Nasal Irrigation: An Imprecisely Defined Medical Procedure
Abstract
:1. Introduction
2. Mechanisms of Action of Nasal Irrigation (NI)
3. Composition of Solutions Commonly Used for Nasal Irrigation (NI)
4. Means of Nasal Irrigation (NI)
5. Tolerability and Safety of Nasal Irrigation (NI)
6. Clinical Efficacy
6.1. Acute Upper Respiratory Tract Infections (URTIs)
6.2. Chronic Rhinosinusitis (CRS)
6.3. Allergic Rhinitis (AR)
7. Conclusions
Acknowledgments
Ethics, Approval and Consent to Participate
Author Contributions
Conflicts of Interest
References
- Rama, S.; Ballentine, R.; Hymes, A. Science of Breath: A Practical Guide; Himalayan Institute Press: Honesdale, PA, USA, 1998. [Google Scholar]
- Burns, J.L. Nasal lavage. J. Otholaryngol. 1992, 21, 83. [Google Scholar]
- Sur, D.K.; Plesa, M.L. Treatment of allergic rhinitis. Am. Fam. Physician 2015, 92, 985–992. [Google Scholar] [PubMed]
- Benninger, M.S.; Holy, C.E.; Trask, D.K. Acute rhinosinusitis: Prescription patterns in a real-world setting. Otolaryngol. Head Neck Surg. 2016, 154, 957–962. [Google Scholar] [CrossRef] [PubMed]
- Rudmik, L.; Hoy, M.; Schlosser, R.J.; Harvey, R.J.; Welch, K.C.; Lund, V.; Smith, T.L. Topical therapies in the management of chronic rhinosinusitis: An evidence-based review with recommendations. Int. Forum Allergy Rhinol. 2013, 3, 281–298. [Google Scholar] [CrossRef] [PubMed]
- Beswick, D.M.; Ramadan, H.; Baroody, F.M.; Hwang, P.H. Practice patterns in pediatric chronic rhinosinusitis: A survey of the American Rhinologic Society. Am. J. Rhinol. Allergy 2016, 30, 418–423. [Google Scholar] [CrossRef] [PubMed]
- Marchisio, P.; Picca, M.; Torretta, S.; Baggi, E.; Pasinato, A.; Bianchini, S.; Nazzari, E.; Esposito, S.; Principi, N. Nasal saline irrigation in preschool children: A survey of attitudes and prescribing habits of primary care pediatricians working in northern Italy. Ital. J. Pediatr. 2014, 40, 47. [Google Scholar] [CrossRef] [PubMed]
- Sobol, S.E.; Samadi, D.S.; Kazahaya, K.; Tom, L.W. Trends in the management of pediatric chronic sinusitis: Survey of the American Society of Pediatric Otolaryngology. Laryngoscope 2005, 115, 78–80. [Google Scholar] [CrossRef] [PubMed]
- Slapak, I.; Skoupá, J.; Strnad, P.; Horník, P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch. Otolaryngol. Head Neck Surg. 2008, 134, 67–74. [Google Scholar] [CrossRef] [PubMed]
- Rosenfeld, R.M.; Piccirillo, J.F.; Chandrasekhar, S.S.; Brook, I.; Kumar, K.A.; Kramper, M.; Orlandi, R.R.; Palmer, J.N.; Patel, Z.M.; Peters, A.; et al. Clinical Practice Guideline (Update): Adult sinusitis executive summary. Otolaryngol. Head Neck Surg. 2015, 152, 598–609. [Google Scholar] [CrossRef] [PubMed]
- Chow, A.W.; Benninger, M.S.; Brook, I.; Brozek, J.L.; Goldstein, E.J.; Hicks, L.A.; Pankey, G.A.; Seleznick, M.; Volturo, G.; Wald, E.R.; et al. Infectious Diseases Society of America: IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin. Infect. Dis. 2012, 54, e72–e112. [Google Scholar] [CrossRef] [PubMed]
- Wald, E.R.; Applegate, K.E.; Bordley, C.; Darrow, D.H.; Glode, M.P.; Marcy, S.M.; Nelson, C.E.; Rosenfeld, R.M.; Shaikh, N.; Smith, M.J.; et al. American academy of pediatrics: Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics 2013, 132, e262–e280. [Google Scholar] [CrossRef] [PubMed]
- Roberts, G.; Xatzipsalti, M.; Borrego, L.M.; Custovic, A.; Halken, S.; Hellings, P.W.; Papadopoulos, N.G.; Rotiroti, G.; Scadding, G.; Timmermans, F.; et al. Paediatric rhinitis: Position paper of the European academy of allergy and clinical immunology. Allergy 2013, 68, 1102–1116. [Google Scholar] [CrossRef] [PubMed]
