Nasal irrigation

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Nasal irrigation
Jalaneti.JPG
Woman flushing her nose with a neti pot
ICD-9-CM 22.0
MeSH D055556

Nasal irrigation (also called nasal lavage, nasal toilet, or nasal douche) is a personal hygiene practice in which the nasal cavity is washed to flush out mucus and debris from the nose and sinuses, in order to enhance nasal breathing. Nasal irrigation can also refer to the use of saline nasal spray or nebulizers to moisten the mucous membranes.

Contents

Medical uses

To prepare an isotonic saline solution for nasal rinsing, approx. 0.25 liter lukewarm drinking water and 2.5 ml of table salt (about half a level teaspoon) is required. Nasendusche IMG 3357.jpg
To prepare an isotonic saline solution for nasal rinsing, approx. 0.25 liter lukewarm drinking water and 2.5 ml of table salt (about half a level teaspoon) is required.
Nasal irrigation device commonly available at pharmacies Nasendusche.jpg
Nasal irrigation device commonly available at pharmacies

Nasal irrigation can be an effective therapy to relieve symptoms of acute sinusitis caused by upper respiratory tract infections such as the common cold. [1] The evidence for effectiveness in relieving chronic sinusitis is weak. [2]

It can also be useful for the temporary relief of the symptoms associated with allergic rhinitis. [3]

Adverse effects

Adverse effects include nasal irritation, nosebleeds, headache, and drainage after the irrigation is done. It is generally well tolerated. [2]

There is a risk of infection if the water is not sterile or the device is not cleaned after use. If the device is used improperly this can be harmful. [4] In fact, proper application suggests the use of boiled water or saline water. In 2018, a patient was reported to have contracted Balamuthia mandrillaris after one month of using tap water filtered through a Brita water purifier for nasal irrigation. [5]

Rare cases of fatal naegleriasis have occurred due to nasal insufflation of the amoeba Naegleria fowleri (the "brain-eating amoeba") from untreated tap water. Two people died from Naegleria fowleri infections tied to using neti pots containing tap water in 2011. [6] A Louisiana man died from the same amoeba in 2013. [7]

Mechanism of action

Flushing the nasal cavity can soothe inflamed tissue and remove irritants like allergens; it may help clear mucus. [2] [3]

Typical use involves the pouring or pumping of saline water through one nostril and letting it drain from the other.

Solutions and devices

Solutions

The water should not be tap water, which may contain small amounts of bacteria that are safe to drink but may be dangerous in the nose. The water should be sterile or filtered for micro-organisms; if tap water is used it should be boiled and cooled. [4] Saline solution is also sometimes used. [2]

The U.S. Centers for Disease Control and Prevention has a fact sheet recommending one of four methods to make the water safe: [8]

  1. Boil: Use water that has been previously boiled for 1 minute and left to cool. At elevations above 6,500 feet, boil for 3 minutes.
  2. Filter: Use a filter designed to remove some water-loving germs. The label may read "NSF 53" or "NSF 58". Filter labels that read "absolute pore size of 1 micron or smaller" are also effective.
  3. Buy: Use water with a label specifying that it contains distilled or sterile water.
  4. Disinfect: Learn how to disinfect your water to ensure it is safe from Naegleria. Chlorine bleach used at the right level and time will work as a disinfectant against this germ.

A number of other compounds may be included in irrigation fluids such as the steroid budesonide in an effort to treat chronic rhinosinusitis. [9]

Devices

Ceramic neti pot Neti pot.jpg
Ceramic neti pot

Neti pots are commonly used and rely on gravity and head position in order to rinse the outer sinus cavities. Typically they have a spout attached near the bottom, sometimes with a handle on the opposite side. [4]

Various squeeze bottles for nasal irrigation have also been used to apply the water. [4]

Bulb syringes are commonly used for infants and children. [4]

There are also irrigation machines available that utilize electric motor-driven pumps. [4]

History

The earliest record of nasal irrigation is found in the ancient Hindu practice of Indian Ayurveda whose roots are traced to the Vedas. It was customary to perform jala-neti daily, as part of soucha (personal hygiene according to scriptures). Jala neti , which means to cleanse the nose with water, is an old yogic technique from India. The container used to administer the saline is called a "neti pot". This process removes mucus and dirt and clears the nose. A second neti technique known as sutra neti uses a piece of string instead of water.

