A recent review article compiled and showcased the scientific evidence supporting the use of nasal irrigation, an Ayurvedic medical tradition that dates back in medical literature to the early 20th century.
What is it?
A mild saline solution in warm water is inserted into one nostril and drains out of the other nostril. This can be administered using a low-pressure device such as a spray or squirt bottle or using a gravity-based pressure such as a netti pot.
How does it work?
The exact mechanism of action has yet to be completely understood. The proposed physiological possibilities are that nasal irrigation improves nasal mucosa function by direct clearing, elimination of inflammatory mediators and improve mucociliary function.
What conditions is nasal irrigation good for?
In preventive studies, nasal saline irrigation was found to be protective with patients having fewer infections, shorter symptom duration, and fewer days of symptoms vs patients who did not perform nasal irrigation.
There is strong evidence that nasal irrigation is effective adjunctive treatment in chronic rhinosinusistis (Runny nose or nasal congestion lasting more than 12 weeks). In a Cochrane review of nasal irrigation demonstrated that daily use was associated with a 64% reduction in overall symptom severity, significant decrease in use of saline sprays, decrease in antibiotics as well as significant improvement in quality of life.
The evidence is limited and less conclusive in the following conditions. Despite these findings it is strongly recommended in consensus guidelines that a trial of nasal irrigation should be performed as the benefit far outweighs the risk as long as you do not have any contra-indications.
- Rhinitis of pregnancy
- Acute rhinosinusitis
- Irritant or allergic rhinitis (reduces histamine and leukotrienes)
- Upper respiratory tract infection
- Post operative care after endoscopic sinus surgery
- Mild to moderate allergies
- Wegener’s granuloatosis
Minor adverse effect
Fewer than 10% report mild self-limiting adverse effects which include sensation of ear fullness, stinging of the nasal mucosa, and rarely epistaxis (nosebleeds). No serious adverse events have been reported.
If stinging of the nasal mucosa is significant ensure you have prepared the saline solution correctly. A higher concentration than desired can produce these symptoms. All other symptoms can be normal when first initiating the practice of nasal irrigation and should cease after several treatments once the mucous has been thinned and easier movement and flow of the irrigation will result. If these symptoms persist after several treatments you should consider ceasing the practice.
Contraindications
Saline nasal irrigation is strong not recommended:
Incompletely healed facial trauma
Conditions associated with increased risk for aspiration: significant intention tremor or other neurologic or musculoskeletal problems.
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Harvey, R., Hannan, SA., Badia, L., Scadding, G. (2009). Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst. Rev. 4: 1-44.
Rabago, D., Barrett, B., Marchand, L. (2005). Nasal irrigation to treat acute bacterial rhinosinusitis. Am Fam Physician. 72(9): 1661-1662.
Rabago, D., Zgierska, A. (2009).Saline nasal irrigation for upper respiratory conditions. Am Fam Physician. 80:1117-1119.
Scheid, D., Hamm, R. (2004).Acure bacterial rhinosinusitis in adults: part II. Treatments. Am Fam Physician. 70(9): 1697-704