- Bousquet, J.; Schunemann, H.J.; Fonseca, J.; Samolinski, B.; Bachert, C.; Canonica, G.W. MACVIA: ARIA sentinel network for allergic rhinitis (MASK-rhinitis): The new generation guideline implementation. Allergy 2015, 70, 1372–1392. [Google Scholar] [CrossRef] [PubMed]
- Bastier, P.L.; Lechot, A.; Bordenave, L.; Durand, M.; de Gabory, L. Nasal irrigation: From empiricism to evidence-based medicine. A review. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2015, 132, 281–285. [Google Scholar] [CrossRef] [PubMed]
- Georgitis, J.W. Nasal hyperthermia and simple irrigation for perennial rhinitis: Changes in inflammatory mediators. Chest 1994, 106, 1487–1492. [Google Scholar] [CrossRef] [PubMed]
- Carothers, D.G.; Graham, S.M.; Jia, H.P.; Ackermann, M.R.; Tack, B.F.; McCray, P.B., Jr. Production of β-defensin antimicrobial peptides by maxillary sinus mucosa. Am. J. Rhinol. 2001, 15, 175–179. [Google Scholar] [CrossRef] [PubMed]
- Ghafouri, B.; Stahlbom, B.; Tagesson, C.; Lindahl, M. Newly identified proteins in human nasal lavage fluid from non-smokers and smokers using two-dimensional gel electrophoresis and peptide mass fingerprinting. Proteomics 2002, 2, 112–120. [Google Scholar] [CrossRef]
- Talbot, A.R.; Herr, T.M.; Parsons, D.S. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope 1997, 107, 500–503. [Google Scholar] [CrossRef] [PubMed]
- Woods, C.M.; Tan, S.; Ullah, S.; Frauenfelder, C.; Ooi, E.H.; Carney, A.S. The effect of nasal irrigation formulation on the antimicrobial activity of nasal secretions. Int. Forum Allergy Rhinol. 2015, 5, 1104–1110. [Google Scholar] [CrossRef] [PubMed]
- Ludwig, P.; Petrich, K.; Schewe, T.; Diezel, W. Inhibition of eicosanoid formation in human polymorphonuclear leukocytes by high concentrations of magnesium ions. Biol. Chem. 1995, 376, 739–744. [Google Scholar] [CrossRef]
- Larbi, K.Y.; Gomperts, B.D. Complex pattern of inhibition by Mg2+ of exocytosis from permeabilised eosinophils. Cell Calcium 1997, 21, 213–219. [Google Scholar] [CrossRef]
- Tesfaigzi, Y. Roles of apoptosis in airway epithelia. Am. J. Respir. Cell Mol. Biol. 2006, 34, 537–547. [Google Scholar] [CrossRef] [PubMed]
- Trinh, N.T.N.; Privé, A.; Maillé, E.; Noël, J.; Brochiero, E. EGF and K+ channel activitycontrol normal and cystic fibrosis bronchial epithelia repair. Am. J. Physiol. Lung Cell. Mol. Physiol. 2008, 295, L866–L880. [Google Scholar] [CrossRef] [PubMed]
- Buchanan, P.J.; McNally, P.; Harvey, B.J.; Urbach, V. Lipoxin A4-mediated KATP potassium channel activation results in cystic fibrosis airway epithelial repair. Am. J. Physiol. Lung Cell. Mol. Physiol. 2013, 305, L193–L201. [Google Scholar] [CrossRef] [PubMed]
- Chusakul, S.; Warathanasin, S.; Suksangpanya, N.; Phannaso, C.; Ruxrungtham, S.; Snidvongs, K.; Aeumjaturapat, S. Comparison of buffered and nonbuffered nasal saline irrigations in treating allergic rhinitis. Laryngoscope 2013, 123, 53–56. [Google Scholar] [CrossRef] [PubMed]
- England, R.J.; Anthony, R.; Homer, J.J.; Martin-Hirsch, D.P. Nasal pH and saccharin clearance are unrelated in the physiologically normal nose. Rhinology 2000, 38, 66–67. [Google Scholar] [PubMed]
- Baraniuk, J.N.; Ali, M.; Yuta, A.; Fang, S.Y.; Naranch, K. Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans. Am. J. Respir. Crit. Care Med. 1999, 160, 655–662. [Google Scholar] [CrossRef] [PubMed]
- PubChem. Open Chemistry Database. Ringer-Lactate. Available online: https://pubchem.ncbi.nlm.nih.gov/compound/6335487#section=Top (accessed on 3 March 2017).
