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Tag: Nasal Washing

Spray or Irrigation: Choosing the Right Remedy to Relieve Nose and Sinus Congestion

Washing the inside of the nose with saline is a well-regarded measure widely prescribed by doctors to relieve symptoms of cold and allergic rhinitis. As part of regular hygiene, nasal washing could also help in keeping the nasal passages clean and preventing illness by flushing away irritants such as dirt, dust, and infectious agents like bacteria and viruses.

Nasal washing is commonly done either with a saline spray or large volume saline irrigation, each with its own set of benefits suited for the right condition.

Saline spray: the convenience of a handy and ready-to-use nasal wash

Saline sprays provide a convenient and practical method of washing and clearing nasal passages. Spraying saline solution into the nose loosens thick mucus secretions and help in mucus drainage and removal. It also restores vital moisture to the nasal tissues and provide relief for dry, crusted, irritated and inflamed nasal membranes caused by the following:

     • Cold, runny nose, allergies
     • Dry air from air-conditioners, cold weather or airplane flights
     • Dust, pollutants
     • Overuse of nasal decongestants
     • Use of steroid nasal spray
     • Postnasal drip
     • Nosebleed
     • Rebound sinus reaction from drugs and smog

Saline sprays are readily available as handy devices convenient for use at home, at work or even during travel. Patients must also be advised to apply the nasal spray away from crowds to avoid spreading any infectious material which may drain out of the nose.  

Sinonasal Irrigation: a deep and thorough nasal wash

Sinonasal irrigation is a method of introducing a large volume of solution into the nose and sinuses to achieve a deeper and more thorough wash. The approach is best done using a positive and low pressure to safely direct the fluid into the nose and other areas in the sinus cavities beyond the reach of typical nasal sprays. This clears away any irritating and infectious material as the fluid drains out from the other nostril.

Sinonasal irrigation is indicated for conditions with a heavier burden of mucus, irritating agents and infectious microbes. It is also particularly useful for patients before and after diagnostic or surgical procedures involving the nose and sinuses. Sinonasal irrigation clears away debris like encrusted mucus or blood that may be hindering the procedure or wound healing.

Sinonasal irrigation kits usually come with an irrigating bottle and packets of mineral salts ready for mixing with water to create a balanced solution suitable for the delicate nasal tissues.

Should I spray or irrigate? 

Both saline spray and irrigation operate on the principle of hydrating and cleansing the sinonasal passages. The points of difference mainly lie on the convenience of use and depth of reach in the sinonasal passages. Saline sprays have the convenience of being handy and ready-to-use. Meanwhile, large volume sinonasal irrigation allows for a deeper and more thorough wash of the sinonasal passages. These two methods may however be used together allowing for a regular and on-demand nasal washing.

Consult your doctor to determine the treatment plan best suited for your condition.

Reference:

Principi N, Esposito S. Nasal Irrigation: An Imprecisely Defined Medical Procedure. Int J Environ Res Public Health.

Keep Your Nasal Spray and Sinus Irrigation Bottle Clean with these Tips

If you have nasal or sinus congestion which may be caused by colds, allergies, or sinusitis, you may need to use a nasal spray or sinus irrigation.

Since these devices help introduce fluids into your nose and sinuses, you have to make sure that they are kept clean and sanitary. So here are some tips on the proper use of nasal sprays and sinus irrigation bottles to help keep infections at bay.

     1. Always carefully read and follow the instructions provided in the box and product information leaflet. Do not discard these important materials and keep them as handy references. Every device has its own unique prescribed cleaning method.

     2. Nasal sprays and sinus irrigation bottles are for personal use only. Always use your own device, and do not share your device with others. Sharing the same device may cause spread of infection.

     3. After using a sinunasal irrigation, discard any remaining solution. Never keep remaining solution for later use as bacteria and other microorganisms might grow on them.

     4. Thoroughly clean the nasal spray and irrigation bottles after every use.

     5. In cleaning nasal sprays, you may use a clean cotton swab to wipe the tip of the nozzle before covering it with the protective cap.

     6. Always clean all parts of the irrigation bottle (including the cap and tube) very well using warm water and rinse thoroughly with tap water.

     7. After washing, thoroughly dry all parts of the irrigation bottle using a clean paper towel.

     8. Reassemble the irrigation bottle and its components and store in a cool dry place until next use

     9. In preparing your sinus irrigation for the next use, rinse the bottle and the other parts with cooled preboiled water.

For expert advice, always consult your doctor on the proper use of your nasal spray and sinus irrigation.

