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Nasal irrigation (also called nasal lavage, nasal toilet, or nasal douche) is a personal
hygiene Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
practice in which the
nasal cavity 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 c ...
is washed to flush out
mucus Mucus ( ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both serous and mucous cells. It is ...
and debris from the
nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...
and
sinuses 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 spheno ...
, in order to enhance nasal breathing. Nasal irrigation can also refer to the use of saline nasal spray or
nebulizer In medicine, a nebulizer (American English) or nebuliser (British English) is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of asthma, cystic fibr ...
s to moisten the
mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
s.


Medical uses

Nasal irrigation can be an effective therapy to relieve symptoms of both chronic
sinusitis 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, hea ...
as well as acute sinusitis caused by
upper respiratory tract infections 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, to ...
such as the
common cold The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear fewer than two days after exposur ...
. The evidence for use in chronic sinusitis is weak. It can also be useful for the temporary relief of the symptoms associated with
allergic rhinitis Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. Signs and symptoms include a runny or stuffy nose, sneezing, red, i ...
.


Adverse effects

Adverse effects include nasal irritation, nosebleeds, headache, and drainage after the irrigation is done. It is generally well tolerated. 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. In fact, proper application suggests the use of boiled water or
saline water Saline water (more commonly known as salt water) is water that contains a high concentration of dissolved salts (mainly sodium chloride). On the United States Geological Survey (USGS) salinity scale, saline water is saltier than brackish wate ...
. In 2018, a patient was reported to have contracted '' Balamuthia mandrillaris'' after one month of using
tap water Tap water (also known as faucet water, running water, or municipal water) is water supplied through a tap, a water dispenser valve. In many countries, tap water usually has the quality of drinking water. Tap water is commonly used for drinking, ...
filtered through a Brita water purifier for nasal irrigation. Rare cases of fatal
naegleriasis Naegleriasis (also known as primary amoebic meningoencephalitis; PAM) is an almost invariably fatal infection of the brain by the free-living unicellular eukaryote '' Naegleria fowleri''. Symptoms are meningitis-like and include headache, f ...
have occurred due to nasal insufflation of the amoeba ''
Naegleria fowleri ''Naegleria fowleri'', colloquially known as a "brain-eating amoeba", is a species of the genus ''Naegleria'', belonging to the phylum Percolozoa, which is technically not classified as true amoeba, but a shapeshifting amoeboflagellate excava ...
'' (the "brain-eating amoeba") from untreated tap water. In 2011, two people died from ''Naegleria fowleri'' infections tied to using Neti pots containing tap water. In 2013 a man in
Louisiana Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is border ...
died from the same amoeba.


Mechanism of action

Flushing the nasal cavity can soothe inflamed tissue and remove irritants like allergens; it may help clear mucus. 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.
Saline solution Saline (also known as saline solution) 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 also sometimes used. The U.S.
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...
has a fact sheet recommending one of four methods to make the water safe: # 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. # 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. # Buy: Use water with a label specifying that it contains distilled or sterile water. # 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 Budesonide, sold under the brand name Pulmicort among others, is a medication of the corticosteroid type. It is available as an inhaler, nebulization solution, pill, nasal spray, and rectal forms. The inhaled form is used in the long-term mana ...
in an effort to treat chronic
rhinosinusitis Rhinosinusitis is a simultaneous infection of the nasal mucosa ( rhinitis) and an infection of the mucosa of the paranasal sinuses (sinusitis). A distinction is made between acute rhinosinusitis and chronic rhinosinusitis. Background Because si ...
.


Devices

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. Various squeeze bottles for nasal irrigation have also been used to apply the water. Bulb syringes are commonly used for infants and children. There are also irrigation machines available that utilize electric motor-driven pumps.


History

The earliest record of nasal irrigation is found in the ancient
Hindu Hindus (; ) are people who religiously adhere to Hinduism.Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pages 35–37 Historically, the term has also been used as a geographical, cultural, and later religious identifier for ...
practice of Indian
Ayurveda Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population repor ...
whose roots are traced to the
Vedas upright=1.2, The Vedas are ancient Sanskrit texts of Hinduism. Above: A page from the '' Atharvaveda''. The Vedas (, , ) are a large body of religious texts originating in ancient India. Composed in Vedic Sanskrit, the texts constitute the ...
. 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

*
Neti (Hatha Yoga) Neti (Sanskrit: नेती ''netī'') is an important part of Shatkarma (sometimes known as Shatkriya), the yogic system of body cleansing techniques. It can have universal application, irrespective of their religion. It is intended mainly to ...
*
Post-nasal drip 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 ...


References


External links


University of Wisconsin instructions, study and video

Saline nasal irrigation: Its role as an adjunct treatment
{{DEFAULTSORT:Nasal irrigation Hygiene Rhinology