- Rabago, D.; Zgierska, A.; Mundt, M.; Barrett, B.; Bobula, J.; Maberry, R. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: A randomized controlled trial. J. Fam. Pract. 2002, 51, 1049–1055. [Google Scholar] [PubMed]
- Tomooka, L.T.; Murphy, C.; Davidson, T.M. Clinical study and literature review of nasal irrigation. Laryngoscope 2000, 110, 1189–1193. [Google Scholar] [CrossRef] [PubMed]
- Brown, C.L.; Graham, S.M. Nasal irrigations: Good or bad? Curr. Opin. Otolaryngol. Head Neck Surg. 2004, 12, 9–13. [Google Scholar] [CrossRef] [PubMed]
- Ho, E.Y.; Cady, K.A.; Robles, J.S. A case study of the Neti pot’s rise, americanization, and rupture as integrative medicine in U.S. media discourse. Health Commun. 2016, 31, 1181–1192. [Google Scholar] [CrossRef] [PubMed]
- Wormald, P.J.; Cain, T.; Oates, L.; Hawke, L.; Wong, I. A comparative study of three methods of nasal irrigation. Laryngoscope 2004, 114, 2224–2227. [Google Scholar] [CrossRef] [PubMed]
- Salib, R.J.; Talpallikar, S.; Uppal, S.; Nair, S.B. A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products Sterimar™ and Sinus Rinse™ following functional endoscopic sinus surgery. Clin. Otolaryngol. 2013, 38, 297–305. [Google Scholar] [CrossRef] [PubMed]
- Campos, J.; Heppt, W.; Weber, R. Nasal douches for diseases of the nose and the paranasal sinuses—A comparative in vitro investigation. Eur. Arch. Otorhinolaryngol. 2013, 270, 2891–2899. [Google Scholar] [CrossRef] [PubMed]
- Garavello, W.; Romagnoli, M.; Sordo, L.; Gaini, R.M.; Di Berardino, C.; Angrisano, A. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomized study. Pediatr. Allergy Immunol. 2003, 14, 140–143. [Google Scholar] [CrossRef] [PubMed]
- Marchisio, P.; Varricchio, A.; Baggi, E.; Bianchini, S.; Capasso, M.E.; Torretta, S.; Capaccio, P.; Gasparini, C.; Patria, F.; Esposito, S.; et al. Hypertonic saline is more effective than normal saline in seasonal allergic rhinitis in children. Int. J. Immunopathol. Pharmacol. 2012, 25, 721–730. [Google Scholar] [CrossRef] [PubMed]
- Chen, J.R.; Jin, L.; Li, X.Y. The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children. Int. J. Pediatr. Otorhinolaryngol. 2014, 78, 1115–1118. [Google Scholar] [CrossRef] [PubMed]
- Barham, H.P.; Harvey, R.J. Nasal saline irrigation: Therapeutic or homeopathic. Braz. J. Otorhinolaryngol. 2015, 81, 457–458. [Google Scholar] [CrossRef] [PubMed]
- Jeffe, J.S.; Bhushan, B.; Schroeder, J.W., Jr. Nasal saline irrigation in children: A study of compliance and tolerance. Int. J. Pediatr. Otorhinolaryngol. 2012, 76, 409–413. [Google Scholar] [CrossRef] [PubMed]
- Brook, I. Bacterial contamination of saline nasal spray/drop solution in patients with respiratory tract infection. Am. J. Infect. Control 2002, 30, 246–247. [Google Scholar] [CrossRef] [PubMed]
- Lee, J.M.; Nayak, J.V.; Doghramji, L.L.; Welch, K.C.; Chiu, A.G. Assessing the risk of irrigation bottle and fluid contamination after endoscopic sinus surgery. Am. J. Rhinol. Allergy 2010, 24, 197–199. [Google Scholar] [CrossRef] [PubMed]
- Psaltis, A.J.; Foreman, A.; Wormald, P.J.; Schlosser, R.J. Contamination of sinus irrigation devices: A review of the evidence and clinical relevance. Am. J. Rhinol. Allergy 2012, 26, 201–203. [Google Scholar] [CrossRef] [PubMed]
