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Steven Y Park, MD  
Male, 47
New York, NY

Specialties: Sleep-breathing disorders

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Long-term Nasal Saline Irrigation: Helpful or Harmful?

Nov 20, 2009 - 11 comments
Tags:

nasal saline irrigation

,

chronic sinusitis

,

afrin



For many people with obstructive sleep apnea, nasal congestion and chronic sinus infections are a common problem. Nasal irrigation with saline is a natural way of clearing nasal and sinus passageways. The Neti-Pot is a yogic variation of saline irrigation that became much more popular after Oprah's recommendation. Many of my patients that have tried this method report good results, with better breathing and less sinus pressure and headaches.

A recent study showed that contrary to popular belief, irrigating the nose on a daily basis over a long-tern period may actually make things worse. Researchers studied 68 people who used nasal saline irrigation every day for one year. In those that stopped after one year, 62% had a significant drop-off in the number of infections, compared with those that continued irrigating their noses.

The authors of the study proposed that the likely reason for this finding is that frequent irrigation depletes nasal mucous, which contains several important defense mechanisms, including antibodies, lactoferrin, and lysozyme. It's also known that the nose produces nitric oxide, which also has antimicrobial properties.

These results are a bit conflicting with what many of my patients report, but there may be some good reasons to follow their recommendations. Besides the reasons mentioned above, saline acts as a mild decongestant, which is similar to the over-the-counter decongestant, Afrin, but not as strong. This is why you can breathe better after irrigation. One of the reasons why you can't use Afrin for more than 3 days is because of the rebound effect, where after the medicine wears off, your nose gets stuffy again, making you use it more and more frequently. Nasal saline, although not as bad as Afrin, also has a mild rebound effect. This is why some people use it 2 to 4 times every day.

It's also been shown that if the salt concentration is a bit saltier than your nasal membranes' concentration, the cilia that help to move the mucous blanket down into your throat become paralyzed.

If used for short-term periods, such as during an acute sinus infection, it can be useful (just like Afrin), but this study's result shows that long-term use may be more harmful.

My feeling is that if you feel better and you don't get as many infections, keep doing it. After a few weeks or months, you can experiment by stopping the irrigation and see what happens.

Since this study didn't look at cultures or x-rays, there's no proof that these were true bacterial infections. Recent studies also show that the vast majority of what may feel like sinus infections are actually a variation of a migraine headache. Furthermore, it's been shown that nasal saline doesn't really go into your sinus passageways. It works by decongesting your nasal passageways, which indirectly opens the passageways to your sinuses.

Do you irrigate your nose with nasal saline every day? If so, for how long? Are you having less sinus "infections" as a result of irrigating on a regular basis?

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by Tammy2009, Nov 20, 2009
I used nasal rinse system (the squirt bottle from neil-med) for roughly 6 months twice a day.  Once I stopped getting "stuff" out I stopped the rinsing to once or every other day.  

There was roughly about 2 months that I didn't rinse at all because it wasn't helping at all.  I started again when I felt that I was getting sick and seriously was getting 1/2 cup of green slime out of my nose 2-4 times a day for 4 days.  And that was my last cold .... 8 months ago.  So, I only have the one example.  :)

I haven't rinsed for the last 3 months or so because recently all it was doing was putting pressure back into my ear on one side.  Thus, it is not comfortable and I can tell that some of the rinse isn't coming out (I only get a trick coming out) and I don't like the idea of the saline sitting in my sinuses/nasal passage.  However, I have an ENT appointment in a month and a half because according to my GP it might be nasal polyps (lots of fun -rolls eyes-).

The nasal rinsing helped my allergies A LOT and I love it, even when it gives me ~20 minutes of bad congestion right away and then goes away.

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by ENTMD, Nov 20, 2009
Could you provide the citation for the reference discussed in your post?

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by Steven Y Park, MDBlank, Nov 21, 2009
Here's the citation: http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870

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by ENTMD, Nov 21, 2009
Well I agree with you that this comes as something of a surprise.  I remain rather skeptical - have never heard patients report this phenomenon.  But this is only an abstract -- I will be anxious to see the actual paper before I make too much of it.

