Nasal Treatment

Nasal irrigation, nasal spray or nasal nebulizer

The process of keeping the nose clean, moist and to deliver appropriate medication or treatments.

Nasal steroids

There are many to chose from. Flonase, Rhinocort, Nasonex avaialable by prescription. Nasocort is now available over the counter without a prescription. These are medications important in reducing inflammation and irriation of the nasal and sinus linings.  Particularly important in those patients with environmental allergies.

Proper use of nasal steroids involves the cross handed technique. Most people are right handed and do a good job delivering to the left side of the nose. Unfortunately when spraying the right nostril with the right hand most patients hit the septum or the middle of the nose. This leads to irritation and eventually bleeding in the area. This is best avoided by spraying the left nostril with the right hand aiming at the left corner of the eye and then switching to the left hand for the right nostril aiming at the corner of the right eye.

The process of actually rinsing out the nasal and sinus passages is probably more important that what you rinse with. The following options are available. Rinsing the nose helps keep the nose moist, clean and removes irritants or allergens. It is especially important in the post operative period while the mucosa is recovering to keep it moist and clean while it heals.

Despite many of the directions that you will read elsewhere it is not important for the nasal irrigation to run out the back of your nose or from on side to the other.  It is more important that flushes in under low pressure and is allowed to drain back out. My personal technique is to lean over the sink flush it in and let it flow out.

What about salt water? Why salt water?

The reason to use salt water is to avoid irritation of the nasal mucosa (lining). Plain water tends to draw salts out of the nasal lining leaving it more irritated. Properly balanced with salt nasal irrigation should be soothing not burning.

Which water? Which salt?

The best water to use is clean water. To this end I reccomend that my patients use a clean water source. Really any water that is bottled is clean enough to use in your nose. This would include distilled water, purified water, drinking water or if you have a submicron filter such as a fresh Brita filter that too can work.

How about salt?

The right quantity is more important than the right kind. Too much and it will irritate and too little and it will burn. It is about 1/2 teaspoon in 8 ounces which is the size of a NeilMed irrigation bottle. Some people like a little more or less. Doubling the recipe makes it hypertonic which can help when the nose is congested or runny. The solution can be buffered by adding a large pinch of baking soda.

Which salt?

We cook with a lot of sea salt. It is great for cooking and adds flavor and additional texture. Our favorite is Aztec Sea Salt. It is a naturally harvested sea salt with lots of flavor and extra trace elements. You can find it at saltrevolution.com. Unfortunately it is a horrible salt for your nasal irrigation. For your nose you want the cleanest salt possible that goes into solution the easiest. That would be pickling salt. It is very cheap and available at any grocery store. The other option is to use the packets that made by Neilmed for the nasal irrigation system. These are very convenient and premeasured and buffered to be just right for the Neilmed irrigation bottle. Available at almost any pharmacy.

Irrigation bottle, Netipot or the Sinugator?

Irrigation bottle is the clear winner. It is the easiest system for anyone to master with the least amount of effort and the fastest time to use. The Netipot requires a certain amount of neck flexibility to properly irrigate the nose (here is a link if you wish to try). The Sinugator is the power washer of nasal irrigation. If you need this for your nose I will let you know. It does have some advantages in that it can be kept clean by running it through the dishwasher once a week. The pressure is fairly high and it takes an imperfect seal to keep from over filling and over pressurizing your nose.

Antibacterial irrigations

Bactroban ointment is a water soluble substance, which can be readily dissolved in saline. Typically we use 22 grams of 2% ointment in one liter of normal saline (1 1/2 to 2 inches of ointment in a Neilmed rinse kit) and have patients irrigate for four to six weeks as needed. This takes a bit of coaxing to go into solution, you either have to shake the solution vigorously or warm the saline solution in the microwave first. Make sure you shake well before using.

Antifungal irrigations

The antifungals are expensive and usually more effective as a nasal nebulizer.

Ponaris Nasal Emollient

This cold season reach for all-natural Ponaris to relieve your stuffy, congested nose, postnasal drip, and nasal dryness, just as folks have done since 1931.

Once standard in NASA’s medical space kit, this effective formula contains oils of pine, eucalyptus, peppermint, cajeput, and cottonseed. Just a half dropper into each nostril is all it takes to get the job done.

Ponaris is a compound of carefully selected mucosal lubricating and moisturizing botanical oils, specially treated through the exclusive J-R iodization process since 1931.

Adjunctive topical nasal measures

Other rinses with moisturizing properties exist, such as:

  • Blairex, Nose Better, Ponaris, Pretz-d, Nasal Moist, and Rhinaris are all moisturizing sprays
  • Entertainer’s Secret spray is a special formulation used as a throat spray that some have used as a nasal moisturizer
  • Capsaicin is the agent which makes hot pepppers hot, and can help open up the nasal and sinus passages as well as stimulate the secretion of mucous (available as a pre-made spray)
  • Singulair (two 10mg tabs dissolved in 4 oz of enhanced nasal moisturizer solution) sprayed in the nose has been advocated by the University of Pennsylvania.
  • Sinofresh is one which contains glycerin and also posesses antibiotic and antifungal properties
  • UPENN has also recommended dissolving Benadryl (50mg tabs in 4 oz of saline) in saline and rinsing the nose three times a day
  • Lactated ringers is a commonly used intravenous fluid solution, which some feel is less toxic to the nasal mucosa than saline
  • Johnsons Baby Shampoo. Biofilms are essentially thick tenacious snot that protects bacteria and fungi from the effects of antimicrobials and irrigants. It has been hypothesized that the use of 1% Johnsons baby shampoo (1/2 tsp in 1 NeilMed Sinus Rinse bottle bid) helps emulsify the biofilms and allows for irrigation and removal of the offending organisms. It is essentially a detergent or surfactant that allows for the dissolution of the thick ropy mucous and crusting.
  • Pulmicort Respules 0.5mg/2cc in 250cc saline.  This is a prescription item used in cases of recalcitant nasal polyposis.  (irrigate each nostril with 125 ml twice daily)
  • Betadine 1/2 teaspoon in a Neilmed bottle 8 ounces
  • White vinegar is 3 teaspoons in Neilmed bottle 8 ounces
  • Acetic Acid 1 oz in 16 oz of NS
  • Lasix IV in NS has been reported to diminish polyps
  • X clear is a moisturizing nasal spray. Instead of salt it uses an artificial sugar Xylotol. The advantage is that bacteria and fungus cannot use the artificial sugar to feed on. Xylotol can be purchased in the pure form and used in place of sugar in irrigation. Prepackaged in by Xclear or buy the artificial sweetener and make your own.

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