I feel this could be the headline when someone uses a “neti pot” incorrectly (or even correctly). This week’s topic is nasal irrigation which seems to be gaining popularity in recent decades.
People have been cleansing their nasal passageways for centuries. Not only has water been used, but also string and surgical tubing! Water has been poured into the nose allowing gravity to run its course. Water has also been forced into the nose under pressure. Techniques also exist where water is taken in through the mouth and then exits through the nose. If not done correctly, various ill effects can occur.
The main reasons to rinse or lavage the nose is to moisturize passageways and clear mucous and debris. It seems to have the most efficacy with clearing allergens and helping with sinus infections. I have found many people who work in landscaping or around animals to benefit from the practice once their work day is done. Patients with acute and chronic sinus infections also derive benefit from the rinse thinning and loosening mucous, especially patients that have undergone surgery. The rinse allows better flow into their maxillary and ethmoid sinuses. (Nasal irrigation rarely reaches the frontal sinuses in the forehead or the deeper sphenoid sinus.)
The practice does have some drawbacks. If not done correctly, gagging, nausea and vomiting can occur. If the water is instilled under too much pressure, back flow into the Eustachian tube can occur with fluid reaching the middle ear. This can cause ear pain, vertigo or an ear infection. And let’s not forget about brain eating amoebas (see my blog from January 11). A parasite called Naegleria fowleri can come from contaminated tap water. Distilled, boiled or sterile water should be used if making your own solution.
There are various types of nasal rinses available. Most are a combination of salt and bicarbonate to match or exceed the body’s tonicity and pH. Those looking for nasal moisture should try the smaller squeeze bottles or saline gel sprays. Small amounts of fluid are sprayed into the nose with each squeeze of the bottle. At the other end of the spectrum lie the “neti pots” and larger squeeze bottles. These dispense larger volumes of water and are not for those that gag easily. I like to compromise with the ones that come sterilized with a button that allows for a continuous spray for as long as you hold the button.
Finally, let’s talk physics only so much as to help you make a decision if you are staring at choices on the shelves in the store. On the shelf, you’ll find both “isotonic” and “hypertonic” choices. “Iso” refers to the same salt concentration as the human body and “hyper” refers to the solution being more concentrated than the human body. I would suggest trying the “hypertonic” first. Mrs. Hill, my high school physics teacher, would be happy that I remember a higher salt solution can pull water through a semi-permeable membrane to help dilute the solution. In regular terms, this could translate to a mild benefit with nasal congestion.
Spray or pour. You decide. I’m a sprayer.
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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.