Talk:Nasal irrigation

Amount of salt in isotonic saline

An isotonic saline solution can be made by adding 0.9 gram of salt to one litre of lukewarm (i.e. around body temperature) water.

This is dubious. Other sources online suggest that the proper amount of salt in an isotonic saline solution is 0.9%, not 0.9 grams per litre which is equal to 0.09%. It is also given as if it is quoted from somewhere but no source is provided. -- B.D.Mills  (T, C) 05:42, 30 December 2008 (UTC)

B.D.Mills is correct. To be precise, a 0.9% by weight solution of NaCl in water is isotonic (has the same osmotic pressure of water)as human blood plasma and the contents of red blood cells. See Medline Plus Medical Encyclopedia, http://www.nlm.nih.gov/medlineplus/ency/article/003463.htm "Normal values range from 280 to 303 milliosmoles per kilogram." and WebMD, http://www.webmd.com/a-to-z-guides/serum-osmolality?page=2 "280–300 milliosmoles per kilogram (mOSm/kg) of water". By calculation, a 0.9% by weight solution has 9 g NaCl per 1000 grams of solution = 9.08 g NaCl per 1000 g of water = 0.155 moles of NaCl per kg of water. Assuming NaCl is fully disassociated in water, this results in 0.310 osmoles/kg of water. The CRC Handbook of Chemistry and Physics, 60th Edition (1979), CRC Press, page D-261 gives the osmolality of a 0.9% NaCl solution as 0.287 osmoles/kg. Barton A. Smith (talk) 23:55, 1 January 2009 (UTC)

Y I have amended the article accordingly. Colonel Warden (talk) 00:32, 2 January 2009 (UTC)

The current instructions for an isotonic solution say that 1 tsp salt per pint is isotonic and 1 tsp salt plus 1 tsp baking soda per pint is also isotonic. Can this be right? Is the molarity of baking soda so much less? —Preceding unsigned comment added by 130.225.2.143 (talk) 10:40, 6 November 2009 (UTC)

I recently came here to find the recommended solution after having a very good experience with a commercial product. 1 tsp each of salt and baking soda per pint of water was significantly stronger than the commercial solution. So while the info about how to create an isotonic solution may be accurate, it may be useful to #1 confirm as 130.225.2.143 stated above that the addition of baking soda does not require a reduction in salt to remain isotonic, and #2 to offer a range of typical solution strengths so that people can start on the weak end and adjust upward as needed. HumanJHawkins (talk) 01:27, 20 May 2010 (UTC)

I too have noticed that the measurement of salt/soda seems to be misleading. The article specifies 1 teaspoon of salt and 1 teaspoon of baking soda, yet the reference (19) [1] specifies two to three heaped teaspoons of salt and one teaspoon of baking soda. 2-3:1 ratio appears a lot close to the commercial products from my experience, and agrees with the professional advise that I had as well. --SteveLang (talk) 11:23, 1 July 2010 (UTC)

Does anybody have any objections to converting the recipe of home-made solution to metric? Aside from being the international standard, I don't have a good feel for how much something is in US units. You could tell me to add 100 teaspoons to a gallon and I wouldn't have a clue. Rknight (talk) 02:54, 13 April 2011 (UTC)

Gramma RKnight's homemade booger wash

• Pure Salt
  • Isotonic 0.9% Rinse Pure Salt requires 9 grams NaCl per 1 L of water. (3.54g of Na+)
  • Hypertonic 3% Rinse Pure Salt requires 30 grams of NaCl per 1 L of water. (11.8g of Na+)
• Pure Baking Soda
  • Isotonic 1.3% Rinse Pure Baking Soda (Sodium bicarbonate) requires 13 grams NaHCO3 in 1 L of water. (3.56g of Na+)
  • Hypertonic 4.2% Rinse Pure Baking Soda requires 42 grams of NaHCO3 in 1 L of water. (11.5g of Na+)
• Mixture as above
  • Isotonic mixture 7 grams NaCl and 3 grams NaHCO3 in 1 L of water. (3.57g of Na+)
  • Hypertonic mixture 23 grams NaCl and 10 grams NaHCO3in 1 L of water. (11.79g of Na+)
    • Alternate hypertonic mixture since HCO3 is such a good buffer: 27 grams of NaCl and 4 grams of NaHCO3. (11.69g of Na+)

Anyone care to check my math? Rknight (talk) 23:26, 14 April 2011 (UTC)

You want you ask this sort of questions at Wikipedia:Reference_desk (just choose the topic that looks more appropriate to reach one of the desks). Talk pages of articles are mostly for discussing changes to articles. --Enric Naval (talk) 01:45, 15 April 2011 (UTC)

I'm actually having second thoughts; this is probably treading a bit over the line of how-to. I think an example recipe is probably ok; but certainly not "these are recipes you can use!" Rknight (talk) 03:03, 15 April 2011 (UTC)

Paranasal sinuses

So, which of the paranasal sinuses do these techniques clear?