See also

Related Research Articles

<span class="mw-page-title-main">Paranasal sinuses</span> Air-filled spaces surrounding the nasal cavity

Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoidal sinuses are behind the eyes. The sinuses are named for the facial bones and sphenoid bone in which they are located. Their role is disputed and no function has been confirmed.

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.

<span class="mw-page-title-main">Nasal cavity</span> Large, air-filled space above and behind the nose in the middle of the face

The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract.

Free-living amoebae in the Amoebozoa group are important causes of disease in humans and animals.

<span class="mw-page-title-main">Naegleriasis</span> Rare and usually fatal brain infection by a protist

Naegleriasis is an almost invariably fatal infection of the brain by the free-living unicellular eukaryote Naegleria fowleri. Symptoms are meningitis-like and include headache, fever, nausea, vomiting, a stiff neck, confusion, hallucinations and seizures. Symptoms progress rapidly over around five days, and death usually results within one to two weeks of symptoms.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Medical condition

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Nasal polyp</span> Noncancerous growths within the nose or sinuses

Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.

<i>Naegleria</i> Genus of protists

Naegleria is a free living amoebae protist genus consisting of 47 described species often found in warm aquatic environments as well as soil habitats worldwide. It has three life cycle forms: the amoeboid stage, the cyst stage, and the flagellated stage, and has been routinely studied for its ease in change from amoeboid to flagellated stages. The Naegleria genera became famous when Naegleria fowleri, a human pathogenic strain and the causative agent of primary amoebic meningoencephalitis (PAM), was discovered in 1965. Most species in the genus, however, are nonpathogenic, meaning they do not cause disease.

<span class="mw-page-title-main">Saline (medicine)</span> Saline water for medical purposes

Saline is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein, it is used to treat dehydration such as that from gastroenteritis and diabetic ketoacidosis. Large amounts may result in fluid overload, swelling, acidosis, and high blood sodium. In those with long-standing low blood sodium, excessive use may result in osmotic demyelination syndrome.

<span class="mw-page-title-main">Cribriform plate</span> Part of the ethmoid bone in the skull

In mammalian anatomy, the cribriform plate, horizontal lamina or lamina cribrosa is part of the ethmoid bone. It is received into the ethmoidal notch of the frontal bone and roofs in the nasal cavities. It supports the olfactory bulb, and is perforated by olfactory foramina for the passage of the olfactory nerves to the roof of the nasal cavity to convey smell to the brain. The foramina at the medial part of the groove allow the passage of the nerves to the upper part of the nasal septum while the foramina at the lateral part transmit the nerves to the superior nasal concha.

<span class="mw-page-title-main">Post-nasal drip</span> Medical condition

Post-nasal drip (PND), also known as upper airway cough syndrome (UACS), occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the back of the nose, and eventually in the throat once it drips down the back of the throat. It can be caused by rhinitis, sinusitis, gastroesophageal reflux disease (GERD), or by a disorder of swallowing. Other causes can be allergy, cold, flu, and side effects from medications.

<span class="mw-page-title-main">Rhinorrhea</span> Type of medical symptom where the nasal cavity is filled with fluid mucus

Rhinorrhea, rhinorrhoea, or informally runny nose is the free discharge of a thin mucus fluid from the nose; it is a common condition. It is a common symptom of allergies or certain viral infections, such as the common cold or COVID-19. It can be a side effect of crying, exposure to cold temperatures, cocaine abuse, or drug withdrawal, such as from methadone or other opioids. Treatment for rhinorrhea is not usually undertaken, but there are a number of medical treatments and preventive techniques.

<i>Balamuthia mandrillaris</i> Species of pathogenic Amoebozoa

Balamuthia mandrillaris is a free-living amoeba that causes the rare but deadly neurological condition granulomatous amoebic encephalitis (GAE). B. mandrillaris is a soil-dwelling amoeba and was first discovered in 1986 in the brain of a mandrill that died in the San Diego Wild Animal Park.

Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.

<span class="mw-page-title-main">Functional endoscopic sinus surgery</span> Surgery to enlarge the paranasal sinus drainage pathways

Functional endoscopic sinus surgery (FESS) is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.

A sinus is a sac or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue. In common usage, "sinus" usually refers to the paranasal sinuses, which are air cavities in the cranial bones, especially those near the nose and connecting to it. Most individuals have four paired cavities located in the cranial bone or skull.

