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HEALTH SENSE

Keeping your nose clean

OK. So your daily attempt at perfection already includes brushing and flossing, exercising, meditating, eating fruits and veggies, and overall clean, healthy living. Here's one more health habit you might consider. (Or not.) In lay terms, it's called keeping your nose clean. In fancier language, it's nasal lavage -- also known as nasal irrigation or sinus rinsing.

 

It's a simple, low-tech way to wash out the viruses, bacteria, mold, allergens, dust, mucus, and general crud that land inside the nose and sinus passages and contribute to colds, chronic nasal congestion, post nasal drip, frequent sinus infections, asthma, and other respiratory ills.

The basic idea, unappealing as it sounds, is to squirt a solution of slightly salty water up your nose, let it drip out, blow your nose gently, then repeat. The mechanical action of flushing out thickened mucus cleanses the nasal passages, making it easier for tiny hair-like cilia that line the nose to push the remaining mucus out.

Before we get to the bewildering array of products out there for the nasally challenged, take it from a reluctant connoisseur of this somewhat arcane practice: No matter what product you use, technique matters.

Squirt the solution up your nose with too much force and it hurts. Squirt too gently and you're not accomplishing a thing. If the solution is too salty, it stings. Ditto if it's not salty enough.

That said, here's the case for indulging in this weirdness. For one thing, it's been around in many cultures for centuries. For another, ear, nose, and throat specialists swear by it for anyone with chronic sinus problems -- even children.

"Many patients who have sinus disease, allergies, or chronic infections are improved tremendously by lavaging their nose out once or twice a day," says Dr. Gerald Berke, chief of head and neck surgery at the University of California, Los Angeles. And for those who have had surgery to open up narrowed sinuses, regular cleansing is a must. "The main improvement they experience is the ability to lavage out the cavity," says Berke.

Even if antibacterial medications are added to the lavage solution, "most of the benefit is from the mechanical rinsing of the nasal cavity," says Dr. Eric Holbrook, an otolaryngologist at the Massachusetts Eye and Ear Infirmary. Among other things, the gunk you rinse out in mucus includes natural chemicals called cytokines, which promote inflammation. "If you remove the mucus, you can actually reduce the inflammation," Holbrook says.

"I am a strong believer in nasal lavage," adds Dr. Ralph Metson, another sinus specialist at Mass Eye and Ear. But people need to do it with salty water "to wash out mucus."

While large, controlled studies of nasal lavage for treating and preventing colds and sinus infections are hard to come by, the little data that does exist seems to support the practice.

One study of more than 200 patients published in 2000 in the journal Laryngoscope found that after three to six weeks of nasal irrigation, patients reported statistically fewer nasal symptoms. A 1997 study of 21 volunteers in the same journal found that lavage improved the speed with which nasal cilia were able to move mucus along. A 1998 study in children published in the Journal of Allergy and Clinical Immunology showed that lavage is "tolerable, inexpensive, and effective."

So, how to do it. First, the recipe. To make an isotonic solution (the same saltiness as body fluids), add to 8 ounces of water one-quarter teaspoon of salt and one-quarter teaspoon of baking soda. (The baking soda keeps it from stinging.) To make a hypertonic solution, use more salt.

The simplest, albeit messiest, way to get the solution up your nose is to cup it in your hand and sniff, although this lacks a certain elegance. Ceramic Neti pots, popular among the yoga set, work better, although you may not get the water up high enough.

Those blue bulb syringes for cleaning out babies' ears and noses work, too, though, again, it can be hard to get the solution up high enough. Turkey basters and flower pots with nostril-sized spouts are also said to work, although this could not be confirmed. (Well, it could have been, but it wasn't.)

Small, 3-ounce squeeze bottles of pre-packaged saline nasal spray available at most drugstores don't really flush out the sinuses; they just moisten the inside of the nostrils.

Nebulizers also deliver a spray, not a real jet of water, but they work well for children, says Dr. Sandra Lin, an otolaryngologist at Johns Hopkins School of Medicine, who says she has "seen patients really turn around" on nasal lavage.

Larger squeeze bottles such as the 14-ounce ones made by SaltAire Sinus Relief get the cleaning solution higher up into the sinuses. This system, developed by doctors Robert Pincus and Scott Gold, co-directors of the New York Sinus Center, is indeed, just as they claim, easy to use and the buffered hypertonic solution does not sting. (Buffering means the acidity of the solution is adjusted so that it is close to that of the body.) The SaltAire product costs $12.50.

Dr. Ketan Mehta, a pulmonologist and intensive-care specialist based in Santa Rosa, Calif., has developed a different lavage system called "Sinus Rinse," made by his company, NeilMed Products Inc. For $10.95, you get an 8-ounce squeeze bottle with a gently pointed tip and 50 packets of pre-mixed solution to which you add 8 ounces of water. The NeilMed product can also be hooked up to a Waterpik or similar system that is electrically powered and delivers pulses of solution.

The Waterpik Technologies folks, who make oral irrigation devices that squirt water around the teeth under the gums, also have their own attachment called Gentle Sinus Rinse. The Waterpik irrigators cost from $35 to $50 depending on the model, with an extra $10 to $15 for the sinus adapter.

Other nasal hygiene products are becoming increasingly available on the Internet and in stores. Yeah, it sounds weird. But you just might end up with one of the true blessings in life -- clear sinuses.

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com

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