Sinus/Nasal Rinse & Topical Treatment Instructions

Anh Q . Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What is sinusitis (sinus infection)?

Rhinosinusitis, or commonly known as sinusitis, is inflammation and infection of the paranasal sinuses. This typically occurs when the channels (ostiums) of the sinuses are blocked and the sinuses and nasal cavities are filled with mucous and pus. The underlying cause may be anatomical abnormalities (deviated septum, enlarged turbinate, narrow ostium), nasal polyps, allergy, a viral infection (cold/flu), a bacterial infection, or a fungal infection. Click here to learn more about sinus infections.

The treatment for rhinosinusitis depends on the underlying cause. In general, watchful waiting with supportive treatment such as nasal saline irrigation (sinus rinse or neti pot), topical nasal steroid spray, short term nasal decongestant and oral decongestants can alleviate symptoms with most types of sinusitis. In cases of refractory sinusitis, antibiotics, oral steroids and sinus surgery may be employed.

Topical therapies have been proven to be an effective adjunct to the treatment of sinus infections. They are generally safe and can be used on a long-term basis when indicated.

What is sinus irrigation (nasal saline irrigation)?

Sinus irrigation is an ancient technique that has been well studied in the recent literature and shown to be a safe, effective and well tolerated treatment. Sinus irrigation is achieved by delivering a large volume (e.g. 8 oz) of isotonic (0.9% normal salt concentration) or hypertonic (3% salt concentration) salt solution (saline) through the nasal cavity. Although the irrigation is more effective after sinus surgery, it remains a helpful technique to clear mucous, allergens, bacteria and viruses in all patients with an active sinus infection.

Neti Pot (left) | Squeeze Sinus Rinse (middle) | Electric Sinus Irrigator (right)

There are different types of delivery systems that are available for purchase over-the-counter at most drugstores. The neti pot passively delivers the salt water through the nasal cavity without force. The squeeze bottle can deliver salt water through the nasal cavity with gentle pressure from squeezing the bottle. Recently, powered sinus irrigators became available and utilize electricity to actively rinse the nasal cavity. Most sinus rinse kits will have pre-made salt packages and instructions on how to sterilize, mix and use the kit.

How is the salt water prepared and used?

• 1. Pour 240 mL (8 oz) of distilled water, filtered water or tap water that has been boiled and cooled into the irrigating bottle. Boiling of tap water is necessary to reduce the risk of an extremely rare brain infection that occurs when the local water supply is contaminated with an amoeba, Naegleria fowleri.

  2. If you have the pre-packaged salt mixture, then pour the salt mixture into the bottle as directed by the manufacturer and shake it to dissolve the salt. If you are mixing your own salt solution, then follow the recipe below:

     • Mix 2-3 teaspoons of iodine-free salt and 1/2 teaspoons of baking soda to 1 liter of distilled water, filtered water, or boiled water that has been cooled. You may divide the solution up for multiple uses.

     • To mix a smaller volume, mix 1 flat teaspoon of iodine-free salt and 1/8 teaspoons of baking soda to 250 mL (about 8 oz) of distilled water, filtered water, or boiled water that has been cooled.

  3. Rinse 4 oz of the salt solution through the left nostril and 4 oz of the salt solution through the right nostril. You may view the instructional videos by clicking the links below.

  4. Gently blow your nose without pinching it.

  5. You may apply any topical medication AFTER the irrigation if needed.

     • If you are using a neti pot, tilt your head downward over the sink or shower. Rotate your head to the left and place the tip of the device snugly against your right nostril. Keep your mouth open and without holding your breath, gently let half of the solution flow through the right nostril. It should flow out of the left side. Rotate your head and perform the procedure in the same manner on the opposite site. If the solution drains into your throat, spit it out.

What is the best way to clean the sinus rinse kit?

It is important to keep your sinus rinse kit clean to avoid contamination from repeated use. Ideally, it should be cleaned daily. If you purchase a sinus rinse kit, make sure you follow the manufacturer’s instruction on how to keep the equipment clean. In general, the most effective method of cleaning the sinus device is by microwaving the device for 2 minutes in a bath of water or to clean it with Milton’s antibacterial solution (a diluted bleach). Make sure that your device is microwave-safe before sterilizing it with the microwave. Do not use a dish-washer to clean the device – it is not effective.

What is the appropriate method of applying topical nasal medication?

Topical intra-nasal medication such as antihistamine and corticosteroid can be an effective adjunct in managing symptoms of allergy and sinus infections. It is important to use the nasal spray appropriately in order to achieve the most optimal result and to minimize side effects such as nose bleed and throat irritation.

Use the right hand to apply medication to the left nostril by tilting out (left) and vice versa (right)

Use the right hand to apply medication to the left nostril by tilting out (left) and vice versa (right)

• 1. Hold head in a neutral upright position

  2. Clear nose of any thick or excessive mucus, if present, by gently blowing the nose.

  3. Insert spray nozzle into the nostril.

  4. Direct the spray laterally or to the side, away from the middle of the nose (septum) and toward the outer portion of the eye or the top of the ear on that side. (If possible, use the right hand to spray the left nostril and left hand to spray the right nostril, to direct the spray away from the septum.)

  5. Activate the device as recommended by the manufacturer and with the number of sprays recommended by the doctor. You may need to prime the device prior to use.

  6. Gently breathe in or sniff during the spraying.

  7. Breathe out through the nose.

References:

• 1. Harvey, Richard J., et al. "Current Concepts in Topical Therapy for Chronic Sinonasal." Journal of Otolaryngology-Head & Neck Surgery 39.3 (2010): 217-231.

  2. Lee, Jivianne T., and Alexander G. Chiu. "Topical anti-infective sinonasal irrigations: Update and literature review." American journal of rhinology & allergy 28.1 (2014): 29-38.

  3. Snidvongs, Kornkiat, et al. "Sinus surgery and delivery method influence the effectiveness of topical corticosteroids for chronic rhinosinusitis: systematic review and meta-analysis." American journal of rhinology & allergy 27.3 (2013): 221.

  4. Achilles, Nils, and Ralph Mösges. "Nasal saline irrigations for the symptoms of acute and chronic rhinosinusitis." Current allergy and asthma reports 13.2 (2013): 229-235.

  5. Huang, Alice, and Satish Govindaraj. "Topical therapy in the management of chronic rhinosinusitis." Current opinion in otolaryngology & head and neck surgery 21.1 (2013): 31-38.

  6. Psaltis, Alkis J., et al. "Contamination of sinus irrigation devices: a review of the evidence and clinical relevance." American journal of rhinology & allergy 26.3 (2012): 201-203.

  7. Rudmik, Luke, et al. "Topical therapies in the management of chronic rhinosinusitis: an evidence‐based review with recommendations." International forum of allergy & rhinology. Vol. 3. No. 4. 2013.

  8. Benninger, Michael S., et al. "Techniques of intranasal steroid use."Otolaryngology-Head and Neck Surgery 130.1 (2004): 5-24.