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by Fluffysmom, Nov 21, 2009
I've used both a neti pot and the neil-med bottle.  I have had several sinus infections, and find that if I use nasal irrigation, I don't get as many. I do slack forget to use it, so I do take breaks. I wonder if my normally thick nasal secretions have anything to do with my getting sinus infections?

This summer, I hadn't been using nasal irrigation, and got a sinus infection.  I tried for over a month to clear it out; it would seem better, then get worse.  I finally went to the doctor when I started having bad pain in my neck that settled around the base of my throat and my upper chest.  I was given a Z-pack and told to take plain mucinex, since I had come crackles in my right lung.  The Dr. didn't think my throat/upper chest pain was related, and it did respond to Tegretol.  

Anyway, I can't help but wonder if the neil-med squeeze bottle is not as good; maybe more difficult to clean completely.  

I like my neti pot, especially during the spring and summer when pollen is abundant.  I try to make it a part of my bedtime routine, and seem to have fewer episodes of thick yellow nasal secretions with sinus pain.  

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by FolkMusic, Nov 30, 2009
I found the recent study cited above very interesting, as I have irrigated for years and found it helpful, but lately it seems to not be preventing sinus problems as it previously was.  Have you heard of the following procedure and what do you think of it?  I tried it on a maxillary sinus infection that I'd had for 2 weeks and it seemed to clear it up.  

SINUS FLOODING
Perform this procedure with a true colloidal silver only. Do not use silver protein products. Silver protein products can cause a serious infection if used in the sinuses.

Add one-eigth teaspoon Xylitol to one ounce of colloidal silver to make the rinse solution. Xylitol is available in most health food stores. For additional comfort warm the rinse solution to slightly above body temperature or approximately 100 degrees F. This solution may also be used with a sinus irrigator to flush out the sinus cavities if a sinus irrigator is available.

The Sinus Flooding Procedure:

a. Lay on a bed face up with the head hanging over the edge of the mattress so the nostrils are pointing straight up toward the ceiling.

b. Use an eye dropper to fill each nostril with the rinse solution. Keep filling each nostril until the rinse solution starts to drip in the throat, indicating the sinus cavities are filled. Remain in the same position for 2 to 3 minutes.

c. Roll over on the stomach and let the head flop forward over the edge of the mattress. This allows the rinse solution to flow into the forward sinus cavities. Remain in that position for 2 to 3 minutes then sit up and let the rinse drain out through the nose.

d. Important: Repeat this procedure 45 minutes later. The two rinses 45 minutes apart constitute a single rinse session. Perform two or more such rinse sessions per day. Relief will typically be noticeable by the second day. It is not unusual for the sinus infection to be gone within three days.

e. Repeat two sessions per day until the infection subsides. Very persistent infections may require five to seven day or more.

Nasal spray: Mesosilver can be used in a nasal spray type bottle and sprayed directly in the nose as an adjunct to the sinus flooding procedure. No Xylitol is needed when using a nasal spray bottle. This method can be used several times throughout the day to improve the healing benefits. This is especially convenient and transportable.


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by momteacher3, Dec 17, 2009
I would like to hear the doctor's opinion on this procedure before trying it.

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by Steven Y Park, MDBlank, Dec 17, 2009
Foklmusic,

If it works for you, then keep doing it. I don't have any experience with the ingredients that years of mentioned, whether in terms of efficacy or safety. However, it's doubtful that the wash is actually going into the sinus cavities proper. It's been shown that vigorous irrigation fluids never go into the sinuses. Rather, it decongests and shrinks the nasal mucous membranes, helping to open up very thin sinus passageways.

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by saltyseadog, Dec 23, 2009
Saltyseadog, Hartlepool, England.
I am in the UK and started using a neti pot about two months ago. I use a saline solution of 1tsp of Bicarb + 2tsps of sea salt in 1200ml of lukewarm water. This gives me 4 + 300ml cleanses ie two in each nostril. I started doing this as since being diagnosed with GERD I have a terrible problem with mucus in my nose and throat due to the acid especially at night. I have tried almost everything for it from medicinal to raising the head of the bed etc etc. I find that the nasal irrigation gives me more relief than anything I have previously tried. I do it twice daily once in the morning and again last thing at night. The feeling of being able to breathe properly again is great. It has also helped my pet allergy symptoms and another thing I have noticed is that at 60 I had developed a "problem" if you like with excessive nasal hair growth which has really eased up since starting nasal irrigation. I had wondered over the possible long term effects which is why I found this page but weighing up the pros and cons of my case I will just keep on doing it.