• maxillary sinuses
• frontal sinuses
• ethmoid sinuses
• sphenoid sinuses —Preceding unsigned comment added by 81.203.36.49 (talk) 10:37, 17 April 2009 (UTC)

This is a very good question; I will try to incorporate the answer in the article.

Brown and Graham cite the following paper: Olson DE, Rasgon BM, Hilsinger RL Jr: Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope 2002, 112:1394–1398. They say that the solution reaches ethmoidal and maxillary sinuses, but only a limited amount reaches the other two. Sprays do not reach frontal and sphenoidal sinuses at all. --Hans Adler (talk) 00:49, 9 May 2009 (UTC)

Note that some techniques involve irrigating and flooding the whole sinus cavity. The mucus is usually discharged away, and fluid also reaches into those cavities. The patient, laying on a bed with their head tilted backwards over the edge, or crouched on three points (left foot, right food and knee, and right hand) with their head pressed back against the shoulders ... uses an ear wash bulb to deposit warm saline solution into the nose.Yris (talk) 16:27, 4 June 2010 (UTC)

New Section: adverse effects

Hey yo, like any treatment, nasal irrigationisn't perfect. I found an abstract (mined it from the netti pot article, read through it and elaborated for this article), regarding long-term use and the harm this causes. Additionally, I made light of the fact that efficacy studies haven'T really been conducted on the technique. I titled this section 'contraindications and harm', I hope this is neutral enough for everyone :). Talonxpool (talk) 21:04, 14 February 2011 (UTC)

I don't know who removed the section, but the information is still included in the article. Let's keep an eye open for studies. I think that, in the interest of safety, we can list the adverse effects from any primary sources, lacking a secondary source. Does anyone feel like a new section for adverse effects is merited? Rknight (talk) 06:17, 14 April 2011 (UTC)

I removed the heading [2], and in the following edit I also removed an unsourced paragraph that speculated on an "adverse affect" (sic) of flushing while infected. I stand by my opinion that a single conference abstract is not enough to warrant an entire paragraph on adverse effects, let alone a section. (Just imagine what our articles on hand washing or other basic hygiene practices could look like...) Hans Adler 09:08, 14 April 2011 (UTC)

I wasn't complaining. We may want to consider adding a warning about contamination although elevated infection risk was found. Perhaps cleaning methods. I don't feel very strongly one way or the other about this; it's just something to keep an eye on, I think. Rknight (talk) 18:45, 14 April 2011 (UTC)

I didn't mean to sound adversarial – sorry if I did. Currently I don't have much time for this article, but my impression so far is that you are taking it in the right direction. Thanks for your efforts. Hans Adler 19:28, 14 April 2011 (UTC)

Proposal to merge Pulsatile_Nasal/Sinus_Irrigation here

I agree with the proposal by Enric Naval. It's not clear to me that pulsatile irrigation is independently notable, and from an organisational point of view it's better if it's covered by this article, anyway. (This decision could of course be revisited if and when the material on pulsatile irrigiation grows significantly.) Hans Adler 10:35, 11 March 2011 (UTC)

Agreed. Rknight (talk) 19:58, 12 April 2011 (UTC)

you guys are so misinformed there are hundreds of clinicals on the efficacy of pulsatile irrigation which is used for surgery, debridement, burn centers and many other applicaions Thank god for Google Wikipedia is irrelevant moderated by folks that have little or no expertise — Preceding unsigned comment added by 172.250.66.181 (talk) 05:32, 22 April 2016 (UTC)

Merge nasal douche to this here

I suggest we merge Nasal douche to here because it is the same thing! 96.244.254.20 (talk) 17:31, 6 April 2011 (UTC)

I agree. Nasal irrigation isn't such a huge and well documented topic that it would benefit from spreading all over the encyclopedia. If this article ever gets too big we can still split it again. Hans Adler 18:08, 6 April 2011 (UTC)

Agreed. Rknight (talk) 19:58, 12 April 2011 (UTC)

I also agree. --Rocksanddirt (talk) 20:27, 13 September 2011 (UTC)

Neti_Pot Merge Proposal

I think most of the info in Neti_Pot is already here. It looks like the term Neti Pot is trademarked, so a redirect here would be more appropriate. Rknight (talk) 19:58, 12 April 2011 (UTC)

I agree. But note that I had previously merged the article elsewhere and it was reverted. Let's give it some time in case someone disagrees. Hans Adler 20:19, 12 April 2011 (UTC)

Agreed. The subject does not require its own article. Imagine Reason (talk) 00:53, 4 July 2011 (UTC)

looks like a good idea VikÞor | Talk 02:42, 14 October 2011 (UTC)

