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Everything You Wanted To Know About Nasal Irrigation

A neti pot.Nasal irrigation is sometimes recommended to thin or remove mucous from the nose. The two most common conditions that produce mucous are upper respiratory infections (e.g., the “common cold”) and allergies. Irrigation may also be beneficial to clear out dust, dirt, and allergens, and to allow the cilia within the nose to function more efficiently. Cilia are organelles that work to move mucous and debris in the nose (among other parts of the body) to a location where they can be expelled more easily. Another benefit of nasal irrigation is that it moisturizes the mucous membranes inside the nose.

Methods of Nasal Irrigation

Irrigation can be pulsatile or non-pulsatile (sometimes called “laminar flow”). Each type has its advocates. It is generally felt to be a safe practice so long as no allergens or contaminants are used in the irrigating solution. A neti pot can be used to pour the irrigating fluid into one nostril while the head is tipped to the opposite side, so that the solution can run out the other nostril via gravity, while the recipient breathes through his or her mouth. Squeeze bottles can be used to create positive pressure, and mechanized pulsation systems can sometimes be useful in assisting the process of introducing fluid into the nose and sinuses. For instance, there are nasal irrigators that can be attached to a Teledyne Water Pik.

The Irrigant

The irrigant can be tap water, but this sometimes causes pain because it may be slightly acidic and create irritation of mucous membranes. Salt is added to the water to make it more similar to body fluids. To maximize the potential for comfort, use four liters (approximately a gallon) of water with a teaspoonful of table salt and a half teaspoonful of baking soda. If tap water is not available, use clean, disinfected water. Body temperature is best solution. Do not use cold or hot water, and irrigate once to three times per day.

Potential Risks

Be aware that bacteria may grow in water. Many people carry the germ Staphylococcus aureus in their noses, so if the tips of irrigating devices allow any backflow, then the bacteria can enter the fluid reservoirs and contaminate the device and water, even creating biofilms on the inside walls of the containers. This may not be a problem for a single user who is the only person using a particular container, but if the container is contaminated and shared, it could pose a real infection risk. It is probably not a good idea to share nasal irrigation containers or systems unless they are reliably disinfected between users. If they cannot be cleaned with instilled boiling hot water or internal heating (i.e., as provided by a microwave oven), they may be washed with a diluted solution of household bleach or vinegar.

When to Irrigate

In what outdoor situations might nasal irrigation be helpful? If someone is exposed to a large pollen burden, it might be a worthwhile technique to consider. Another situation that might warrant nasal irrigation is extended time spent at high altitude, which can lead to dehydration of mucous inside the nose. Irrigation alone will probably not be sufficient to prevent cracking mucous membranes at high altitude (where the air is dry, cold and lacks moisture because of low humidity), so the post-irrigation addition of a thin film of a greasy (ointment) antibiotic, such as mupirocin, will both keep the inside of the nose moist and perhaps prevent colonization with harmful bacteria.

This post, Everything You Wanted To Know About Nasal Irrigation, was originally published on by Paul Auerbach, M.D..

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