- Kofonow, J.M.; Bhuskute, A.; Doghramji, L.; Palmer, J.N.; Cohen, N.A.; Chiu, A.G. One-way valve bottle contamination rates in the immediate post-functional endoscopic sinus surgery period. Am. J. Rhinol. Allergy 2011, 25, 393–396. [Google Scholar] [CrossRef] [PubMed]
- Heatley, D.G.; McConnell, K.E.; Kille, T.L.; Leverson, G.E. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol. Head Neck Surg. 2001, 125, 44–48. [Google Scholar] [CrossRef] [PubMed]
- Foreman, A.; Wormald, P.J. Can bottle design prevent bacterial contamination of nasal irrigation devices? Int. Forum Allergy Rhinol. 2011, 1, 303–307. [Google Scholar] [CrossRef] [PubMed]
- Williams, G.B.; Ross, L.L.; Chandra, R.K. Are bulb syringe irrigators a potential source of bacterial contamination in chronic rhinosinusitis? Am. J. Rhinol. 2008, 22, 399–401. [Google Scholar] [CrossRef] [PubMed]
- Keen, M.; Foreman, A.; Wormald, P.J. The clinical significance of nasal irrigation bottle contamination. Laryngoscope 2010, 120, 2110–2114. [Google Scholar] [CrossRef] [PubMed]
- Welch, K.C.; Cohen, M.B.; Doghramji, L.L.; Cohen, N.A.; Chandra, R.K.; Palmer, J.N.; Chiu, A.G. Clinical correlation between irrigation bottle contamination and clinical outcomes in post-functional endoscopic sinus surgery patients. Am. J. Rhinol. Allergy 2009, 23, 401–404. [Google Scholar] [CrossRef] [PubMed]
- Lewenza, S.; Charron-Mazenod, L.; Cho, J.J.; Mechor, B. Identification of bacterial contaminants in sinus irrigation bottles from chronic rhinosinusitis patients. J. Otolaryngol. Head Neck Surg. 2010, 39, 458–463. [Google Scholar] [PubMed]
- Yoder, J.S.; Straif-Bourgeois, S.; Roy, S.L.; Moore, T.A.; Visvesvara, G.S.; Ratard, R.C.; Hill, V.R.; Wilson, J.D.; Linscott, A.J.; Crager, R.; et al. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin. Infect. Dis. 2012, 55, e79–e85. [Google Scholar] [CrossRef] [PubMed]
- Gelardi, M.; Taliente, S.; Piccininni, K.; Silvestre, G.; Quaranta, N.; Ciprandi, G. Nasal irrigation with Nasir® in children: A preliminary experience on nasal cytology. J. Biol. Regul. Homeost. Agents 2016, 30, 1125–1130. [Google Scholar] [PubMed]
- Fashner, J.; Ericson, K.; Werner, S. Treatment of the common cold in children and adults. Am. Fam. Physician 2012, 86, 153–159. [Google Scholar] [PubMed]
- De Luca, M.; Donà, D.; Montagnani, C.; Lo Vecchio, A.; Romanengo, M.; Tagliabue, C.; Centenari, C.; D’Argenio, P.; Lundin, R.; Giaquinto, C.; et al. Antibiotic prescriptions and prophylaxis in Italian children. Is it time to change? Data from the ARPEC Project. PLoS ONE 2016, 11, e0154662. [Google Scholar] [CrossRef] [PubMed]
- King, D.; Mitchell, B.; Williams, C.P.; Spurling, G.K. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst. Rev. 2015, 4. [Google Scholar] [CrossRef]
- Adam, P.; Stiffman, M.; Blake, R.L., Jr. A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Arch. Fam. Med. 1998, 7, 39–43. [Google Scholar] [CrossRef] [PubMed]
- Bollag, U.; Albrecht, E.; Wingert, W. Medicated versus saline nose drops in the management of upper respiratory infection. Helv. Paediatr. Acta 1984, 39, 341–345. [Google Scholar] [PubMed]