Merge it. Undo the split mentioned by Adler. Also, "Neti Pot" is not trademarked, at least not in the US. — Preceding unsigned comment added by Andyberks (talk • contribs) 19:34, 22 October 2011 (UTC)

Origins in Methods

Someone want to tackle the yoga origins section, and remove all the unnecessary digression from the Methods section? Rknight (talk) 05:51, 13 April 2011 (UTC)

Pulsatile irrigation cleanup

Ok, I just didn't feel comfortable with this in the article. It doesn't seem to deserve its own section, and it needs some serious cleanup. Please begin a list of sources, and indicate whether they are secondary or primary as per WP:MEDRS Rknight (talk) 06:12, 14 April 2011 (UTC)

Pulsatile Nasal/Sinus Irrigation

The Pulsatile Nasal/Sinus Irrigation can be said to be the most advanced nasal irrigation method, which is based on anatomy and physiology of nasal mucociliary function and motor function (mucociliary movement). It can irrigate warm saline water into one of the nasal passage through the nasal cavity, paranasal sinuses, nasopharynx, and come out from the other nasal passage. Since it doesn’t have the strong pressure as the squeeze bottle, the water flow is gentle, so it is safe and will not cause injury or bleeding nasal mucosa. More over, the water flow pulsates at frequencies similar to that of the natural mucociliary movement, it can more effectively remove thick mucus and pus bacterial toxins. During use, your head should bend down, which from the anatomical point of view, it is easy for the water to flow into the nasal cavity from one side, around the nasopharynx and exit from the other side. It also suggests a much lower chance to flow into Eustachian tube or throat, and in turn, the patient would feel more comfortable.

One method and type of pot not represented

The "Sarvikuono" (word play on the Finnish name for Rhinoceros, literally "horn nose") style nasal irrigation pot link to fi.wikipedia image is more common than other methods featured in the article in at least Scandinavia, and the image origin lists the image to be from de.wikipedia originally. It relies on gravity and the tapering shape of the spout to produce positive pressure. The pot is sold with a measuring spoon that is proportioned to give a filled pot the correct salinity in the finished solution. I own two of them, and they are far easier to use than the current article's description makes the use of this method sound like. You tilt your head to the right and down, pour the saline solution into your left nostril, breathe through your mouth, and let the water run through and out the other nostril. Refill the pot, and repeat with the other side. Doesn't sound scientific, but would make it sound a wee tad easier to use than the current article. 98.237.196.152 (talk) 03:16, 2 July 2011 (UTC)

Solutions used for nasal irrigation

Proposed revision to the last statement:

this: Xylitol is commonly used to prevent acute otitis media in Europe and dental caries in the United States,[23] but research into xylitol use in the sinus cavities is lacking.

to this: Xylitol is commonly used to prevent acute otitis media in Europe and dental caries in the United States[23]. Research into xylitol use in human sinus cavities is lacking, although a study shows xylitol efficacy against sinusitis in rabbits [3].

Note: I would edit the main page, but I know moderators would just undo my changes, so.... this either gets in there some other way or it doesn't. You decide. Anonymous — Preceding unsigned comment added by 173.164.52.242 (talk) 01:55, 20 September 2011 (UTC)

The warning to boil water should be at the top

In the first section tap water is recommended. Unboiled tap water is reportedly what caused the deaths. If people only read the first section and do what it says they could get infected. Consider moving the warning up. — Preceding unsigned comment added by 24.192.187.53 (talk) 21:48, 18 December 2011 (UTC)

I don't agree. The reported cases of infection with Naegleria fowleri which caused fatal primary amoebic meningoencephalitis (PAM) occured through the use of tap water in the State of Louisiana USA and Pakistan. Tap water in Pakistan is not suitable for drinking and thus certainly not for nasal irrigation. Tap water in Louisiana and elsewhere in the USA is normally potable, but in certain locations it has occasional impurities that on rare occasions cause disease. Infection with the protist in question is far more likely by swimming in warm bodies of fresh water, such as ponds, lakes, rivers, and hot springs. However, infection is both rare and not new. Recorded cases have occured in the United States since at least 1937. See the wikipedia article (cited above) to verify references. I think the warning can be retained in the article for those who wish reduce the rare chance of infection, but it hardly needs to be put at the top of the article. With that sort of reasoning, such a warning should be the first entry in any article on hot springs, ponds, fresh water swimming, etc. Jm3106jr (talk) 17:53, 20 January 2012 (UTC)

The most obvious question is not answered here

Is the chlorination in municipal water systems adequate to kill the amoeba that causes death?CountMacula (talk) 05:38, 1 March 2012 (UTC)

