Battle of the Nasal Washes

October 8, 2008 -- How many times are children admonished not to put things up their noses? Yet somehow fingers, food and small toys eventually get up there and a disgruntled parent, teacher, doctor or other unfortunate party is stuck with the slimy job of removing said object from those twin mucousal highways.

So, it is understandable that the idea of snorting, squirting or pouring a salt water solution up the nose on purpose might be regarded with suspicion.

"You squeeze [water] in one nostril and out the other. It's freaky," said Dr. Donald Levy, medical director at the Osher Clinical Center for Complementary and Integrative Medical Therapies at Brigham and Women's Hospital in Boston. "But you're letting the body find a way to heal itself with minimal intervention."

Nasal irrigation, sometimes called a nasal rinse or, if you want to be posh, nasal lavage, can ease sinus-related problems, from the common cold to allergies. While there are several methods of getting the water up there in the first place, the general process involves water going up the nose and out again in order to flush out mucous, allergens and germs to ease sinus-related problems, from the common cold to allergies.

The simplest way to irrigate might be to sniff the water up from a cupped hand, while a nebulizer, which creates a fine mist that one breathes in to clear out the nasal passages, would be more complicated.

Ultimately, the method of nasal irrigation used depends on what people find works best to manage their symptoms, though there have been studies that show some methods are more effective than others.

A 2002 study published in the journal The Laryngoscope used a dyed solution laced with traceable markers to compare three methods of nasal irrigation to determine how much solution traveled through the nasal passages and where the solution went. Irrigation techniques that allowed more water to reach further into the nasal passages were deemed most effective.

The only technique that did not pass muster was the nebulizer, according to the study, because the vapor remains in the fleshy part of the nose and is ineffective at irrigating the nasal passages.

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The following are videos of three different nasal irrigation methods. With expert comments, see which method comes out on top and which one goes down the drain.

Technique #1: Syringe

Robyn Curhan, 43, found relief from the pain and pressure in her sinuses by using a syringe to do saline nasal irrigation.

Watch a video demonstrating nasal irrigation using a syringe.

Using syringes to do nasal irrigation is an example of positive pressure irrigation, in which pressure is applied to a liquid so that it travels up the nostrils. The Laryngoscope study found positive pressure to be most effective at distributing a lot of solution far into the nasal passages.

Flushing a large area of the nasal passages clears mucous buildup and irritating allergens, allowing fluids in the sinuses -- the large and small cavernous areas concentrated around the nose, behind the eyes and up into the forehead -- to drain freely through the nose.

Clearing these regions helps prevent the pain and pressure that occur due to backed up sinus fluids during a cold or severe allergies.

But doctors urge caution when using syringes because they can spray water with force. And if water does not drain out through the nostrils, it drains through the throat.

"I worry that people would be too vigorous," said Dr. Roberta Lee, medical director at the Continuum Center for Health and Healing at Beth Israel Medical Center in New York. "People don't realize how delicate the tissues up there are."

To protect those tissues a little and remove some of the sting of the salt water, Haddon recommends adding a pinch of baking powder, as Curhan does, to lower the pH and buffer the solution.

Technique #2: Squeeze Bottle

Kellie Gentry, 28, relies on a nasal rinse with a squeeze bottle to keep her sinuses clear, and it is a proven method.

"It gets to the sinuses as well as you're going to get," said Levy of the Osher Clinical Center. "To me the gut feeling is I'm now draining better. I feel less irritated."

Watch a video demonstrating nasal irrigation using a squeeze bottle.

Rinsing with squeeze bottles is a fast, cheap and easy way to clear nasal passages and reduce the effects of a cold or an allergy as well as the need for medications. Packs like Gentry's, complete with prepared salt mixes, are available at almost any drugstore or supermarket.

And squeeze bottles are another form of positive pressure irrigation. The Laryngoscope study found that positive pressure irrigation is particularly effective at clearing the drainage areas for the ethmoid sinus regions by the bridge of the nose and the maxillary sinus regions on either side of the nose.

Negative pressure irrigation -- water sniffed up from a cupped hand -- was comparable to positive irrigation, according to the study, although it did not distribute the solution as evenly.

But saline nasal rinses can be uncomfortable unless you get the technique down.

Dr. Sezelle Gereau Haddon, assistant professor and clinical instructor of pediatric otolaryngology at Children's Hospital of New York, recommends a technique for using squeeze bottles that involves bending forward and panting "like a puppy" to keep the palate elevated and close off the back of the nose so the rinse water does not flow down the throat.

"All this gunk kind of comes out your nose," which clears out the area where many of the major sinus cavities drain, said Haddon.

And for those who are still wary of shooting water into the nose, Levy has some reassuring words:

"Water is not going to go into the brain, even if you try."

Technique #3: Neti Pot

Carrie Erwin, 26, tapped into a less modern but still effective technique to clear her nose.

Watch a video demonstrating nasal irrigation using a neti pot.

Though neti pots were not included in the 2002 study, they have long been used to manage sinus problems. Neti pots originated in Southeast Asia as an Ayurvedic cleansing technique. Traditional pots look like ceramic Aladdin lamps, squat with long, slender spouts that get pushed into the nostrils.

Tilting the head allows the water to flow into one nostril, travel up behind the nose into the nasopharynx and flow out the other nostril. Water that does not drain through the nose can be spit out through the mouth.

Irrigating with neti pots falls somewhere between positive and negative irrigation, Lee said, as a more passive way to cleanse the nasal passages.

But some may not find the "pouring" sensation combined with tilting the head comforting.

"Patients often feel like they're drowning," Haddon said.

The drowning sensation could be a matter of technique, but Haddon said that it was impossible to get her patients to comply with using it.

Still, there are reasons to try irrigating with neti pots if other methods do not work well.

"They're gentle, they're not under pressure," Lee said. "Simpler is better."

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