Saline Nasal Irrigation - Review of indications and adverse effects

From a 2009 review in the AFP and Medscape:

Saline nasal irrigation bathes the nasal cavity with liquid or spray by instilling saline into 1 nostril and allowing it to drain out of the other nostril (typically, it drains from both nostrils and the mouth - author's note).

Techniques and devices

Techniques and devices include:

- low positive pressure from a spray or squirt bottle
- gravity-based pressure using a neti pot or other vessel with a nasal spout



Mayo Clinic: What can you do about that runny nose and nasal congestion? Medications are one option, but so is nasal cleansing.



Treatment Options for Allergic Rhinitis (click to enlarge the image).

Solution concentration

0.9% (normal saline) to 3% (hypertonic) saline solutions are used. Optimal salinity (solution concentration), pH, and temperature are unknown.

Nasal irrigation may be helpful to manage symptoms of chronic rhinosinusitis (symptoms for more than 12 weeks) and this is the most common indication.

In one study, daily use of 2% liquid (not spray) was associated with a 64% reduction in symptom severity vs routine care alone.

Indications

A range of conditions may respond to saline nasal irrigation but the evidence supporting its use is less conclusive:

- allergic rhinitis
- acute upper respiratory tract infections (URTI)
- rhinitis of pregnancy
- acute rhinosinusitis

The exact mechanism of action of saline nasal irrigation is unknown. Saline nasal irrigation may improve nasal mucosa function through direct cleansing; removal of inflammatory mediators, and improved mucociliary function, as suggested by increased ciliary beat frequency.

Adverse effects

Fewer than 10% of patients reported adverse effects:

- self-limited sensation of ear fullness
- "stinging" of the nasal mucosa
- rarely epistaxis
- case reports of fatal amoeba meningitis in patients who used tap water for the rinses. Read more here: Is Rinsing Your Sinuses Safe? FDA replies: http://goo.gl/XL5bJ. Louisiana Department of Health and Hospitals warned against improper use following the deaths of two people who were infected with Naegleria fowleri after using tap water to irrigate their sinuses.

Contraindications

Contraindications for saline nasal irrigation include:

- incompletely healed facial trauma
- increased risk for aspiration, such as intention tremor or other neurologic or musculoskeletal problems.

Recommendations

- For chronic rhinosinusitis, nasal irrigation is an effective adjunctive therapy (level of evidence, A).

- Limited evidence for effective adjunctive treatment of irritant or allergic rhinitis, viral upper respiratory tract infection, and postoperative care after endoscopic sinus surgery (level of evidence, B).

- rhinitis of pregnancy, acute rhinosinusitis, sinonasal sarcoidosis, and Wegener's granulomatosis (level of evidence, C).


SinusRinse video.

 References:

Use of Saline Nasal Irrigation Reviewed. Laurie Barclay, MD. Medscape, 2009.
Saline Nasal Irrigation for Upper Respiratory Conditions. Am Fam Physician. 2009 November 15; 80(10): 1117–1119 (PDF).
Nasal Irrigation as part of daily hygiene routine? "They brush their teeth, they wash their face, they rinse their nose" http://goo.gl/F0N11 Neti Pot, Nasal Irrigation - Pros and Cons and Slideshow. WebMD, 2011.
Is Rinsing Your Sinuses Safe? FDA replies: http://goo.gl/XL5bJ