April 30, 2019

Nasal Irrigation Helps Control Sinus Problems

The public image toward nasal irrigation, which UW Health physician David Rabago has studied over the past 15 years, has changed dramatically during that time. From early days as an esoteric alternative therapy, nasal irrigation is now widely recognized as helpful for many sinus and nasal conditions, and materials are readily available in neighborhood drug stores. While pouring salt water into your nose remains a bit odd, most patients quickly catch on. The process involves filling a neti pot (a tea pot, of sorts, designed specifically for nasal irrigation) or squeeze bottle with a gentle saltwater mix and pouring it into one nostril. The lukewarm liquid rinses the nasal cavity and drains out the other nostril. The process is then repeated with the other nostril.

It looks a little strange or even funny, but the health benefits of nasal irrigation are anything but comical.

In Dr. Rabago's studies, people with chronic sinus symptoms who consistently practiced nasal irrigation reported a decrease in symptoms (congestion, runny nose), an increased quality of life and a reduced use of nasal sprays and antibiotics. Subsequent studies in the US and abroad have corroborated these findings.

It's also inexpensive, takes only a few minutes and is easy to learn.

"(Some study participants) said that while nasal irrigation is effective, it's not very natural and takes a little bit of determination for the first or second use," says Dr. Rabago, a UW family-medicine physician. "After that it becomes progressively easier and people begin to view this as a normal part of their daily hygiene routine. They brush their teeth, they wash their face, they rinse their nose."

Sinus problems are attributable to a breakdown in the normal function and protective role of the nasal cavity. The lining of the nasal cavity protects the upper respiratory system against infection by viruses and bacteria. When the mucosa is inadequate to the task, sinus symptoms can result.

How to Use a Neti Pot

Watch a brief video demonstrating nasal irrigation

Nasal irrigation, study results suggest, helps the mucosa do its job.

Dr. Rabago recommends daily nasal irrigations while sinus symptoms persist. Though it may not present an absolute cure for their congestion, participants in Dr. Rabago's initial study, published in The Journal of Family Practice in 2002, reported a greater than 50 percent improvement in symptoms. Nasal irrigation helped them feel better.

But can it prevent them from feeling bad in the first place?

Nasal irrigation as a preventive measure has not been well examined. While there are initial promising results, studies investigating this role for nasal irrigation have been small and inconclusive. However, because nasal irrigation has few side effects – some people experience stinging, which can be remedied by adjusting the salt concentration in the water or adding a little baking soda – Dr. Rabago recommends it to patients who feel comfortable with it.

The evidence is best for chronic sinus symptoms.

"The literature is fairly robust on this," Dr. Rabago says. "For people with chronic sinus symptoms we recommend daily nasal irrigation while symptomatic. If people have significant symptoms that come frequently and they had a good response, then we might recommend it as a preventive measure as well." He adds there is also evidence that symptoms of seasonal allergic rhinitis - commonly called hay fever, though it can occur in other seasons - can also be managed with nasal irrigation. 

Dr. Rabago offers a few provisos for people interested in trying out nasal irrigation with a neti pot. The procedure does require some physical dexterity – you're leaning to the side at about a 45-degree angle to enlist the aid of gravity – and thus can be challenging for people with neurological difficulties that affect balance and coordination. But for those challenged by this sapect of the procedure, the squeeze bottle requires less dexterity. And water should be clean, from a municipal source; or distilled, or boiled then cooled.

"People who have had facial fractures that may not have healed completely are also advised not to use nasal irrigation," Dr. Rabago says. "Otherwise, there are few people with upper respiratory symptoms who would not be considered appropriate."

Dr. Rabago encourages people to seek out instruction prior to attempting nasal irrigation. Patients in his studies indicate that viewing handouts and videos was very important to proper use. He also says irrigators needn't be shy about adjusting their methods according to their personal preferences.

"A small amount of salt goes a long way," he says. "The patients can control the therapy themselves by adjusting the temperature and the salinity of the water. It's patient-controlled and patient-centered health care. Nasal irrigation appears to be a real winner."

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