Saline lavage, or washing of the nose is highly effective in reducing colonization of the nose by bacteria and fungi, cleaning dried mucous from the nose, and pre and post-operative sinus surgery hygiene. In some individuals, saline lavage works well to control chronic nasal drainage. We believe that such lavage works well because of the combination of mechanical cleaning with large volumes of saline, use of sufficient saline to reach the primary drainage site of the sinus (known as the middle meatus or osteomeatal complex) and the physiologic effect of using normal saline as the irrigation solution.
Although commercial products are available for this purpose, we recommend the following:
Mix 1 level teaspoon (5 grams) of non-iodized salt in 2 cups (16 ounces or 480 milliliters) of clean water, which yields a 0.94% saline solution. The salt content of human blood, or also known as normal saline, is 0.9%.
This solution can be applied to the nose using a nasal irrigation or bulb syringe (as would be used for cleaning the nose or irrigating the external ear), a clean turkey baster or a Water Pik nasal irrigation attachment (such as the Grossan Nasal Irrigator®, [HydroMed]). In using any of these methods, the saline should be used daily; the device should be placed within the nostril without occluding the nose and directed towards the inner margin of the eye; the head leaned over a sink to permit the irrigant to passively drain from the nose or mouth; and, no pain should occur if the nose is irrigated properly.
Minutes to hours following nasal lavage, the saline solution will often drain from the nose during movement of the head. This may be minimized by moving one's head downward or from side to side to permit this irrigant to drain out of the nose and sinuses. This planned maneuver allows the patient to clear their nose of saline, rather than during a socially embarrassing moment.
Although numerous commercial nasal irrigants are available, in our opinion the saline is active or essential ingredient, and the patient is served well by this simple therapy.
Nasal irrigation with saline, or other therapeutic solutions, is directed towards the medial canthus (inner margin of the eye [arrow]). This aims the irrigant towards the site of drainage of the frontal, ethmoid and maxillary sinuses into the nose.
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