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Nasal Irrigation

Nasal Irrigation 1

When performed regularly, nasal saline irrigations have been shown to reduce inflammation by cleansing mucous and irritants (including germs, pollen, dust, etc.) from your nasal cavities and sinuses. While beneficial for any patient regardless of surgical status, they are more effective at cleansing your sinuses after sinus surgery and may be used to deliver topical medications such as steroids and antibiotics. Nasal saline irrigations with or without medications may be recommended by your physician before considering surgery, during your surgical recovery, and often as an option for long-term symptom control in more severe cases of chronic sinusitis.

Tips for using nasal saline irrigations:

  1. Always use sterile water.  Distilled water is available at most grocery stores and is the safest option.  Bottled water may suffice while traveling, but isn’t recommended long-term.  Any other water source should be boiled for at least 3 to 5 minutes and cooled to a comfortable temperature prior to using in a nasal rinse.  Saline rinses can be gently warmed in the microwave for comfort or used at room temperature.
  2. Use pre-mixed salt packets when available.  Options include NielMed, Chito-Rhino, and others that may be available in pharmacies or online.  It is possible to mix your own, and recipes generally include 2 or 3 teaspoons of non-iodized salt and ¼ to ½ teaspoons of baking soda in one liter of sterile water.  Chito-Rhino may have added benefits compared to traditional pre-mixed salt packets, particularly if other options leave your nose feeling dry or irritated.
  3. Multiple different bottles and devices are available for nasal rinsing.  Any of these should suffice if your goal is to improve mucous clearance and reduce inflammation.  However, the squeeze bottles (ex. NielMed 240mL bottle) should be utilized for the various head positions needed to deliver medications into all sinuses (more info below).  If rinses enter your ears or cause ear discomfort despite rinsing with your nose aimed at the floor and squeezing the bottle gently, this can often be avoided by using a suction-based device such as the Navage.
  4. After sinus surgery your surgeon may ask you to target specific sinuses with your rinsing to address problem areas noted on nasal endoscopy in the clinic.  For rinsing frontal sinuses (forehead area), you should sit or lean forward with your nose aimed at the floor (chin to chest).  For rinsing maxillary sinuses (in your cheeks), you should turn each cheek downward slightly while rinsing that side.  For rinsing sphenoid sinuses (in the back of the sinus cavities), you should aim your nose upward at the ceiling while rinsing.
  5. Clean your rinsing bottle or device frequently by using a bottle brush with warm water and soap, a dishwasher (if non-powered), and/or filling it partially with sterile water and microwaving for 90 seconds.  Biofilms may form over time and protect germs from these methods of cleansing.  It is recommended that any sinus rinsing bottle be replaced every 3 months.
  6. If you are adding medications to your nasal rinses, remember to add the salt packet as well or the rinse may cause burning and irritation.

The following are medications that can be ordered from a compounding pharmacy for nasal rinses.  This list is not comprehensive, but includes those used most often.

  1. Steroids: Budesonide, Mometasone, Fluticasone, Betamethasone, and more.
  2. Antibiotics: Amikacin, Azithromicin, Ciprofloxacin, Clindamycin, Doxycycline, Gentamicin, Levofloxacin, Mupirocin, Sulfamethoxazole-Trimethoprim (Bactrim, SMZ-TMP), Tobramycin, Vancomycin, and more.
  3. Antihistamines: Azelastine, Diphenhydramine (Benadryl)
  4. Mucolytic (thins mucous): Acetylcysteine
  5. Antifungals: Itraconazole, Nystatin, Amphotericin B

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