For patients suffering from chronic rhinosinusitis, the two most effective treatments as reported by patients are nasal corticosteroids and saline rinses. Saline rinsing of the nasal passages can be performed with a variety of devices, in different volumes of solution, and in different frequencies. Chronic rhinosinusitis is one of the most common healthcare complaints to primary doctors in the U.S.
What is Chronic Rhinosinusitis?
The basic qualifier for a diagnosis of chronic rhinosinusitis is that symptoms are present for longer than 3 months. This is an inflammatory condition of the sinuses that can result in symptoms such as nasal obstruction and congestion, facial pain and pressure, and a partial or full loss of smell.
What is a Saline Rinse?
Saline rinsing involves simply rinsing the nasal cavities with salt water. There are a few different ways that saline rinse is thought to be effective at treating nasal conditions. One theory is that it may thin the mucus, which makes it easier to leave the nose. Another is that the saline physically removes debris and allergens from the nose to reduce irritation.
The saline can be in various concentrations – the key difference being whether the solution is more or less than the concentration of salt in the body (0.9% NaCl). The 0.9% concentration is also sometimes referred to as the physiologic concentration. The solutions can then be described as either hypertonic (>0.9% NaCl) or isotonic (0.9% NaCl). While both types of rinses have been shown to be effective, some studies show that an isotonic rinse produces less irritation.
Plain water does not work! The salt is an essential component of the rinse that makes it effective, safe, and non-irritating. Using tap water can potentially introduce harmful bacteria into the sinuses. In addition the pH of tap water may cause it to be irritating to the nasal passages. There is more information in the next section on how to prepare or select the right water for your saline rinse.
Most individuals with rhinosinusitis report some benefit from the use of saline rinses. There are few adverse effects if the rinse is done properly using the right solution.
Important Tips for Nasal Saline Rinsing
Only use distilled or sterile water – do not use tap water. Tap water can contain harmful bacteria that can lead to serious infections. According to the FDA, only these types of water should be used for nasal rinsing:
- Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
- Boiled and cooled tap water — boiled for 3 to 5 minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.
- Water passed through a filter designed to trap potentially infectious organisms. CDC has information on selecting these filters.
- Source: “Is Rinsing Your Sinuses With Neti Pots Safe?” – FDA.gov (content current as of 8/04/2021) https://www.fda.gov/consumers/consumer-updates/rinsing-your-sinuses-neti-pots-safe
A saline rinse should generally be used before any other nasally administered medication. This will allow the medication to better absorb. Saline rinses can be used daily and patients often use them several times per day to get the best results.
It is important to note the difference between sinus irrigation and sinus nebulization. Sinus irrigation involves a high-volume rinse that is administered with an irrigation bottle or neti pot. Sinus nebulization with saline involves a lower volume rinse that sends a fine mist into the nasal passages and sinuses.
Long-Term Clinical Follow-Up of Patients With Chronic Rhinosinusitis – The Annals of Otology, Rhinology, and Laryngology (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044630/)