Nasal Irrigation Recommendations

[Duke Dive Medicine]

I don’t have chronic sinus and allergy issues like some folks do, but I do get a cold or the flu about once a year. As soon as I start getting symptoms, I do nasal irritation a couple times a day and it makes a big difference in how long I’m sick. I also do it for a couple weeks before a dive trip to minimize chances of equalizing issues.

For those people who struggle with sinus, allergy or equalizing challenges, I offer my nasal irritation procedure here and hope it helps someone

I use a waterpik as my device. It holds a couple of cups of water and it’s delivered under mild pressure. Amazon sells Waterpik nasal tips that create a seal in the nostrils. I have a Waterpik that I use for my teeth and a separate one for nasal irrigation because I never want tap water in the unit I use for my sinuses.

I make my own saline solution to save money. Use a clean measuring cup, fill with 2 cups of distilled water, and microwave on high for 1 minute. Add 1 teaspoon of sea salt and 1/2 teaspoon of baking soda. The baking soda cuts out about 90% of the sting in your sinuses. Mix the solution until clear.

Fill the reservoir of the Waterpik with the saline solution and make sure the flow rate is on the lowest possible setting. Lean your face forward over the sink, press the nasal tip on one nostril and switch on the Waterpik. The saline solution flows under pressure up one nostril, through the sinus area and out the other nostril into the sink. Resist the urge to swallow. When half the saline is gone, stop the flow, switch to the other nostril and start the flow again.

Once the saline is completely gone, don’t blow your nose. Let the solution “marinate” in there and just use a tissue to pat down the bottom of your nose. Sit back on the couch, breathing through your mouth for about 10 minutes. You’ll get post nasal in your throat but it’s not a big deal. You should pretty much feel normal after about 20 minutes.

Emphasis on the "distilled water" part. Use of tap water in sinus rinses has led to fatal Naegleria fowleri infections.

Best regards,
DDM

 

[Duke Dive Medicine]

I think that when you start proposing adding steroids to nasal irrigation, you're crossing the line into stupid and dangerous advice.

I would not go that far. Kindly keep it civil in the learning zone.

Best regards,
DDM

 

[The Chairman]

I have a prescription for a steroid I use in my ears... I don't know the name. But it was prescribed to me.

 

[The Chairman]

Emphasis on the "distilled water" part. Use of tap water in sinus rinses has led to fatal Naegleria fowleri infections.

Especially in Mexico.

 

[Wallowa]

I would not go that far. Kindly keep it civil in the learning zone.

Best regards,
DDM

Totally agree...keep posts respectful and tolerant of other's opinions and actions...hey, N. folwleri......while it is always a possibility, consider the odds of anyone contracting this rare disease, notwithstanding the more often than not fear of 'everything' nowadays: "According to the Centers for Disease Control and Prevention (CDC), there were 157 confirmed human cases of N. fowleri infection in the United States between 1962 and 2022. Four survived. Elsewhere in the world, the numbers are similar.".....just my view, 157 cases in a population of over 200+ million in 60 years does not rise to the level of a major health threat...of course health care providers may view it differently...

Kinda like steroid use, individual choice vs possible cost vs benefits....to each their own, but informed decisions help...

 

[chillyinCanada]

I don’t have chronic sinus and allergy issues like some folks do, but I do get a cold or the flu about once a year. As soon as I start getting symptoms, I do nasal irritation a couple times a day and it makes a big difference in how long I’m sick. I also do it for a couple weeks before a dive trip to minimize chances of equalizing issues.

For those people who struggle with sinus, allergy or equalizing challenges, I offer my nasal irritation procedure here and hope it helps someone

I use a waterpik as my device. It holds a couple of cups of water and it’s delivered under mild pressure. Amazon sells Waterpik nasal tips that create a seal in the nostrils. I have a Waterpik that I use for my teeth and a separate one for nasal irrigation because I never want tap water in the unit I use for my sinuses.

I make my own saline solution to save money. Use a clean measuring cup, fill with 2 cups of distilled water, and microwave on high for 1 minute. Add 1 teaspoon of sea salt and 1/2 teaspoon of baking soda. The baking soda cuts out about 90% of the sting in your sinuses. Mix the solution until clear.