I know at least some amoeba are remarkably resistant to chemical agents due to their ability to form cysts. I'll try to find a source this weekend. — Preceding unsigned comment added by 76.181.43.60 (talk) 23:28, 2 August 2012 (UTC)

2 Deaths

This article repeats the 2 deaths so many times for no reason, It barely goes 2 paragraphs before mentioning it again, honestly 2 deaths in 80? years of usage is very low. 184.88.37.235 (talk) 15:57, 26 April 2012 (UTC)

Safety

In the section "Solutions used for nasal irrigation", I suggest that the assertion that "...can be carried out using ordinary tap water, this is not safe" either be removed or be backed up with documentation. Since the section "Nasal irrigation warning" documents that "even light chlorination will kill" Naegleria fowleri, and since ordinary tap water in every reasonably modern nation is normally treated sufficiently to kill that parasite, it seems unreasonably alarmist to claim that tap water is ordinarily "not safe". Wikipedia may as well maintain a list of people who have died from rare intestinal infections from drinking ordinary tap water. Sue D. Nymme (talk) 02:35, 11 November 2012 (UTC)

Danger of ear infection or damage

Someone added a "dubious" tag (May 2013) to a comment under Method that irrigating with excessive pressure can damage or infect the ear canal. This isn't rocket science. Blowing one's nose in such a way that exerts too much pressure can do the same thing. I have removed the "dubious" tag.

The information might be better placed under the section discussing the negative consequences of nasal irrigation, with just a note under Method that only gentle pressure is required. KC 15:58, 19 April 2016 (UTC) KC 15:58, 19 April 2016 (UTC) — Preceding unsigned comment added by Boydstra (talk • contribs)

Incorrect Sanskrit and etymological explanation

The Sanskrit word and explanation given in this article, should be netī with a long vowel, not to be confused with neti with a short vowel. Here's an online Sanskrit dictionary as a reference Note it shows the word in IAST as netī, not neti. This is a different word from the one in http://en.wiki.x.io/wiki/Neti_neti, which is formed as sandha from na + iti, but that word is the one used herein. Therefore the na + iti explanation is incorrect etymology for this term. 73.251.172.82 (talk) 19:29, 14 January 2017 (UTC)

References

Chitosan

"Chitosan is an emerging biomaterial used in the field of ENT (Otolaryngology) which shows promise in reducing inflammation after sinus surgery. Chitosan is used as a additive in nasal irrigation because of these properties."

Valentine does not mention "nasal irrigation"

The PLOS paper says "Chitosan, prepared from chitin, has been long known to be an effective hemostatic agent [13]. A novel gel has been formed by cross-linking chitosan and dextran derivatives (CD gel) for use as a hemostatic agent after nasal surgery [14]."

How does either of this support the text added to this article? Doc James (talk · contribs · email) 15:54, 25 March 2017 (UTC)

Again "Newer biopolymers such as chitosan have been studied extensively for use in the sinuses due to its anti-inflammatory, anti-bacterial and hemostatic properties. The addition of chitosan as an additive as a nasal and sinus rinse is a promising new development."

Which ref says it has been studied extensively? Doc James (talk · contribs · email) 06:09, 28 March 2017 (UTC)

• no reviews in pubmed on chitosan in nasal rinses. Massey doesn't discuss nasal irrigation as far as I have seen. There are no MEDRS sources for this nasal rinse/irrigation + chitosan stuff, that i have seen. Jytdog (talk) 08:31, 1 April 2017 (UTC)

THanks Doc James (talk · contribs · email) 15:48, 1 April 2017 (UTC)

References

Ref

Were does this ref support this text?

"CPAP usage Nasal congestion and nasal stuffiness are common reasons for CPAP failure, especially during the first several weeks of the initiation of treatment. A sinus rinse and nasal irrigation with a saline solution may be beneficial in improving outcomes as it relates to CPAP compliance."

Doc James (talk · contribs · email) 06:06, 28 March 2017 (UTC)

References

This article reads like an advertisement

The second sentence says, "The practice is reported to be beneficial with only minor side effects." Is reported by whom? Is it prescribed by doctors? Have scientific studies shown it to be effective and safe? The whole business sounds suspicious, especially in light of the recent fatality. HowardMorland (talk) 05:51, 8 December 2018 (UTC)

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Use for chronic sinusitis, article says evidence is weak

Somewhat humorously, the article says clinical guidelines indicate saline nasal irrigation for acute and chronic sinusitis, but then turns around and cites a study that says there is weak evidence for that indication. As an aside, the results/conclusions section of that study is worded in a way that would normally warrant a "There is no good clinical evidence to use nasal irrigation for chronic sinusitis" from the anti-fringe editors. However, I've found a more recent review study that does seem to think there is sufficient study to indicate its use for chronic sinusitis: [4]

List of relevant studies: [5]

MarshallKe (talk) 17:20, 24 October 2021 (UTC)