Nasal Irrigation Recommendations

[tridacna]

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

I thought this discussion was about NaCl not NAC

 

[duke dive medicine]

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...

Thanks. Re N. fowleri: it's a low-probability, very high-consequence event that is easily preventable. The NeilMed instructions specify the type of water to be used.

Best regards,
DDM

 

[duke dive medicine]

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.

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Would you mind elaborating on "OTC topical steroids"? Some readers could interpret this as a topical steroid cream or ointment that's mean to be put on intact skin. Do you mean nasal spray steroids?

What are your thoughts on the effects of long-term saline rinse use on the normal functions of mucus in the sinuses?

Best regards,
DDM

 

[living4experiences]

This is a fascinating discussion. I've learned some new info. Thanks for all the input.

 

[Khoujo1]

Would you mind elaborating on "OTC topical steroids"? Some readers could interpret this as a topical steroid cream or ointment that's mean to be put on intact skin. Do you mean nasal spray steroids?

What are your thoughts on the effects of long-term saline rinse use on the normal functions of mucus in the sinuses?

Best regards,
DDM

Fair questions.

OTC steroids in this case are over the counter topical nasal steroids. The common ones include fluticasone (Flonase), triamcinolone (Nasacort), mometasone (Nasonex), and budesonide (Rhinocort). They are all sprays, not solutions, gels, creams, etc.

With regard to long term effects of saline lavage, I don’t know of any data suggesting serious issues with normal physiologic function. There is the risk of infections, mostly bacterial, if a patient fails to clean the equipment being used routinely and appropriately.