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by AlmackHouse, Mar 31, 2010
I have known about nasal irrigation for about ten years.

I first started buying bottles of saline solution to irrigate my sinus passages whenever I would have a cold or a bout of bronchitis.  However, at that time, I didn't know that this practice on a daily basis is good for preventative reasons.  Also, I've been plagued with night time headaches for over a decade.  They wake me out of a sound sleep.  I've had MRIs and a cat scan and was, eventually, diagnosed by a neurologist with migraines.  I am not a candidate for hormonal therapy so the doctor told me there was nothing I could do to prevent the migraines.  So I take Excedrin for Migraines which offered some relief but, obviously, was not a cure.  

For the past year I have been using a neti pot (dishwasher safe) more and more frequently because my colds, and bouts of bronchitis, are occurring more increasing regularity.  I read about a condition called Chronic Sinusitis and it seemed to fit with what I have been experiencing.  The neti pot really did help when I used it on a daily basis, but I began to have vertigo which I came to associate with the frequent use of the neti pot;  just never could get the water out of the pot and into my nose without tilting my head to the side a bit.  So when the vertigo would start up, I would stop with the nasal irrigation, and then the headaches, colds, sore throats, etc., would come back.  

Earlier this month, I decided to give the nasal irrigation one last shot before going into the doctor who I knew would prescribe the usual, antibiotics.  This time, however, I made the decision to order one of the irrigation machines.  I had purchased the Hydro Med irrigator a few years back but only used it whenever I was sick, and since it only lasted about a year, I was not inclined to invest another $100.  But since the cost to visit the doctor and  purchase the prescription is about the same, I justified it and placed the order with the intent, this time, to use it on a daily basis.  

It's been almost three weeks now.  And, despite the fact that allergy season is well underway here in Virginia,  my sore throat has gone away, my ear is no longer aching, my vertigo is clearing up, the green stuff is no longer coming out of my nose, and, best of all, no night time headache.  

I'm not sure if you want this information, but I purchased the Sanvic irrigator for the family, and bought a six month supply of their premeasured saline powder packets.  While I've been sick I have prepared the hyper-tonic solution, but now that I'm feeling better I thought I would try to cut back to the isotonic strength.  Also, I've been using the irrigator twice a day.  Actually, there have been a few days that I have used it three times, but that is because my husband and I have been cleaning out the garage and I thought it best to do a wash after coming in from a less than ideal environment.

Here is some added information on an unrelated topic.  I don't know much about the condition known as Sleep Apnea, but a family member who is a heavy snorer took part in a sleep study and now uses a breathing apparatus that she says does wonders for her.  And she says that as long as she wears the apparatus while sleeping she no longer has sleep apnea.  My husband is a heavy snorer.  Listening to him snore can really put a damper on getting a good night's sleep.  Since my husband has started doing the sinus irrigation, too, he no longer snores.  Wow.  All without having to wear a breathing apparatus.  I tried to tell the family member about this method, but she is firmly attached to her machine.  

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by cthtexas, Jun 08, 2011
I have also irrigated for over 10 years for sinus infections/nasal congestion and yes it helped alot. However, i developed positional vertigo and after some time continual vertigo (though slight, the sensation you get when you have been in the waves at the beach all day and then get out and you still feel like you are getting rocked by the waves) that lasted for a year.  I went to the doctor for it and it was assumed it was benign positional and "don't sleep on your stomach".  I noticed that the bengign positional vertigo became much worse after irrigating my nasal passages and i was still having the everyday dizziness so I stopped irrigating.  Slowly but surely the daily dizziness went away and then the benign position vertigo slowed and now has seemed to stop for the most part. Been weeks since I've awakened with the spinning censation.  So caution if you do this.

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