Nasal Irrigation101

A little saltwater can make a huge difference in your sinuses. Nasal irrigation systems can soothe blocked sinus passages and escort dirt, mucus and other irritants out of your nose. It’s one of the many nasal irrigation benefits.

Typically, “normal” noses and sinuses are able to clean themselves, but for those who have allergies and chronic sinusitis, this is not the case. That’s why it’s so important to do saline rinses and nasal irrigation on a regular basis—they help you “clean house.” 

When your sinuses are stopped up, bacteria and irritants take forever to exit your nose, leading to congestion and even chronic sinus infections.

Think of it this way: Nasal irrigation is similar to brushing your teeth, but for your nose! 

Have you taken advantage of nasal irrigation benefits? Do you understand the process for saline rinsing? Don’t worry, we’ve got all the information you need to get you started on this healthy habit.

Nasal Irrigation 101 and Nasal Irrigation Benefits 

At first, nasal irrigation—or even the sight of a neti pot – may be intimidating.  However, those who regularly irrigate their nasal passages say the benefits far outweigh any temporary inconveniences. 

Of course, if this is your first time considering nasal irrigation, it may take a bit of practice to get used to the process. That’s why we’re taking you through the nasal irrigation process step-by-step.

The Step-by-Step Process

1. Purchase a nasal irrigation system.
We’ll be able to give advice on which one will best suit your needs. There are several varieties, from neti pots to saline rinses, and all of them should be available at your local pharmacy.

While there are several bottles on the market, we typically recommend NeilMed sinus rinse bottle or Netipot. These are generally easy to clean, readily available and inexpensive. 

Raleigh Capitol Ear, Nose and Throat does not have a financial relationship with the companies or manufacturers of these devices.

The device that delivers the irrigation is not as important as the volume. The point is to deliver a high volume of salt water through one side of your nose and out the other. This is why a nasal irrigation device is much more beneficial than a mere mist or saline nasal spray. 

However, the most important aspect is to get started with a nasal irrigation program, regardless of the type of device you use to deliver it.

2. Prepare the equipment.
Follow the instructions that came with your system. Many come with a prefilled bottle of saline solution, others require you to buy a saline powder and mix it yourself. If you have to prepare the rinse yourself, be sure you are using distilled, sterile water. Do not use well water. 

Don’t forget to sterilize the device as well. For example, for the NeilMed sinus rinse bottle, the quickest and easiest method is microwaving the bottle for 30-60 seconds before each use, depending on the strength of the microwave. 

These bottles should also be replaced every three months based on scientific and manufacturer recommendations.

If you decide to use tap water, it MUST be sterilized before use.  A useful sterilization option is a UV light device, such as the SteriPen (~$50 on Amazon). 

Raleigh Capitol Ear, Nose and Throat has no financial relationship with the manufacturer of SteriPen.

The FDA also provides these additional recommendations:

  • When using your device, always wash and dry your hands.
  • Inspect your device before use to ensure it’s completely dry and clean.
  • Be sure to follow the manufacturer’s directions for use.
  • Wash the device between uses and dry the inside with a paper towel.

Failure to properly sterilize could lead to a serious, even life-threatening, infection---we’ll get into more details about that later.

3. Prepare the salt solution

The amount of water that the NeilMed sinus rinse bottle and Netipot hold is 240 ml. This converts to 1 cup, 8 ounces, 1/2 pint, 1/4 quart.

A NeilMed salt packet should be added to this amount of water with each use. Do not rinse the nose with plain water. This will cause burning.

If you’d like to make your own salt solution, here’s a “recipe” we recommend:

Add a 1/2 teaspoon of salt and 1/2 teaspoon of baking soda to the water. Or, make a 1:1 mixture of salt and baking soda and store in an empty jelly jar, then add 1 teaspoon of this mixture to the water. The amount and ratio can be adjusted per your preference.

4. Now that you have the solution prepared, you’re ready to begin your sinus rinse. 

Lean over a sink at a 45-degree angle, tilting your head so one nostril is pointed toward the sink. See a video demonstration here.

Place the tip of the device at your nostril opening and gently squeeze or pour the solution into your nose. (Remember to breathe through your mouth or hold your breath while performing the irrigation.) The solution should come out of your other nostril.

Blow your nose to clear out any remaining solution.

Repeat the procedure with the other nostril. Remember that you will generally use 1/4 to 1/2 of the solution for each nostril.