References:

Shargorodsky J, Lane AP. What is the best modality to minimize bacterial contamination of nasal saline irrigation bottles? Laryngoscope. 

Keen, M., Foreman, A., & Wormald, P.-J. (2010). The clinical significance of nasal irrigation bottle contamination.

High Volume Nasal Irrigation Aids Topical Steroids to Access the Sinus Mucosa in Chronic Rhinosinusitis

Chronic Rhinosinusitis (CRS), which is associated with multiple causes, is a common illness that makes millions of people from different parts of the globe suffer. CRS poses a profound impact on the quality of patients’ lives due to its disturbing symptoms on top of the huge cost in treating the underlying cause. 

Since the nasal and sinus mucosa are persistently inflamed, nasal steroid sprays have been used for the relief of CRS especially after surgery. However, in a clinical review published in the International Forum of Allergy & Rhinology, Dr. David Jang and his fellow researchers noted that nasal steroid sprays may not deliver adequate amounts of medication to the postoperative sinus cavity. In this study, they compared the condition of the patients when on high volume steroid nasal irrigation versus off-irrigation periods using conventional nasal steroid sprays only. It was found that patients had worsening of symptoms when they were not on high volume steroid nasal irrigation.

Dr. Auddie Sweis and a team of researchers also did a retrospective chart review of 90 patients with chronic rhinosinusitis to evaluate steroid nasal saline irrigation using budesonide or mometasone prior to surgery. In this study published in May 2020 at the International Forum of Allergy & Rhinology, Dr. Sweis and colleagues found that after a trial of steroid nasal irrigation, 64.4% had significant improvement enough to avoid surgery.

The use of devices that deliver large volume with positive pressure irrigation aids topical steroids to effectively access the sinus mucosa. This also provides an efficient lavage through enhanced mechanical removal of mucus, bacteria and inflammatory agents.

Findings from the study by Dr. Kornkiat Snidvongs and colleagues published in the International Forum of Allergy & Rhinology supported the strategy of utilizing high volume delivery system for irrigation to ensure that intranasal corticosteroids are appropriately delivered to the sinus mucosa. The study was done on 111 patients with CRS who underwent Endoscopic Sinus Surgery (ESS) and found that intranasal corticosteroid is an effective therapy when appropriately delivered using a high-volume delivery system.

In a controlled trial published in May 2020 in the Indian Journal of Otolaryngology Head and Neck Surgery, Dr. Maheshbabu Thanneru and his colleagues showed that in patients with chronic allergic rhinosinusitis who underwent surgery, the use of budesonide nasal irrigation after surgery led to significant reduction of symptom scores by an average of 70% compared to the 44% reductions seen in patients who just had standard care after surgery.

In July 2020, a controlled trial by Dr. Lisa Cherian and colleagues which was published in Rhinology compared the oral steroid prednisolone, nasally irrigated steroid budesonide, and the oral antibiotic doxycycline for patients with chronic rhinosinusitis. The results of treatment that lasted for 3 weeks revealed that clinical improvement was significant with both oral and irrigated steroid but not with the antibiotic doxycycline.

While some investigators have used saline solution as the vehicle in delivering topical steroids through large volume irrigation, some clinical experts recommend Ringer-Lactate as a more appropriate solution for sinunasal irrigation.

Murat Ünal and colleagues wrote in a study published in The Journal of Laryngology & Otology, “Ringer’s Lactate has a composition that more closely approximates the extracellular fluids and is more deserving of the adjective physiological”. It was explained that Ringer-Lactate, a solution composed mainly of Sodium Chloride, Potassium Chloride and Calcium Lactate Pentahydrate, closely mimics the body’s own extracellular fluid that bathes the cells. Ringer-Lactate solution has no negative effect on Ciliary Beat Frequency (CBF), which is one of the most important parameters of mucociliary clearance.

As emphasized in various clinical reviews, the treatment of CRS underscores not only the aim of reducing the underlying mucosal inflammation by corticosteroids, but also the overarching goal of restoring normal sinus physiology.

References:


Jang, D. W., Lachanas, V. A., Segel, J., & Kountakis, S. E. (2013). Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis. International Forum of Allergy & Rhinology.

Sweis AM, Locke TB, Douglas JE, et al. Management of chronic rhinosinusitis with steroid nasal irrigations: A viable nonsurgical alternative in the COVID-19 era.

Snidvongs, K., Pratt, E., Chin, D., Sacks, R., Earls, P., & Harvey, R. J. (2012). Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis. International Forum of Allergy & Rhinology.