- Wang, Y.H.; Yang, C.P.; Ku, M.S.; Sun, H.L.; Lue, K.H. Efficacy of nasal irrigation in the treatment of acute sinusitis in children. Int. J. Pediatr. Otorhinolaryngol. 2009, 73, 1696–1701. [Google Scholar] [CrossRef] [PubMed]
- Ragab, A.; Farahat, T.; Al-Hendawy, G.; Samaka, R.; Ragab, S.; El-Ghobashy, A. Nasal saline irrigation with or without systemic antibiotics in treatment of children with acute rhinosinusitis. Int. J. Pediatr. Otorhinolaryngol. 2015, 79, 2178–2186. [Google Scholar] [CrossRef] [PubMed]
- Satdhabudha, A.; Utispan, K.; Monthanapisut, P.; Poachanukoon, O. A randomized controlled study comparing the efficacy of nasal saline irrigation devices in children with acute rhinosinusitis. Asian Pac. J. Allergy Immunol. 2016. [Google Scholar] [CrossRef]
- Tugrul, S.; Dogan, R.; Eren, S.B.; Meric, A.; Ozturan, O. The use of large volume low pressure nasal saline with fluticasone propionate for the treatment of pediatric acute rhinosinusitis. Int. J. Pediatr. Otorhinolaryngol. 2014, 78, 1393–1399. [Google Scholar] [CrossRef] [PubMed]
- Harvey, R.; Hannan, S.A.; Badia, L.; Scadding, G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst. Rev. 2007, 3. [Google Scholar] [CrossRef]
- Bachmann, G.; Hommel, G.; Michel, O. Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease. Eur. Arch. Otorhinolaryngol. 2000, 257, 537–541. [Google Scholar] [CrossRef] [PubMed]
- Hauptman, G.; Ryan, M.W. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol. Head Neck Surg. 2007, 137, 815–821. [Google Scholar] [CrossRef] [PubMed]
- Pynnonen, M.A.; Mukerji, S.S.; Kim, H.M.; Adams, M.E.; Terrell, J.E. Nasal saline for chronic sinonasal symptoms: A randomized controlled trial. Arch. Otolaryngol. Head Neck Surg. 2007, 133, 1115–1120. [Google Scholar] [CrossRef] [PubMed]
- Pinto, J.M.; Elwany, S.; Baroody, F.M.; Naclerio, R.M. Effects of saline sprays on symptoms after endoscopic sinus surgery. Am. J. Rhinol. 2006, 20, 191–196. [Google Scholar] [PubMed]
- Freeman, S.R.; Sivayoham, E.S.; Jepson, K.; de Carpentier, J. A preliminary randomised controlled trial evaluating the efficacy of saline douching following endoscopic sinus surgery. Clin. Otolaryngol. 2008, 33, 462–465. [Google Scholar] [CrossRef] [PubMed]
- Liang, K.L.; Su, M.C.; Tseng, H.C.; Jiang, R.S. Impact of pulsatile nasal irrigation on the prognosis of functional endoscopic sinus surgery. J. Otolaryngol. Head Neck Surg. 2008, 37, 148–153. [Google Scholar] [PubMed]
- Chong, L.Y.; Head, K.; Hopkins, C.; Philpott, C.; Glew, S.; Scadding, G.; Scadding, G.; Burton, M.J.; Schilder, A.G. Saline irrigation for chronic rhinosinusitis. Cochrane Database Syst. Rev. 2016, 4. [Google Scholar] [CrossRef]
- Cassandro, E.; Chiarella, G.; Cavaliere, M.; Sequino, G.; Cassandro, C.; Prasad, S.C.; Scarpa, A.; Iemma, M. Hyaluronan in the treatment of chronic rhinosinusitis with nasal polyposis. Indian J. Otolaryngol. Head Neck Surg. 2015, 67, 299–307. [Google Scholar] [CrossRef] [PubMed]
- World Allergy Organization. Rhinitis. Available online: http://www.worldallergy.org/professional/allergic_diseases_center/rhinitis/rhinitissynopsis.php (accessed on 3 March 2017).