Useful Tips for Nasal Irrigation

It takes practice, so don’t be discouraged if the first time doesn’t go as smoothly as you had hoped. Following are some useful tips that can help:

  • Holding your head down while irrigating can help the fluid reach the sinuses located in the forehead and top of the nose.
  • Do not lean your head back.
  • Breathe through your mouth or hold your breath while flushing.
  • Stop if you have to sneeze or cough.
  • Do not swallow or speak while you’re flushing your sinuses. Doing so may change the pressure in your ears and accidentally cause infectious material to flow deeper into your sinuses.

Few people learned how to effectively use contact lenses on the first try, so you should not be discouraged if it takes you a while to get the hang of nasal irrigation. 

Your doctor is an important partner in your care, and we will be able to help you with any chronic sinus or allergy problems as well as create a course of treatment specifically tailored to meet your needs.

What About Traveling With a Nasal Irrigation System?

There are various options, but the most convenient and safest option is to pack the bottle and salt packets. Then, you can purchase distilled water at the destination. 

The other option would be using tap water from the hotel and sterilizing it with the SteriPen. If you decide to travel (fly) with the SteriPen, make sure the device is approved for travel by TSA before going to the airport.

Nasal Irrigation Benefits 

The best part about nasal irrigation systems? Providing some relief from sinus problems. Other benefits include:

  • Shrinking swollen sinuses
  • Washing away allergens
  • Clearing sinus passages
  • Pulling out fluid
  • Improving breathing

Using nasal irrigation for chronic rhinosinusitis is an almost universal recommendation. They can be very effective at alleviating symptoms and helping your sinuses drain.

Following are a few interesting facts medical studies have uncovered.

  • Nasal irrigation doesn’t penetrate the sinuses as well in patients who have not undergone surgery.
  • The nose-to-ceiling position is the best one for rinsing the sphenoid sinuses. These are the sinuses that are located behind the nose and between the eyes.
  • Squeeze bottles seem to be more effective to irrigate the maxillary, frontal and sphenoid sinuses. 
  • There is no additional benefit to heating the nasal solution before delivering it.

Is Nasal Irrigation Safe?

Tips For Nasal Irrigation

The benefits of nasal irrigation far outweigh the risks—provided you take precautions and properly sterilize your equipment. We can summarize this importance in two words:

Amebic meningoencephalitis.

That’s a mouthful.

In layman’s terms, you may have heard it referred to as the “brain-eating amoeba.” This microscopic organism is found in lakes, rivers and hot springs. People are infected when contaminated water enters the nose.

But what does that have to do with nasal irrigation and sinus infection treatment? In rare cases, using contaminated tap water for nasal irrigation can lead to infection. 

This is why it’s important to practice proper sterilization procedures regardless of what type of nasal irrigation system you use.

The first two cases of amebic infection from nasal irrigation occurred in Louisiana in 2011 as a result of using contaminated tap water. 

In 2018, there was another case in Washington state. Although a Brita filter was used to purify the water, the water was still not sterilized enough.  In order to be effective, all water purifiers must meet the microfiltration requirements specified in the guidelines from the CDC.

Fortunately, this amebic disease is incredibly rare, but it has a terrifying fatality rate. The CDC states that out of 145 Americans who were infected from 1961 to 2018, only four survived. 

You’d think that the chance of obtaining a serious amebic disease—no matter how remote--- would encourage more diligence, but despite recommendations, 48 percent of patients say they use regular tap water to irrigate their nasal passages, according to information from the International Forum of Allergy and Rhinology.

DEDICATION. EXCELLENCE. COMPASSION. THESE ARE OUR PRINCIPLES AT RALEIGH CAPITOL ENT

All of our physicians have graduated from some of the most highly regarded medical schools in the country. Their extensive pediatric and adult ENT training is from some of the leading programs in the United States, including Johns Hopkins University, the University of North Carolina, Duke University, the University of Virginia, Emory University, Ohio State University and the University of Pittsburgh and others.

This means you can rest assured that you’re not only working with a team of compassionate, seasoned professionals, but you will have access to the latest innovative treatments and procedures available. 

If you are having problems with your sinuses, or if nasal irrigation isn’t effective for you, please contact us so we can assist you.

--This article was reviewed by Dr. Jeevan Ramakrishnan

Raleigh Capitol Ear, Nose, and Throat is the area's premier physician-owned ENT practice with seven convenient locations throughout Wake County. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us.