<span class="mw-page-title-main">Neti (Hatha Yoga)</span> Yogic system of body cleansing

Neti is an important part of Shatkarma, the Hindu yogic system of body cleansing techniques. It can have universal application, irrespective of their religion. It is intended mainly to clean the air passageways in the head. Both the Hatha Yoga Pradipika and other sources usually attribute to Neti many beneficial effects that range from profound physiological ones on the body, mind and personality to even clairvoyance. The two main variants are jala neti (जलनेति) using water and the more advanced sutra neti (सूत्रनेति) using string.

<i>Naegleria fowleri</i> Species of free-living excavate form of protist

Naegleria fowleri, colloquially known as the "brain-eating amoeba", is a species of the genus Naegleria. It belongs to the phylum Percolozoa and is technically classified as a shape-shifting amoeboflagellate excavate, rather than a true amoeba. This free-living microorganism primarily feeds on bacteria but can become pathogenic, causing an extremely rare, sudden, severe, and usually fatal brain infection known as naegleriasis or primary amoebic meningoencephalitis (PAM).

Antral lavage is a largely obsolete surgical procedure in which a cannula is inserted into the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus. It is also called proof puncture, as the presence of an infection can be proven during the procedure. Upon presence of infection, it can be considered as therapeutic puncture. Often, multiple repeated lavages are subsequently required to allow for full washout of infection.

<span class="mw-page-title-main">Fungal sinusitis</span> Inflammation of the paranasal sinuses due to fungal infection

Fungal sinusitis or fungal rhinosinusitis is the inflammation of the lining mucosa of the paranasal sinuses due to a fungal infection. It occurs in people with reduced immunity. The maxillary sinus is the most commonly involved. Fungi responsible for fungal sinusitis are Aspergillus fumigatus (90%), Aspergillus flavus, and Aspergillus niger. Fungal sinusitis occurs most commonly in middle-aged populations. Diabetes mellitus is the most common risk factor involved.

References

  1. Rosenfeld, RM; Piccirillo, JF; Chandrasekhar, SS; Brook, I; Ashok Kumar, K; Kramper, M; Orlandi, RR; Palmer, JN; Patel, ZM; Peters, A; Walsh, SA; Corrigan, MD (April 2015). "Clinical practice guideline (update): adult sinusitis executive summary". Otolaryngology–Head and Neck Surgery. 152 (4): 598–609. doi: 10.1177/0194599815574247 . PMID   25833927.
  2. 1 2 3 4 Chong, LY; Head, K; Hopkins, C; Philpott, C; Glew, S; Scadding, G; Burton, MJ; Schilder, AG (26 April 2016). "Saline irrigation for chronic rhinosinusitis" (PDF). The Cochrane Database of Systematic Reviews. 4: CD011995. doi:10.1002/14651858.CD011995.pub2. PMID   27115216. Open Access logo PLoS transparent.svg
  3. 1 2 Hermelingmeier, Kristina E.; Weber, Rainer K.; Hellmich, Martin; Heubach, Christine P.; Mösges, Ralph (1 September 2012). "Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis". American Journal of Rhinology & Allergy. 26 (5): e119–125. doi:10.2500/ajra.2012.26.3787. ISSN   1945-8932. PMC   3904042 . PMID   23168142.
  4. 1 2 3 4 5 6 "Is Rinsing Your Sinuses Safe?". FDA. 24 January 2017. Archived from the original on 4 January 2019.
  5. "Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage". IJID Online. International Journal of Infectious Diseases. December 2018.
  6. Moisse, Katie (16 December 2011). "Louisiana Issues Neti Pot Warning After Two Fatal Infections". ABC News. Archived from the original on 22 January 2019. Retrieved 17 May 2020.
  7. "Brain infection from water amoeba kills 3; victim used 'neti pot'". King-TV. 4 January 2013. Retrieved 21 January 2021.
  8. "Safe Ritual Nasal Rinsing" (PDF). CDC.gov. Centers for Disease Control and Prevention. Archived from the original (PDF) on 18 June 2019. Retrieved 17 May 2020.
  9. Thaler, Erica; Kennedy, David W. (2009). Rhinosinusitis: A Guide for Diagnosis and Management. Springer Science & Business Media. p. 82. ISBN   9780387730622.