Editing Nasal irrigation

{{Short description|Personal hygiene practice for rinsing out nasal passages}}
{{Use dmy dates|date=October 2020}}
{{Infobox medical intervention
| Name=Nasal irrigation
| Image=Jalaneti.JPG
| Caption=Woman flushing her nose with a neti pot
| ICD10=
| ICD9={{ICD9proc|22.0}}
| MeshID=D055556
| OPS301=
| OtherCodes=
}}

'''Nasal irrigation''' (also called '''nasal lavage''', '''nasal toilet''', or '''nasal douche''') is a personal [[hygiene]] practice in which the [[nasal cavity]] is washed to flush out [[mucus]] and debris from the [[Human nose|nose]] and [[sinuses]], in order to enhance [[Obligate nasal breathing|nasal breathing]]. Nasal irrigation can also refer to the use of [[Saline spray|saline nasal spray]] or [[nebulizer]]s to moisten the [[mucous membrane]]s. 

==Medical uses==
[[File:Nasendusche IMG 3357.jpg|thumb|To prepare an isotonic saline solution for nasal rinsing, approx. 0.25 liter lukewarm, sterilized drinking water and 2.5&nbsp;ml of table salt (about half a level [[teaspoon]]) is required.]]
[[File:Nasendusche.jpg|thumb|upright=0.6|Nasal irrigation device commonly available at pharmacies]]

Nasal irrigation can be an effective therapy to relieve symptoms of acute sinusitis caused by [[upper respiratory tract infections]] such as the [[common cold]].<ref name=Ros2015>{{cite journal |last1=Rosenfeld |first1=RM |last2=Piccirillo |first2=JF |last3=Chandrasekhar |first3=SS |last4=Brook |first4=I |last5=Ashok Kumar |first5=K |last6=Kramper |first6=M |last7=Orlandi |first7=RR |last8=Palmer |first8=JN |last9=Patel |first9=ZM |last10=Peters |first10=A |last11=Walsh |first11=SA |last12=Corrigan |first12=MD |title=Clinical practice guideline (update): adult sinusitis executive summary. |journal=Otolaryngology–Head and Neck Surgery |date=April 2015 |volume=152 |issue=4 |pages=598–609 |pmid=25833927 |doi=10.1177/0194599815574247|doi-access=free }}</ref> The evidence for effectiveness in relieving chronic sinusitis is weak.<ref name=Cochrane2016>{{cite journal |last1=Chong |first1=LY |last2=Head |first2=K |last3=Hopkins |first3=C |last4=Philpott |first4=C |last5=Glew |first5=S |last6=Scadding |first6=G |last7=Burton |first7=MJ |last8=Schilder |first8=AG |title=Saline irrigation for chronic rhinosinusitis. |journal=The Cochrane Database of Systematic Reviews |date=26 April 2016 |volume=4 |pages=CD011995 |doi=10.1002/14651858.CD011995.pub2 |pmid=27115216|url=http://discovery.ucl.ac.uk/1489911/1/Schilder_Chong_et_al-2016-The_Cochrane_library.pdf }} {{open access}}</ref>

It can also be useful for the temporary relief of the symptoms associated with [[allergic rhinitis]].<ref name=Hermelingmeier2012>{{cite journal |last=Hermelingmeier |first=Kristina E. |last2=Weber |first2=Rainer K. |last3=Hellmich |first3=Martin |last4=Heubach |first4=Christine P. |last5=Mösges |first5=Ralph |date=2012-09-01 |title=Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis |journal=American Journal of Rhinology & Allergy |volume=26 |issue=5 |pages=e119–125 |doi=10.2500/ajra.2012.26.3787 |issn=1945-8932 |pmc=3904042 |pmid=23168142}}</ref>

==Adverse effects==
Adverse effects include nasal irritation, nosebleeds, headache, and drainage after the irrigation is done.  It is generally well tolerated.<ref name=Cochrane2016/>

There is a risk of infection if the water is not sterile or the device is not cleaned after use. If the device is used improperly this can be harmful.<ref name=FDA2017>{{cite web |title=Is Rinsing Your Sinuses Safe? |url=https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.htm |website=FDA |date=24 January 2017 |archive-url=https://web.archive.org/web/20190104231633/https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.htm |archive-date=4 January 2019}}</ref> In fact, proper application suggests the use of boiled water or [[saline water]]. In 2018, a patient was reported to have contracted ''[[Balamuthia mandrillaris]]'' after one month of using [[tap water]] filtered through a [[Brita (company)|Brita]] water purifier for nasal irrigation.<ref>{{cite web |title=Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage |url=https://www.ijidonline.com/article/S1201-9712(18)34525-9/fulltext |publisher=International Journal of Infectious Diseases |website=IJID Online |date=December 2018}}</ref>

