Nasal sinus rinses with saline solution

Before we discuss using nasal sinus rinses with saline solution, I think it would better to review the anatomy and physiology of the nose and sinuses. I’m going to try something new, using Youtube videos that I have screened, and also not reinvent the wheel. The nose normally makes some mucus: to protect the mucosal lining from being too dry; to wash off particles, allergens, viruses, and bacteria off of the mucosal lining; and to protect the mucosal lining against infections. When the mucosal lining of the nose is irritated, we call this rhinitis. If the cause is from allergies, we call this allergic rhinitis. The sinuses are bony caves branching off from the nose. Here is a good review of sinusitis. This video says almost the same thing.

Saline solution introduced into the nose and sinus cavities will wash mucus and anything in the mucus off the mucosal lining. Here is a good video demonstrating nasal rinses on Youtube for an adult and another for a child. Some prefer to use the Netipot. Either work for me. Any product that works for you and is cost-effective is an acceptable product. It’s based on personal preference. In the top 3 photos to the right, I am demonstrating what I consider to be optimal technique: head down with chin above the eyes, saline solution being squeezed gently but persistently into the upper nostril, allowing the saline to drain out the lower nostril, mouth breathing. There is no downside when done gently. The three products (Nasaline, Ayr, NeilMed) in the bottom right photos were chosen simply because I had a sample in my office.

I am frequently asked about how much saline solution to use and how often. Mucus by its very nature is sticky, like syrup. So for the saline solution to effectively loosen the mucus up, it generally takes at least 8 ounces or 240 ml per session in my experience. I habitually rinse my nose and sinuses out at least four times per day. Why? I have several reasons. First, I am exposed on a daily weekday basis to many people. Rinsing is simply good hygiene. I have a family history of allergies, plus there’s my wife with very severe allergies, and I do not want my mucosal immune system to develop allergies, so I never let the allergens build up in my nose or sinuses. Think of it as constant spring pollen cleaning. Next, I find it refreshing, like splashing cool water on your face. Finally I am exposed to patient every weekday with respiratory infections. Some of them look pretty miserable. Some of the little twerps (or to be politically correct unhappy little children) cough or sneeze point blank right in my face as I try to examine them. Whatever they have, virus or allergy or bacteria, I DON’T WANT IT. So, once I have finished their office visit, I go straight over to the bathroom for handwashing + nasal sinus rinsing.

How much saline solution is safe to use? Remember what happens when you go swimming in either a pool or the ocean. Lots of water goes up your nose. Your nose and sinuses are getting washed out very thoroughly. Think about how your nose feels after a swim. Usually it is very clear for a few hours. Why? Your nose and sinuses have most of the mucus and anything in the mucus removed. Since mucus is produced normally, the clear feeling does not last forever.

I hope this discussion tells you how I feel about nasal sinus rinsing. As my friend Linus reminded me about Chicago voters each election, they vote early and vote often. Here I recommend rinse with lots of saline and rinse often.