A common health concern, chronic sinus infections can significantly diminish a person’s quality of life. Marked by inflammation in the air-filled sinus cavities, recurrent infections can cause congestion and facial pressure and pain, which can include headaches; they can also inhibit sleep, undermine daily functioning and generally make life miserable.
Treatments range from medications — including antibiotics — to surgery. In addition, one age-old remedy available over the counter that involves flushing out nasal cavities with a saline rinse is often recommended by primary care doctors and ear, nose and throat specialists, and limited research has shown it may be effective to reduce symptoms. In a study published online in July and slated for print later this month in the Canadian Medical Association Journal, participants who used nasal irrigation to treat recurrent or chronic sinusitis saw more symptom improvement over a six-month period than those who didn’t use the technique. Nasal irrigation also reduced headaches and decreased study participants’ use of over-the-counter medications, and fewer participants who used the remedy planned to consult the doctor in the event of future attacks, noted the study’s lead author, Dr. Paul Little, a professor of primary care research at the University of Southampton in England, in an email. The study also found nasal irrigation works better than steam inhalation, which reduced headaches but had no other significant effect on outcomes.
The findings provide validation for what clinicians say they see in their practices. “The majority of patients do get better with irrigations, assuming that they tolerate it,” says Dr. Rick Chandra, chief of rhinology at Vanderbilt University Medical Center in Nashville.
The research wasn’t without limitations. Dr. Rodney Schlosser, a professor and director of rhinology and sinus surgery at Medical University of South Carolina in Charleston, says many patients studied who have sinus symptoms may not actually have sinusitis. “They could have a variety of other conditions that mimic sinusitis,” he says. But rather than undercutting the central finding that nasal irrigation could help address chronic sinus symptoms, that may have just moderated the results. While Little says most study participants had long-standing sinus problems, not all did. “So it is possible that by excluding those with more short-lived disease we would have seen a greater effect,” he says.
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Doctors say nasal irrigation is safe and that it’s worth trying if you suffer from persistent or recurring sinus infections. “In my clinic practice, nasal irrigations are very effective and work for many, many patients,” Schlosser says. And clinicians offer few caveats for those with chronic or recurrent sinus infections who turn to nasal rinses for relief.
“We recommend it once or twice a day kind of depending on the patient’s willingness to do it,” says Dr. Amol Bhatki, director of the Skull Base Center at Baylor University Medical Center in Dallas. “I think it’s important for patients to know that for the first several times they do it, it’s a very unusual sensation. Humans are not used to having water in their nose.” It makes some people feel a bit claustrophobic and can even seem to simulate drowning for others, clinicians say, though most tolerate it fine once they master the technique.
“When you do it, you have to hold your breath so you don’t shoot it down into your airway,” says Dr. Andrew Lane, a professor of otolaryngology-head and neck surgery and director of the Sinus Center at the Johns Hopkins School of Medicine in Baltimore. Bhatki emphasizes three tips. First, forgo high-pressure rinsing. “Some people get the impression that the irrigation needs to be akin to a fire hose, and that’s not the case. Basically, it’s the volume of the fluid that’s doing the cleaning, not the pressure,” he says. Secondly, Bhatki recommends, bring the water to room temperature before using it, or microwave it for 5 to 10 seconds so it’s lukewarm to the touch, to avoid an ice cream headache-like sensation from using cold water. Third: “Expect to make a mess,” Bhatki says. It’s unlike neat and tidy treatments like nasal spray in that way, and the mess is a sign you’re doing it right.
Makers of saline rinses typically suggest using distilled water for safety, rather than tap. The water is mixed with salt to create a saline solution and then poured out of the spout of a tea-pot like neti pot, delivered through a syringe or squeezed out of a squeeze bottle into the nostril to thin out mucus. “In southern Louisiana and places like that, there [are] reports of people who’ve mixed up the salt with well water that was contaminated with an amoeba that causes a brain-eating infection,” Chandra says. The devices themselves should be cleaned after each use with safe water and allowed to air dry; that’s in addition to cleaning the device regularly with soap and water to prevent bacterial growth, and following other instructions to properly clean and maintain the device, as well as replacing it every few months, particularly if used frequently.
For people with nosebleeds or those on blood thinners, Chandra says that if using rinses exacerbates nosebleeds — making them more frequent or severe — it’s probably not a good option. In addition, using neti pot and other similar saline rinses can cause dysfunction of the Eustachian tube, which goes from the back of the nose to the ear. “Sometimes you can get a clogged ear, basically, and that’s probably the most common side effect from the salt water rinses — but it’s usually temporary,” Schlosser explains. “I use saline rinses very, very frequently in my practice for patients with sinonasal conditions, and with good benefit.”
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Some have raised concern about whether frequent nasal irrigation could upset the normal balance in the nose. “There is some ambient amount of mucus that the nose needs, because it does have mediators in it that fight infection,” Chandra says, adding that this helps filter pollens — particulate matter in air pollution, for example, that we breathe in. And a study presented in 2009 at the American College of Allergy, Asthma & Immunology’s annual scientific meeting found that daily long-term use of nasal saline irrigation actually increased the rate of sinus infections. However, while moderation is advised, Chandra notes, there’s no particular cut-off for how often one should use rinses. He adds: “Patients [with chronic sinusitis] already live in a state where their sinuses don’t clear relevant pathogens as efficiently to begin with. So it’s unlikely that the rinsing is going to make that predisposition they have any worse.”
Clinicians say that if nasal rinses aren’t effective at reducing symptoms, it’s important to at least speak to your primary care doctor and perhaps an ENT specialist, if you haven’t already, including to determine if you have sinusitis or another issue instead. “If you want to see the maximal effectiveness, you’ve got to make sure you have an accurate diagnosis in the first place,” Schlosser says.
It’s also recommended that those who have had sinus surgery to treat sinusitis do nasal irrigation, or continue with the practice if they were already using rinses. “It’s standard of care,” Lane says. Nasal irrigation is even more effective in these patients, clinicians say, since the removal of some small bones that separate the sinuses allows rinses to flush out mucus from these chronically inflamed sinus cavities, in addition to nasal cavities.
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For any patient seeking to reduce sinus infection symptoms, experts advise sticking with nasal irrigation for long enough to determine if it’s effective — even if it feels a little weird at first. “I think it’s one of those things that they should try for a week or two, so they can figure out the nuances of how to use it correctly — and then at that time — decide,” Bhatki says.
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Can Nasal Irrigation Reduce Sinus Infections? originally appeared on usnews.com
