Saline Sinus Rinse/Flush - Patient Education Videos

Editor: V. Dimov, M.D., Allergist/Immunologist, Assistant Professor at University of Chicago

Saline nasal irrigation bathes the nasal cavity with liquid by instilling saline into 1 nostril and allowing it to drain out of the other nostril (typically, it drains from both nostrils and the mouth). Only use sterile, distilled, filtered water (using a filter with an absolute pore size of 1 μm or smaller), or previously boiled water for nasal irrigation.

Pediatric Nasal Wash (video)

A demonstration of how to perform a nasal wash for children. Note: The Centers for Disease Control (CDC) recently updated the guidelines for the proper preparation of the water used in the nasal wash. View the guidelines at http://njhealth.org/nasalwash



Adult Nasal Wash (video)

A demonstration of how to perform a nasal wash for adults:



Techniques and devices

Techniques and devices include:

- low positive pressure from a spray or squirt bottle
- gravity-based pressure using a neti pot or other vessel with a nasal spout

Indications

A range of conditions may respond to saline nasal irrigation but the evidence supporting its use is less conclusive:

- allergic rhinitis
- acute upper respiratory tract infections (URTI)
- rhinitis of pregnancy
- acute rhinosinusitis

The exact mechanism of action of saline nasal irrigation is unknown. Saline nasal irrigation may improve nasal mucosa function through direct cleansing; removal of inflammatory mediators, and improved mucociliary function, as suggested by increased ciliary beat frequency.

Adverse effects

Fewer than 10% of patients reported adverse effects:

- self-limited sensation of ear fullness
- "stinging" of the nasal mucosa
- rarely epistaxis
-infections.  Louisiana Department of Health and Hospitals warned against improper use following the deaths of two people who were infected with Naegleria fowleri after using tap water to irrigate their sinuses. Read more here: Is Rinsing Your Sinuses Safe?

Contraindications

Contraindications for saline nasal irrigation include:

- incompletely healed facial trauma
- increased risk for aspiration, such as intention tremor or other neurologic or musculoskeletal problems.

Recommendations

- For chronic rhinosinusitis, nasal irrigation is an effective adjunctive therapy (level of evidence, A).

- Limited evidence for effective adjunctive treatment of irritant or allergic rhinitis, viral upper respiratory tract infection, and postoperative care after endoscopic sinus surgery (level of evidence, B).

- rhinitis of pregnancy, acute rhinosinusitis, sinonasal sarcoidosis, and Wegener's granulomatosis (level of evidence, C).



Mayo Clinic: What can you do about that runny nose and nasal congestion? Medications are one option, but so is nasal cleansing.



Treatment Options for 
Allergic Rhinitis (AR) and 
Non-Allergic Rhinitis (NAR) (click to enlarge the image).

References

Use of Saline Nasal Irrigation Reviewed. Laurie Barclay, MD. Medscape, 2009.
Saline Nasal Irrigation for Upper Respiratory Conditions. Am Fam Physician. 2009 November 15; 80(10): 1117–1119 (PDF).
SinuSurf (nasal saline rinse with surfactant) associated with loss of smell "for months to years". Discontinue use (PDF) http://goo.gl/awQUP
Neti Pot, Nasal Irrigation - Pros and Cons and Slideshow. WebMD, 2011.
North Louisiana Woman Dies from Rare Ameba Infection. DHH warns residents about improper neti pot use, 2011.
Is Rinsing Your Sinuses Safe? FDA replies: http://goo.gl/XL5bJ
Chronic sinus infections with mycobacteria associated with sinus rinses with tap water (nasal washing) http://goo.gl/wiV12
Sinus Rinse - YouTube playlist by National Jewish http://buff.ly/VVLBiV

Published: 02/07/2011
Updated: 12/27/2012

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