Fill the reservoir of the Waterpik with the saline solution and make sure the flow rate is on the lowest possible setting. Lean your face forward over the sink, press the nasal tip on one nostril and switch on the Waterpik. The saline solution flows under pressure up one nostril, through the sinus area and out the other nostril into the sink. Resist the urge to swallow. When half the saline is gone, stop the flow, switch to the other nostril and start the flow again.

Once the saline is completely gone, don’t blow your nose. Let the solution “marinate” in there and just use a tissue to pat down the bottom of your nose. Sit back on the couch, breathing through your mouth for about 10 minutes. You’ll get post nasal in your throat but it’s not a big deal. You should pretty much feel normal after about 20 minutes.

Do you also leave you mouth open over the sink or just let everything that will, run out the other nostril?

 

[RobPNW]

Do you also leave you mouth open over the sink or just let everything that will, run out the other nostril?

Of course you’re breathing with your mouth open but if you focus on not swallowing everything should flow out of your nostril. First time it feels weird but after that it’s a nothing burger imo. If you have serious sinus issues it may take a number of days. Initially, it’s basically a mucus flush. But that saline will decrease inflammation allowing more flow and flushing of irritants, bacteria, infection etc.

 

[rmorgan]

+1 for NeilMed, but consider the battery-operated model (I think it’s now at Costco!). On a trip when I use it daily for a couple of weeks before travel, I barely have to think about clearing. When I’m lazy, back to the pinch-and-blow.

 

[Khoujo1]

Hey everyone. I am a Pulmonologist so can’t help myself to jump in. Forgive the semi-unsolicited medical advice, but I can help simplify this for all.

Many patients have a cough related to upper airway congestion and allergic rhinitis, so this is a common issue for Pulmonary specialists as well as Allergists and ENTs. The sequence of treatments I typically recommend is (in order):

1. Nasal saline lavage twice daily
2. Add OTC topical steroids if symptoms persist
3. Add OTC topical antihistamines if symptoms persist despite the above. (Meds such as Astepro)

Topical saline lavage is different than a saline spray. It is a large volume flushing of the nasal tissue and sinuses with the idea that by doing so you remove obstructing debris and also remove allergens that are stimulating an immune response. It does not matter which device you choose to do this. The most affordable option is a bulb syringe often used for infants.

Making the solution at home is also cost effective, and many recipes are out there. (See example below). Baking soda helps for comfort and balancing of the pH. The key is to use enough volume, typically 4 ounces per side. Be sure to point whichever device you use straight back and not up. Gently squeeze the bulb or bottle you’re using; it does not need to be a fire hose. The solution will come out of the mouth, so position your head over a sink.

One comment regarding the Naegleria risk: I found 3 small case series of infection from tap water use. In general the risk from tap water should be minuscule, especially if it’s treated and from a municipal source, but given if one gets infected it is untreatable and fatal I’d use distilled water or boil tap water to kill anything before use. (I am also an ICU specialist, and have seen one case of this while training at Duke. Was not pretty. Can’t dive if you’re dead.)

Regarding steroids, it does not matter which steroid one uses, and generic OTC products are equivalent to prescription agents. The important thing is to do it routinely, typically daily, and to realize the effect is not immediate. Often improvement takes 1-2 weeks of use. If you begin a steroid in conjunction with saline lavage, be sure the steroid is done after the lavage to avoid flushing out the medication. Steroids will help with both allergic and non-allergic causes of inflammation.

Unlike the steroid, topical antihistamines can often be used as needed for congestion. They only help, however, if the cause is an allergic one. Some patients with true allergic symptoms benefit from routine use, typically twice daily.

Last point: avoid vasoconstrictors such as Afrin. They reduce congestion by tightening the topical blood vessels of the nose and sinuses. After 3 days of regular use, those vessels become acclimated to this state, so that when the drug is stopped there is a rebound vasodilation and return of symptoms but often worse than prior to the treatment. Patients then resume use of the vasoconstrictor and over time reduce blood flow to the region. Death of tissue, especially in the nasal septum, can occur and many people have had erosion and perforation of the nasal septum as a result.

If you have sinus issues and have a dive trip planned, I’d recommend starting these treatments at least one week prior to your first dive.

I hope this is helpful. Happy to answer any questions.

 

[chillyinCanada]

Has anyone tried NAC, a supplement from the healthfood store?