Rare cases of fatal [[naegleriasis]] have occurred due to nasal insufflation of the amoeba ''[[Naegleria fowleri]]'' (the "brain-eating amoeba") from untreated tap water. Two people died from ''Naegleria fowleri'' infections tied to using neti pots containing tap water in 2011.<ref name="ABC-Neti">{{cite news |last=Moisse |first=Katie |date=16 December 2011 |title=Louisiana Issues Neti Pot Warning After Two Fatal Infections |url=https://abcnews.go.com/Health/Wellness/fatal-infections-linked-neti-pots/story?id=15170230 |url-status=live |work=ABC News |archive-url=https://web.archive.org/web/20190122224915/https://abcnews.go.com/Health/Wellness/fatal-infections-linked-neti-pots/story?id=15170230 |archive-date=22 January 2019 |access-date=17 May 2020 }}</ref> A [[Louisiana]] man died from the same amoeba in 2013.<ref>{{cite news |title=Brain infection from water amoeba kills 3; victim used 'neti pot' |url=https://www.king5.com/article/mobile/news/health/brain-infection-from-water-amoeba-kills-3-victim-used-neti-pot/308001356 |access-date=21 January 2021 |publisher=King-TV |date=January 4, 2013}}</ref>

==Mechanism of action==
Flushing the nasal cavity can soothe inflamed tissue and remove irritants like allergens; it may help clear mucus.<ref name=Cochrane2016/><ref name=Hermelingmeier2012/>

Typical use involves the pouring or pumping of saline water through one nostril and letting it drain from the other.

==Solutions and devices==
===Solutions===
The water should not be tap water, which may contain small amounts of bacteria that are safe to drink but may be dangerous in the nose. The water should be sterile or filtered for micro-organisms; if tap water is used it should be boiled and cooled.<ref name=FDA2017/> [[Saline solution]] is also sometimes used.<ref name=Cochrane2016/>

The U.S. [[Centers for Disease Control and Prevention]] has a fact sheet recommending one of four methods to make the water safe:<ref name="CDC-Fact-Sheet">{{cite web |url=https://www.cdc.gov/parasites/naegleria/pdf/naegleria-ritual-ablution-factsheet.pdf |title=Safe Ritual Nasal Rinsing  |author=<!--Not stated--> |website=CDC.gov |publisher=[[Centers for Disease Control and Prevention]] |access-date=17 May 2020 |archive-url=https://web.archive.org/web/20190618181911/https://www.cdc.gov/parasites/naegleria/pdf/naegleria-ritual-ablution-factsheet.pdf |archive-date=18 June 2019}}</ref>
# Boil: Use water that has been previously boiled for 1 minute and left to cool. At elevations above 6,500 feet, boil for 3 minutes.
# Filter: Use a filter designed to remove some water-loving germs. The label may read "NSF 53" or "NSF 58". Filter labels that read "absolute pore size of 1 micron or smaller" are also effective.
# Buy: Use water with a label specifying that it contains distilled or sterile water.
# Disinfect: Learn how to disinfect your water to ensure it is safe from ''Naegleria''. Chlorine bleach used at the right level and time will work as a disinfectant against this germ.

A number of other compounds may be included in irrigation fluids such as the steroid [[budesonide]] in an effort to treat chronic [[Sinusitis|rhinosinusitis]].<ref>{{cite book|last1=Thaler|first1=Erica|last2=Kennedy|first2=David W.|title=Rhinosinusitis: A Guide for Diagnosis and Management|date=2009|publisher=Springer Science & Business Media|isbn=9780387730622|page=82|url=https://books.google.com/books?id=LFQSZR71rGAC&pg=PA82|language=en}}</ref>

===Devices===
[[File:Neti pot.jpg|thumb|Ceramic neti pot]]
Neti pots are commonly used and rely on gravity and head position in order to rinse the outer sinus cavities. Typically they have a spout attached near the bottom, sometimes with a handle on the opposite side.<ref name=FDA2017/>

Various squeeze bottles for nasal irrigation have also been used to apply the water.<ref name=FDA2017/>

Bulb syringes are commonly used for infants and children.<ref name=FDA2017/>

There are also irrigation machines available that utilize electric motor-driven pumps.<ref name=FDA2017/>

==History==
{{More citations needed|section|date=February 2018}}
The earliest record of nasal irrigation is found in the ancient [[Hindu]] practice of Indian [[Ayurveda#India|Ayurveda]] whose roots are traced to the [[Vedas]]. It was customary to perform jala-neti daily, as part of ''soucha'' (personal hygiene according to scriptures). ''[[Neti (Hatha Yoga)#Jala Neti|Jala neti]]'', which means to cleanse the nose with water, is an old yogic technique from India. The container used to administer the saline is called a "neti pot". This process removes mucus and dirt and clears the nose. A second neti technique known as ''[[Neti (Hatha Yoga)#Sutra neti|sutra neti]]'' uses a piece of string instead of water.

==See also==
{{Portal|Medicine}}
* [[Neti (Hatha Yoga)]]
* [[Post-nasal drip]]

==References==
{{Reflist|32em}}

==External links==
{{wikibooks|1=Ethnomedicine|2=Home Remedies/Saline Nasal Wash|3=Saline Nasal Wash}}
* [https://www.fammed.wisc.edu/nasal-irrigation/ University of Wisconsin instructions, study and video]
* [http://www.cfp.ca/content/49/2/168.full.pdf  Saline nasal irrigation: Its role as an adjunct treatment]

{{Authority control}}

{{DEFAULTSORT:Nasal irrigation}}
[[Category:Hygiene]]
[[Category:Rhinology]]