General information about sinus rinses

Sinus rinses are one of the mostly commonly used treatments for nasal and sinus issues. They are referred to by many different names. Some of the terms used include things like nasal washes, saline nasal irrigations, sinus rinses, and the Neti pot rinses.

Nasal rinses have been around for thousands of years. They initially originated as a part of yoga practice. Over time, they have been used for medical purposes to help those who have nasal and sinus issues.

The basic idea is to flush the nasal passages with a solution of saline. There are many different bottles and pots that are now available for this. The saline solution is typically made by mixing salt packets and water.

Many of our patients use these rinses for two main purposes:

To help flush mucus and debris out of the sinuses
To help get medications into the sinuses

Given the tendency for the nasal passages to become dry during certain times of the year, some of our patients also use the rinses to moisturize the nose.

Nasal Rinse Basics

Sinus rinses are a gentle way to help “wash” the inside of the nasal passages. In addition to clearing mucus, the rinses can help clear things like allergens and other inhaled particles. They can also help clear allergic irritants from the nose.

For people who have never had nasal or sinus surgery, these rinses do a good job at flushing the nasal passages. They don’t really get into the sinuses, though. These rinses get into the sinuses much more effectively if someone has had endoscopic sinus surgery. Endoscopic sinus surgery involves enlarging the natural openings into the sinus areas. This allows material from the sinuses to drain out more effectively, but it also allows the irrigation fluid to get into the sinuses more effectively.

Technique

Most of our patients find a sinus rinse bottle to be the easiest way to use the rinse. We don’t endorse any particular brand. One of the most widely available bottles is made by a company called NeilMed.

These are the steps to use a sinus rinse bottle to flush the nose:

Open and mix one of the salt packets into the bottle
Fill the bottle with water to the marked line
Screw on the bottle top
Cover the hole in the top and shake the bottle to fully dissolve the salt
With your head tipped down slightly, place the bottle up to one nostril
Gently squeeze the bottle and let the fluid run through the nose

There is no need to try to snort or suck the fluid in. By squeezing the bottle gently, enough flow can be generated to let the fluid passively flow through the nasal passages. If both nasal passages are open, the fluid will go in through one nostril and come out of the other. As you can imagine, many people with nasal and sinus problems don’t have open nasal passages. That means that the fluid is likely to flow better through one side than the other. It may also mean that some of the fluid will come out of the mouth instead out of the opposite nostril. Most of us have little asymmetries inside the nostrils, so these types of differences in flow are common.

It is important to remember that the goal is not to force the fluid into the nose with lots of pressure. Instead, focus on getting the entire volume of the bottle to flow gently through each nostril. Typically, half the bottle is used for each side of the nose. Some people do prefer to refill the bottle and use a full bottle on each side.

One of our colleagues, Dr. John Craig, has a very brief video that shows these steps. You can view the video using this link.

Frequently Asked Questions

I tried to do a sinus rinse, but it caused a lot of stinging and irritation. Is that normal?

It is rare that anyone likes the feeling of a sinus rinse the first few times they use it. But, after getting used to the idea and the technique, many people find it to be quite soothing.

If the rinse fluid caused stinging, one possible explanation may be that the concentration of salt in the fluid was not quite right. We have found that the easiest way to get the right balance of salt and water is to use little packets that are available over the counter at drug stores. Many different companies make them, and they’re all really the same mixture of materials: sodium chloride (salt), and sodium bicarbonate (a buffer). Most people do not have problems with stinging with the right concentration of salt in the fluid.

What type of water should I use?

The recommendation is to use previously boiled water, distilled water, sterile water, or properly filtered water. Many people do use tap water, but there is a concern that infections can be transmitted through tap water. In recent years, there are some reports of people contracting fatal amoebic infections after using contaminated tap water for sinus rinses. For that reason, the FDA and CDC have advised against use of tap water.

The FDA recommends that water be boiled for 3-5 minutes and then allowed to cool. After it is luke warm (or cooler), it can be used in a nasal rinse. If you prefer to buy distilled water, large bottles and jugs are available at stores.

If these options are not available, the CDC suggests using a filter designed to remove common types of germs. They recommend filters with the labels that indicate at least one of the following:

NSF 53
NSF 58
Cyst removal
Absolute pore size of 1 micron or smaller

More information about treating the water before using a sinus rinse is available at the CDC website: Sinus Rinsing For Health or Religious Practice

The FDA has published a Consumer Update on the safety of sinus rinses. You can read more at: Is Rinsing Your Sinuses Safe?

How often should I use a sinus rinse?

Each person’s nasal issues are different, so there is no one correct answer to this question. Some of our patients use the rinse as needed, once in a while. Others use it every day, even a few times a day. Immediately after surgery, we ask our patients to try to rinse at least 4 times a day to try to clear mucus, clots, and crusts from the inside of the nose and sinuses. If you need specific directions on how often to use the rinse, you should discuss your case with your doctor.

Someone mentioned using a medicated sinus rinse. What does that mean?

Some medications can be dissolved into the sinus rinse. Typically, using a medicated sinus rinse means that antibiotics or steroids are mixed into the rinse fluid. That fluid is then used to flush the nose and sinuses.

While the saline sinus rinse is over the counter, the medications that are mixed into the rinse are prescription medications. So, a medicated sinus rinse would be performed after evaluation by a prescribing doctor. As you can imagine an antibiotic rinse is used to cut down on bacteria in the nose and sinuses. Steroid rinses can be used to help decrease swelling in the nose and sinuses.

Other resources

An article on sinus rinses has been published by the American Medical Association in the medical journal, JAMA Otolaryngology – Head & Neck Surgery. You may read the article using this link.