Nasal Irrigation

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Nasal irrigation can be very helpful in the treatment of a wide variety of problems, such as sinusitis, rhinitis and allergies. It is also very safe when done correctly. Even fairly young children have been able to learn how to use these techniques to reduce the need for other medical or surgical therapy. It's one of the few things in medicine that is safe, cheap and works!

The idea behind nasal irrigation is that you direct a steady stream of water - more volume than just a spray or mist - into one nostril. It flows into the nose, goes around the back of the septum (the wall in the middle of the nose) and then comes out of the other nostril. It's like a river running through the nose, and it does several things.

First, the flow mechanically cleans out dirt, debris and dried mucus from the nasal airway, which improves nasal obstruction caused by these things and promotes better drainage from the sinuses. Second, keeping the nasal lining moist helps the cells on the surface work better to defend against infection. And third, the fact that the water is a salt solution lets it actually work like a safe and natural decongestant. The salt water draws fluid out of the nasal tissue by osmosis to further improve airway congestion from a cold, allergies or sinusitis. You can adjust the salt content to increase this last function, although it's better to start with a weaker solution and work your way up so that it's not too irritating.

There are several ways to do nasal irrigation. I find the gentlest and most effective way of doing this (especially for children) is something called a Neti Pot. This is just a little "teapot" that has a bulb on the spout that fits comfortably into the nostril. There are a number of brands of Neti Pot, some simple plastic, some fancier ceramic, but they all do the same thing. The company NeilMed makes a popular one. It may take some time to get this to work, but once you figure it out, it becomes easy. Just do it in a shower or over a sink, find the right angle to tilt your head, say "ahhh" while the water is flowing and practice. Look at the video below for help.

Another approach is to use a squeeze bottle. This provides greater pressure, but I find this difficult for many kids, and it can be uncomfortable if done wrong. The Neti Pot works by gravity, so it's less likely to cause pain and choking before you get the hang of it. There is even a powered divide called a Navage that some people find useful, but again, this may be more aggressive than many children will tolerate.

It is very important to use clean water when mixing up these solutions. Although nasal irrigation is safe, there have been reports of life threatening or even fatal infections from the use of contaminated water. The way that I recommend to do this safely is to prepare a week's supply of the irrigation solution, keep it in the refrigerator and use it to fill the Neti Pot, letting it get to room temperature before using it. Boiling the water to make up the solution is the best way to make sure that it is clean. You can also use distilled or sterile bottled water if you are away from home, but make sure you refrigerate these bottles after opening them. There are some filters (0.2 micron or smaller) that are adequate for removing germs from tap water, but these can be inconsistent in their action, so it's better to use the boiling method. To sterilize water, it should reach a rolling boil for at least one minute, or for three minutes at an altitude more than a mile above sea level.

Most nasal irrigation devices come with packages to mix with clean water to make the irrigating solution. You can also purchase packages containing Xylitol, a natural plant substance that helps treat nasal irritation. While these packages are convenient (especially when traveling), you can make your own irrigation solution in bulk, with better control of the ingredients. In some cases, following the mixing directions on the packages produces a fairly strong irrigation solution that can cause stinging or burning. If that is the case, it is OK to use less of the package contents with each bottle of solution, to make a more diluted liquid. After a while, it may be possible to go back to using the full strength solution (which works better for keeping the nose decongested).

This is my recipe for the solution. Boil one quart of tap water, then add:
  • 3 rounded teaspoons kosher or canning salt (i.e. salt with no iodine or preservatives)
  • 1 rounded teaspoon baking soda
  • 3 teaspoons of glycerine or corn syrup (not necessary, but may help prevent drying or irritation)

Keep this in the refrigerator, and every day you use the Neti Pot just fill it and let it reach room temperature. Do not microwave, this can heat the solution unevenly. While nasal irrigation can help keep your nose healthy, if you are very obstructed (with a cold or sinus infection) don't try to force this, especially with a squeeze bottle or powered irrigator. There are a lot of videos online showing you how to do this, here is one from NeilMed: