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Tag: Sinusitis

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.

Saline Nasal Spray for Clean and Clear Nasal Airways

We can’t see them but suspended in the air that we breathe are impurities like dust, dirt, pollen or even infection-causing bacteria and viruses. Although our nose is naturally equipped to filter out these impurities, there are many instances wherein the filtering capabilities of our nose are overwhelmed when our environment becomes increasingly polluted and crowded.

Rinsing the nose with water would be an easy thing to do, however our nasal passages are very sensitive. The solution needed should be friendly to the delicate nasal tissues like a saline solution. Isotonic or physiologic saline nasal solutions duplicate the natural characteristics of normal body fluids and are gentle for cleansing the salt-sensitive tissues of the nose. 

Nasal saline solution cleanses and moisturizes the nasal passages which helps the body increase its resistance to respiratory tract infections and even provides a natural remedy in relieving symptoms of various ailments affecting the nose such as the common cold and nasal allergies.

When prepared as a handy nasal spray, saline nasal solution becomes a carry-anywhere and ready-to-use cleansing solution for the nose and delivers multiple benefits:

     • Saline solutions that come in a handy nasal spray provide a convenient means of washing, cleaning and clearing the nasal passages of irritants like dust and pollens, crusted mucus and microorganisms such as viruses.
     • Regular cleansing of the nasal tissues with saline solution promotes health of the cilia, the hair-like structures that trap and sweep away foreign invaders in the nasal airway and help curb inflammation.
     • Nasal saline washes help keep the nasal tissues moist and hydrated or help restore moisture to dry or congested nasal passages.
     • Isotonic saline nasal sprays help thin and loosen nasal secretions and crusted mucus.
     • Using saline nasal sprays can help provide relief of nasal congestion associated with dry, irritated or inflamed nasal passages, low humidity, heat, cold dry air (i.e., in air-conditioned room, air travel).

The best part is that you don’t need to go through the inconvenience of mixing your own salt solution to get all these benefits. Isotonic saline nasal sprays are readily and widely available over the counter in your neighborhood drugstores and pharmacies. If you have persisting or worsening symptoms, it is still best to consult your doctor.

Sinunasal Irrigation: Cleansing Care for a Healthy Nose and Sinuses

The nose that serves as an entrance to our airways is not a straight pathway as some imagine it to be. There are holes leading into our sinuses as well as bends and curves which may serve as areas where germs, dust and dirt from the air that we breathe may lodge into and cause various health problems affecting our nose and sinuses. Clearing away these irritants could be achieved most effectively by thoroughly washing the nasal passages and sinuses through large volume sinunasal irrigation.

Unlike nasal sprays or pumps, sinunasal irrigations deliver a large volume of solution under low pressure to gently wash the nasal passages and the sinus cavities. Sinunasal irrigation washes away and removes excess mucus containing bacteria, viruses and irritants or allergens such as dust, pollen, pet dander, and smoke particles.

Following are the benefits of sinunasal irrigating solution:

     • Clears and cleanses the sinunasal cavity
     • Aids in thinning secretions, lessens pressure and pain in the sinuses relieving symptoms of sinunasal congestion
     • Helps moisturize the sinunasal mucous membranes
     • Promotes the natural protective action of cilia to sweep away mucus, dirt or debris
     • Provides relief of symptoms associated with cold, sinusitis, allergies, pre and postoperative care
     • Optimizes patient’s recovery following nasal and sinus surgery

In irrigating the nose and the sinuses, a number of clinical experts advocate the use of a mineral- rich solution called Ringer’s lactate instead of plain saline as the appropriate irrigating solution. The composition of Ringer’s lactate solution more closely approximates that of the extracellular fluid. Ringer’s lactate, which is composed mainly of sodium chloride, potassium chloride and calcium lactate pentahydrate, closely mimics the body’s own extracellular fluid that naturally bathes the body cells. The minerals of the sinunasal irrigation solution act together for the relief of nasal and sinus conditions. Such irrigating solution is not associated with serious side effects and does not sting as other concentrated solutions are prone to do. There are commercially available sinunasal irrigating preparations that are of the same composition as Ringer’s Lactate.

For more information on sinunasal irrigation and if you have persisting or worsening symptoms, please consult your doctor.

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).

Xylitol: A Sweet Solution to Control Nasal Infections

A solution of xylitol, a natural sugar-like substance, was found to be better than standard salt solution as a nasal irrigating solution for patients with repeated bouts of nose and sinus infections or chronic rhinosinusitis.  This was revealed by Dr. Lin Lin and his team of researchers in their clinical trial published in the American Journal of Otolaryngology Head and Neck Medicine and Surgery in 2017.

Dr. Lin found that patients treated for 30 days with xylitol had significantly better outcomes and symptom control than those treated with standard salt solution.  Xylitol, once considered only for sugar-free candies, could now be considered as a means to effectively irrigate the sinunasal cavities and manage nasal infections.1

What is Xylitol?

Xylitol is a naturally-occurring sugar-like compound.  It got its name from the Ancient Greek xylon meaning wood since it was first extracted from beech trees.2

Although xylitol has a similar degree of sweetness to table sugar, it is low on calories and even proven to be protective against dental cavities.  Xylitol is poorly metabolized by the body – roughly 60% of the calorie yield of table sugar, hence its appeal as a low-calorie sweetener for weight management.  These benefits have made xylitol a widely used sugar substitute.3

Xylitol Supports the Salt-sensitive Immune Defense of the Nose

Clues to the potential benefits of xylitol for the nose emerged with the broader understanding of how the nose typically protects itself from infections.  The cells of the nose were found to be capable of naturally producing antimicrobial compounds like lysozymes and lactoferrins that act to kill the infection-causing germs trapped in the mucus layering the nose.

However, it was discovered that these natural antimicrobial compounds are sensitive to the levels of salts in mucus.  The higher the salt content of mucus, the lower the activity of these antimicrobial compounds becomes, making the body susceptible to infections.  It was also found that the problem of highly salted mucus is more pronounced in cases associated with thickened mucus that results from irritation and inflammation of the nasal passages.  In addressing these concerns, the potential of xylitol was recognized by researchers. 

As determined in 2000 by researchers from the University of Iowa and the Washington University led by Dr. Joseph Zabner, xylitol has some properties that allow it to decrease the salt concentration of mucus and enhance the natural antimicrobial defense of the nasal lining. One, xylitol can act as an osmolyte, an agent that can hold water in a solution, which in effect will prevent the mucus from becoming too thick and concentrated with salt.  Xylitol is also absorbed by the body for several hours allowing it to maintain the water in mucus for a longer period of time.  Two, xylitol maintains the bacterial killing action of the antimicrobial compounds found in nasal secretions in contrast to salt.  This was further supported by the finding that bacterial counts in the noses of healthy volunteers were significantly lowered by xylitol sprays compared to salt solution.  Three, xylitol, although similar to sugar, will not support bacterial growth because it is poorly utilized by bacteria.4

Xylitol May Also Make Bacteria Less Resistant

Some infection-causing bacteria are able to avoid harm by forming biofilms.  Biofilms are a collection of bacteria clumped together in their own secretion of a slimy and sticky organic material.  A common example of biofilm is dental plaque.  Inside biofilms, bacteria are protected from harmful environmental factors such as dehydration, chemicals, the body’s immune system and even antibiotics.  Biofilm formation is a major issue in bacterial resistance particularly for repeated nasal and sinus infections.  Fortunately, Xylitol has also been identified as one of the compounds that has potential in managing bacterial biofilms.  Dr. Ravi Jain and his team of researchers from the University of Auckland in 2016 showed that Xylitol effectively works against biofilms by inhibiting its formation and by disrupting the established biofilms of the usual bacteria implicated for chronic rhinosinusitis.5

Is Xylitol Safe?

The safety of xylitol can be attested by its long history of being used as a sugar substitute even in children’s chewing gum.  The US FDA classifies xylitol as GRAS (Generally Recognized as Safe).  Even at high dosages of 45 g per day in children or 100 g per day in adults, the primary concern is only diarrhea.  Clinical trials using xylitol in irrigating solutions found it well tolerated among patients without dangerous effects.6

While xylitol started out as a sweet substitute for the calorie-conscious, it is now emerging as a viable option in the management of nasal infections.  Our increasing understanding of the different factors that determine the ability of our nose to combat infections has allowed us to explore for unique solutions and in this case, the solution may be actually be sweet in the form of xylitol.

References:



Lin L, Tang X, Wei J, Dai F, Sun G. Xylitol Nasal Irrigation in the Treatment of Chronic Rhinosinusitis. Am J Otolaryngol.

Zacharis C. Sweeteners and Sugar Alternatives in Food Technology. 2nd ed. John Wiley & Sons;

Salli K, Lehtinen MJ, Tiihonen K, Ouwehand AC. Xylitol’s Health Benefits Beyond Dental Health: A Comprehensive Review. Nutrients.

Zabner J, Seiler MP, Launspach JL, et al. The Osmolyte Xylitol Reduces the Salt Concentration of Airway Surface Liquid and May Enhance Bacterial Killing. Proc Natl Acad Sci U S A.

Jain R, Lee T, Hardcastle T, Biswas K, Radcliff F, Douglas R. The in Vitro Effect of Xylitol on Chronic Rhinosinusitis Biofilms. Rhinology.

National Center for Biotechnology Information. PubChem Database. Xylitol, CID=6912.