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Upper respiratory conditions, including chronic and acute sinusitis, the common cold and allergic rhinitis are common and expensive disorders that have a significant impact on patients, medical resources and society. Nasal irrigation using physiological (“normal”, 0.9%) saline or slightly concentrated saline (2-3%) can be used as a rinse of the nasal cavity with saline delivered as a liquid or spray. The practice of nasal irrigation likely originated in the Ayurvedic medical tradition in which it is known as “jala neti”. This website contains links to instructions, instructional video, radio clips and youtube links about nasal irrigation. It also describes several studies in nasal irrigation conducted under the direction of David Rabago, MD, faculty at the University of Wisconsin Department of Family Medicine.
A word about water quality. In the United States, lukewarm tap water from municipal water systems or intact wells deeper than 40 feet is considered safe for saline solution preparation. If these criteria are not met or if water safety is in doubt, distilled water or tap water boiled and then cooled to room temperature is recommended for saline solution preparation. Surface water should not be used for nasal irrigation.
Nasal Irrigation Instructions
We conducted clinical studies (Studies 1-4 below) evaluating the effect of daily nasal irrigation (also known as nasal wash) on the quality of life, symptoms, and medication use of patients with chronic sinus complaints. Sinus disease is common, affects quality of life and is a source of significant medication use. Nasal irrigation is an ancient technique in which salt water is allowed to gently bathe the nasal cavity, facilitating a gentle wash of the structures within. Our studies were done from 1999 to 2008 involving a total of 76 subjects.
We also conducted a study (Study 5 below) evaluating the use by family physicians of nasal irrigation for upper respiratory conditions and wrote a review (Item 6 below) summarizing the clinical information available about saline nasal irrigation.
Study 1: In a randomized controlled trial, we trained 52 patients with histories of sinus disease to use daily nasal irrigation, and compared their experience to 24 control subjects. We assessed quality of life, patients’ compliance and satisfaction with nasal irrigation, sinus symptoms, and medication use. The group using nasal irrigation exhibited improved quality of life, less frequent symptoms, and used antibiotics and nasal sprays less often. They were compliant with nasal irrigation, liked using it, and suffered few side effects. Three follow-up studies have been published which add to the parent study.
Study 2: In Study 2, we wanted to determine whether subjects would continue to use nasal irrigation in a less structured setting and whether the control subjects would use nasal irrigation if trained and followed in an unstructured manner. We therefore monitored the original intervention subjects for an additional 12 months, and trained the initial control group subjects to use nasal irrigation for their chronic sinus conditions and followed them for 12 months. Both groups experienced similar improvement in quality of life and decreased nasal symptoms. Use patterns stabilized at about 3 nasal irrigations per week, used by some subjects on a strict schedule and by others only as needed.
Study 3: In Study 3, we wanted to know how users of nasal irrigation experienced the process of learning to use the therapy, and how they continued to use it at home. We conducted interviews with 28 subjects from the original study. Their comments were consistent across four main themes: 1) nasal irrigation was effective for chronic sinus symptoms and 2) it empowered subjects to care for chronic sinus symptoms on their own rather than always seek a physician’s input. 3) There are some barriers to doing nasal irrigation including the time required and the initial sensation of water in the nasal cavity, but 4) these barriers could be overcome by good instruction and integration of nasal irrigation into subjects’ at-home daily routines.
Study 4: Some people with chronic sinus conditions also have allergic rhinitis. Therefore, in Study 4, we hypothesized that nasal irrigation might be helpful to subjects with allergic rhinitis. We re-analyzed qualitative data to explore the research question “Do subjects using HSNI for chronic sinus symptoms, and who also had allergic rhinitis, experience improvement in allergy symptoms?” More than half of subjects with self-reported chronic sinus symptoms and concurrent allergic rhinitis spontaneously reported positive effects of nasal irrigation on allergy symptoms as distinct from chronic sinus symptoms, suggesting that nasal irrigation may be effective adjunctive therapy for allergic rhinitis.
Study 5: Study 5 assessed the use among family physicians in Wisconsin of nasal irrigation using an electronic questionnaire. Physician respondents have used nasal irrigation as adjunctive care for a variety of upper respiratory conditions including chronic rhinosinusitis (91%), acute bacterial rhinosinusitis (67%), seasonal allergic rhinitis (66%), viral upper respiratory infection (59%), other allergic rhinitis (48%), irritant based congestion (48%) and rhinitis of pregnancy (17%). Physicians also reported having used SNI prior to antibiotics for acute bacterial rhinosinusitis (77%). Use patterns varied regarding type of nasal irrigation used, dosing frequency, saline concentration and patient education.
Paper 6: This short review paper summarizes the clinical information available about saline nasal irrigation.
Conclusion: We conclude from these studies, and from a review of the scientific literature, that nasal irrigation is an effective adjunctive therapy for chronic sinus symptoms. It may also be effective as adjunctive therapy for symptoms of other upper respiratory conditions that are risk factors for chronic sinus symptoms including acute upper respiratory infection (common cold), acute sinusitis, and allergic rhinitis.
1. Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: A randomized controlled trial. Journal of Family Practice. 2002;51(12):1049-1055.
2. Rabago D, Pasic T, Zgierska A, Barrett B, Mundt M, Maberry R. The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck Surg. 2005;133:3-8.
3. Rabago D, Barrett B, Marchand L, Maberry R, Mundt M. Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multi-method study.Annals of Family Medicine. 2006;4:295-301.
4. Rabago D, Guerard E, Bukstein D. Nasal irrigation for chronic sinus symptoms in patients with allergic rhinitis, asthma and nasal polyposis: a hypothesis generating study. Wisconsin Medical Journal. 2008;107:69-75.
5. Rabago D, Zgierska A, Peppard P, Bamber A; The prescribing patterns of Wisconsin family physicians surrounding saline nasal irrigation for upper respiratory conditions; Wisconsin Medical Journal; 108(3):145-50; 2009.
6. Rabago D, Zgierska A; Saline Nasal Irrigation for Upper Respiratory Conditions;American Fam Physician; 80(10):1117-1119, 1121-1122; 2009
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