Thanneru M, Lanke S, Kolavali S. The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Allergic Rhinosinusitis with Polyps. Indian J Otolaryngol Head Neck Surg.

Cherian LM, Bassiouni A, Cooksley CM, Vreugde S, Wormald PJ, Psaltis AJ. The clinical outcomes of medical therapies in chronic rhinosinusitis is independent of microbiomic outcomes: a double-blinded, randomised placebo-controlled trial.

Ünal, M., Görür, K., & Özcan, C. (2001). Ringer-Lactate solution versus isotonic saline solution on mucociliary function after nasal septal surgery. The Journal of Laryngology & Otology, 115(10).

Expert Groups Recommend Nasal Washing to Prevent Viral Respiratory Infections

Handwashing has always been our primary way of warding off a wide range of disease-causing viruses and bacteria.  With our hands being always at risk of making contact with surfaces covered with these germs, it goes without saying that the simple act of washing our hands with soap and water will stop these viruses and bacteria from being carried into our body’s gateways like the mouth, nose and eyes.

However, some viruses can bypass this layer of protection by being carried directly into the nose by droplets in the air released by coughing, sneezing or even talking which causes respiratory tract infections like the common colds, flu, or even the currently dreaded coronavirus of COVID-19 also known as SARS-CoV-2.

In an effort to protect healthcare workers from COVID-19, the China Dermatologist Association, Chinese Society of Dermatology and National Clinical Research Center for Skin and Immune Diseases jointly published in March 2020 a consensus for protecting the skin, eyes, as well as the linings of the nose and mouth.  Among the recommendations is to regularly clean the inside of the nose with normal salt solution especially after visiting isolation wards with COVID-19 patients.1

The nose is recognized to be particularly vulnerable to SARS-CoV-2.  It was found that angiotensin converting enzyme‐2 (ACE2), the exact bodily enzyme which coronaviruses use to enter and infect cells are found on the tissues of the nasal lining.2

This finding is further strengthened in a more recent study published in Nature in May 2020, wherein a group of international researchers led by Dr. Waradon Sungnak of Wellcome Sanger Institute, UK, found that the level of this ACE2 which allows infection of SARS-CoV-2 are actually highest among nasal cells compared with the rest of the body.3

Rinsing the nasal cavities to dislodge these germs before they get the chance of attaching to the cells and causing an infection then becomes a logical consideration. 

Use of salt-based wash or saline, particularly with sodium chloride or potassium chloride, appears appropriate for the purpose of nasal rinsing to protect against viral infection.  In 2018, Virologist Dr. Sandeep Ramalingam and other researchers from the University of Edinburgh, UK, showed in their study that cells are able to absorb chloride and turn it into a form of bleach to neutralize viruses.4 

Numerous studies support the use of nasal washing in managing various nasal conditions, including those caused by viral infections.  In one particular study in 2008 by Dr. Ivo Slapak, pediatric otorhinolaryngologist, and a group of researchers in the Czech Republic, the effectivity of using saline wash for the nose to prevent reappearance of cold and flu was explored. In their study, 401 children aged 6-10 affected with cold or flu were divided into groups with one group receiving a nasal wash while the other had standard treatment.  Aside from showing faster resolution of symptoms among those who did nasal washing, it was found that these children on nasal washing had fewer sick days (31% under nasal washing vs. 75% under standard treatment) and school absences (17% under nasal washing vs. 35% under standard treatment).5

Vaccines and anti-viral agents remain to be the definitive measures against viral respiratory infections.  However, for some conditions like COVID-19, these are still unavailable.  Together with regular handwashing, physical distancing, a healthy diet and exercise, regular nasal washing with the appropriate salt solution may be considered as a safe, economical and accessible means to confer additional protection from respiratory infections.  Nasal washing devices prepared under stringent standards like nasal sprays and large-volume irrigating kits are already readily available.  Nasal sprays which deliver a fine mist of saline solution into the nose are designed to be handy and on-the-go.  Meanwhile, large-volume irrigating kits are intended for a more thorough cleansing of the nose and sinuses.  Indeed, more studies are under way to fully establish their role in preventing these viral infections.  To find out more on how to be effectively and safely protected from viral respiratory conditions, it still is best to have a talk with your personal doctor.

References:

Yan Y, Chen H, Chen L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019.

Sungnak W, Huang N, Bécavin C, et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med.

Ramalingam S, Cai B, Wong J, et al. Antiviral innate immune response in non-myeloid cells is augmented by chloride ions via an increase in intracellular hypochlorous acid levels. Sci Rep.

Slapak I, Skoupá J, Strnad P, Horník P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg.