nasal irrigation". Laryngoscope. 110 (7): 1189–93. 2000. PMID 10892694.
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