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Keeping
Your Nose Clean Okay.
So your daily attempt at perfection already includes brushing and
flossing, exercising, meditating, eating fruits and veggies, and
overall clean, healthy living. Here’s one more health habit you
might consider. (Or not.) In
lay terms, i It’s
a simple, low tech way to wash out the viruses, bacteria, mold,
allergens, dust, mucus and general crud that lands inside the nose
and sinus passages, thereby contributing to colds, chronic nasal
congestion, post nasal drip, frequent sinus infections, asthma and
other respiratory ills. The
basic idea, unappealing as it sounds, is to squirt a slightly
salty water solution up your nose, let it drip out, blow your nose
gently, then repeat. The mechanical action of flushing out
thickened mucus cleanses the nasal passages, making it easier for
tiny hair-like cilia that line the nose to push the remaining
mucus out. Before
we get to the bewildering array of products out there for the
nasally challenged, take it from a reluctant connoisseur of this
somewhat arcane practice: No matter what product you use,
technique matters. Squirt
the solution up your nose with too much force and it hurts. Squirt
too gently and you’re not accomplishing a thing.
If the solution is too salty, it stings. Ditto, if it’s
not salty enough. That
said, here’s the case for indulging in this weirdness. For one
thing, it’s been around in many cultures for centuries. For
another, ear, nose and throat specialists swear by it for anyone
with chronic sinus problems - even kids. “Many
patients that have sinus disease, allergies or chronic infections
are improved tremendously by lavaging their nose out once or twice
a day,” says Dr. Gerald Berke, chief of head and neck surgery at
the University of California, Los Angeles. And for those who have
had surgery to open up narrowed sinuses, regular lavage is a must.
“The main improvement they experience is the ability to lavage
out the cavity,” says Berke. Even
if antibacterial medications are added to the lavage solution,
“most of the benefit is from the mechanical rinsing of the nasal
cavity,” says Dr. Eric Holbrook, an otolaryngologist at the
Massachusetts Eye and Ear Infirmary. Among other things, the gunk
you rinse out in mucus includes natural chemicals called
cytokines, which promote inflammation. “If you remove the mucus,
you can actually reduce the inflammation,” Holbrook says. “I
am a strong believer in nasal lavage,” adds Dr. Ralph Metson,
another sinus specialist at Mass Eye and Ear. But people need to
do it with salty water “to wash out mucus.” While
large, controlled studies of nasal lavage for treating and
preventing colds and sinus infections are hard to come by, the
little data that does exist seems to support the practice. One
study of more than 200 patients published in 2000 in the journal
Laryngoscope found that after three to six weeks of nasal
irrigation, patients reported statistically fewer nasal symptoms.
A 1997 study of 21 volunteers in the same journal found that
lavage improved the speed with which nasal cilia were able to move
mucus along. A 1998
study in children published in the Journal of Allergy and Clinical
Immunology showed that lavage is “tolerable, inexpensive and
effective.” So,
how to do it. First, the recipe.
To make an isotonic solution (the same saltiness as body
fluids), add to eight ounces of water one-quarter teaspoon of salt
and one-quarter teaspoon of baking soda. (The baking soda keeps it
from stinging.) To make a hypertonic solution, use more salt. The
simplest, albeit messiest, way to get the solution up your nose is
to cup it in your hand and sniff, although this lacks a certain
elegance. Ceramic Neti pots, popular among the yoga set, work
better, although you may not get the water up high enough. Those
blue bulb syringes for cleaning out babies’ ears and noses work,
too, though, again, it can be hard to get the solution up high
enough. Turkey basters and flower pots with nostril-sized spouts
are also said to work, although this could not be confirmed.
(Well, it could have been, but it wasn’t.) Small,
3-ounce squeeze bottles of pre-packaged saline nasal spray
available at most drugstores don’t really flush out the sinuses;
they just moisten the inside of the nostrils. Nebulizers
also deliver a spray, not a real jet of water , but they work well
for kids, says Dr. Sandra Lin, an otolaryngologist at Johns
Hopkins School of Medicine, who says she has “seen patients
really turn around” on nasal lavage. Larger
squeeze bottles such as the 14-ounce ones made by SaltAire Sinus
Relief get the cleaning solution higher up into the sinuses. This
system, developed by Drs. Robert Pincus and Scott Gold,
co-directors of the New York Sinus Center, is indeed, just as they
claim, easy to use and the buffered hypertonic solution does not
sting. (Buffering means the acidity of the solution is adjusted so
that it is close to that of the body.) The SaltAire product costs
$12.50. Dr.
Ketan Mehta, a pulmonologist and intensive care specialist based
in Santa Rosa, CA, has developed a different lavage system called
“Sinus Rinse,” made by his company, NeilMed Products, Inc. For
$10.95, you get an 8-ounce squeeze bottle with a gently-pointed
tip and 50 packets of pre-mixed solution to which you add eight
ounces of water. The NeilMed product can also be hooked up to a
Waterpik or similar system that is electrically powered and
delivers pulses of solution. The
Waterpik Technologies folks, who make oral irrigation
devices that squirt water around the teeth under the gums, also
have their own attachment called Gentle Sinus Rinse. The Waterpik
irrigators cost from $35 to $50 depending on the model, with an
extra $10 to $15 for the sinus adapter. Other
nasal hygiene products are becoming increasingly available on the
Net and in stores. Yeah, it sounds weird. But you just might end
up with one of the true blessings in life – clear sinuses. Judy
Foreman is a Lecturer on Medicine at Harvard Medical School. Her
column appears every other week. Past columns are available on www.myhealthsense.com.
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