- Hermelingmeier, K.E.; Weber, R.K.; Hellmich, M.; Heubach, C.P.; Mösges, R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis. Am. J. Rhinol. Allergy 2012, 26, e119–e125. [Google Scholar] [CrossRef] [PubMed]
- Barbieri, M.; Salami, A.; Mora, F.; Casazza, A.; Sovatzis, A.; Teglia, R.; Cordone, M.P.; Mora, R. Behavior of serum IgE and IgA in patients with allergic rhinitis treated with iodine bromide thermal water. Acta Otorhinolaryngol. Ital. 2002, 22, 215–219. [Google Scholar] [PubMed]
- Cingi, C.; Unlu, H.H.; Songu, M.; Yalcin, S.; Topcu, I.; Cakli, H.; Bal, C. Seawater gel in allergic rhinitis: Entrapment effect and mucociliary clearance compared with saline. Ther. Adv. Respir. Dis. 2010, 4, 13–18. [Google Scholar] [CrossRef] [PubMed]
- Cordray, S.; Harjo, J.B.; Miner, L. Comparison of intranasal hypertonic Dead Sea saline spray and intranasal aqueous triamcinolone spray in seasonal allergic rhinitis. Ear Nose Throat J. 2005, 84, 426–430. [Google Scholar] [PubMed]
- Garavello, W.; Di Berardino, F.; Romagnoli, M.; Sambataro, G.; Gaini, R.M. Nasal rinsing with hypertonic solution: An adjunctive treatment for pediatric seasonal allergic rhinoconjunctivitis. Int. Arch. Allergy Immunol. 2005, 137, 310–314. [Google Scholar] [CrossRef] [PubMed]
- Garavello, W.; Somigliana, E.; Acaia, B.; Gaini, L.; Pignataro, L.; Gaini, R.M. Nasal lavage in pregnant women with seasonal allergic rhinitis: A randomized study. Int. Arch. Allergy Immunol. 2010, 151, 137–141. [Google Scholar] [CrossRef] [PubMed]
- Klimek, L.J.V.; Hundorf, F.; Hommel, G.; Hormann, K. Lässt sich der medikamentenverbrauch bei patienten mit saisonaler rhinitis allergica durch nasenspülbehandlungen mit isoosmotischer emser salziosung reduzieren? Allergologie 2001, 24, 309–315. [Google Scholar]
- Li, H.; Sha, Q.; Zuo, K.; Jiang, H.; Cheng, L.; Shi, J.; Xu, G. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. ORL J. Otorhinolaryngol. Relat. Spec. 2009, 71, 50–55. [Google Scholar] [CrossRef] [PubMed]
- Rogkakou, A.; Guerra, L.; Massacane, P.; Baiardini, I.; Baena-Cagnani, R.; Zanella, C. Effects on symptoms and quality of life of hypertonic saline nasal spray added to antihistamine in persistent allergic rhinitis—A randomized controlled study. Eur. Ann. Allergy Clin. Immunol. 2005, 37, 353–356. [Google Scholar] [PubMed]
- Ural, A.; Oktemer, T.K.; Kizil, Y.; Ileri, F.; Uslu, S. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: Clinical study. J. Laryngol. Otol. 2009, 123, 517–521. [Google Scholar] [CrossRef] [PubMed]
- De Souza Campos Fernandes, S.; de Andrade, C.R.; da Cunha Ibiapina, C. Application of peak nasal inspiratory flow reference values in the treatment of allergic rhinitis. Rhinology 2014, 52, 133–136. [Google Scholar] [CrossRef] [PubMed]
Mechanism | Action |
---|---|
Mechanical intervention | Mucus lining dislodgment |
Removal of inflammatory mediators | |
Impact on mucociliary clearance | Reduction in microbial antigens level |
Decline of microbial burden | |
Positive effect on epithelial cell integrity and function in the presence of additional ions | Magnesium promotes cell repair, limits inflammation, limits exocytosis, and reduces apoptosis of respiratory cells |
Zinc reduces apoptosis of respiratory cells | |
Potassium exerts anti-inflammatory action | |
Bicarbonate reduces mucus viscosity |
Mechanism | Action |
---|---|
Most common composition | Isotonic saline (0.9%) or hypertonic saline (1.5–3%) |
pH varying from 4.5 to 7 | |
Optimal means of irrigation | Large volume |
Positive pressure | |
Compressible douching system | |
Indication | Acute upper respiratory tract infections |
Chronic rhinosinusitis | |
Allergic rhinitis |
© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Principi, N.; Esposito, S. Nasal Irrigation: An Imprecisely Defined Medical Procedure. Int. J. Environ. Res. Public Health 2017, 14, 516. https://doi.org/10.3390/ijerph14050516
Principi N, Esposito S. Nasal Irrigation: An Imprecisely Defined Medical Procedure. International Journal of Environmental Research and Public Health. 2017; 14(5):516. https://doi.org/10.3390/ijerph14050516
Chicago/Turabian StylePrincipi, Nicola, and Susanna Esposito. 2017. "Nasal Irrigation: An Imprecisely Defined Medical Procedure" International Journal of Environmental Research and Public Health 14, no. 5: 516. https://doi.org/10.3390/ijerph14050516
APA StylePrincipi, N., & Esposito, S. (2017). Nasal Irrigation: An Imprecisely Defined Medical Procedure. International Journal of Environmental Research and Public Health, 14(5), 516. https://doi.org/10.3390/ijerph14050516