Nasal Saline Irrigation
Nasal saline irrigation has been performed for thousands of years all over the world, although until recently there had not been scientific studies performed to determine the benefits or lack thereof. As with all Western medicine, strong studies are essential to determine a treatment’s worth. Scientific proof is both a necessary and a good thing. It’s helpful to know if there is evidence that a treatment works, and it’s even better to have evidence that it does not cause you harm. Some forms of treatment may seem safe when they are not.
Sometimes information on benefit and risks of therapies can be discerned from a large group discussion, but when science controls for many different parameters that could affect the treatment, like age, race, gender and geographic location, this provides additional valuable information.
Additionally, if the dose or concentration of a medicine is unknown, performing studies helps determine the optimum concentration, since low concentrations may not work and too high concentrations may cause side effects. That gives more credence to what you are doing.
Blood letting was performed for centuries before a study done in the 1850s showed it did not help and was harmful. Bleeding out is a real and dangerous possibility. While a saline irrigation is performed with only salt water, it could also have negative side effects. for example, simply drinking too much fresh water can kill a person. Understanding the parameters of every treatment is essential to discover its limitations. We’ll see that in the next section on apple cider vinegar.
The Benefits of Scientific Studies
Scientific studies are good and can be helpful. I think an open mind by western scientific medicine is good too. And homeopathic and naturalists should be open to studying scientific remedies to make sure they work. No one should be scared of information and evaluation. That only improves our understanding of how the human body works and how the medicines and treatments we use affects it. The goal is to break down whatever scientific evidence is available combined with what people are saying on the internet to give you information about what might be best for you and your child. We as a society are trying to take health back into our own hands – with healthy diet, and more exercise, and less stress.
Scientific studies on nasal saline irritations have occurred for the last 30 years. Various methods for getting the saline spray or rinse or irrigation into your nose has occurred and has been studied. In fact, over the last two decades there have been at least 60 articles published in medical scientific journals on the subject, some from his country and some from around the world. These studies evaluate all delivery methods from saline mist from a bottle, saline irrigation from a bottle or Neti pot, saline sniffed from your hand, and atomized or vaporized saline from a medical device. In these studies various concentrations of salt have been looked at, various forms of buffering by altering the pH with bicarbonate, and whether it is heated of not.
There are essentially two ways to look at it, subjectively or how you feel, and objectively, what do your exams and tests show. Subjectively, you can just ask a person and they’ll tell you if it is good of bad or they are helped or not. And being helped can mean different things. It can mean my sinuses symptoms are gone – which includes resolution of my nasal congestion, my sinus pressure, drainage or cough. Or it might mean I have more energy, less fatigue and more clear headed.
What Kind Of Sinus Treatment Studies are Available?
Doctors, again, want to make this scientific. So they devise questionnaires with these same questions in a certain format to making sure they are comparing apples to apples. For sinus symptoms there are a few questionnaires in this country and the same or different in other countries. So even studies in China, India and Japan use these questionnaires. Scientists call these questionnaires “instruments” and they validate them to make sure they are accurate. The instrument sinus allergy people use the most is called the Sino Nasal Outcome Test or SNOT 20. Doctors love to make up acronyms that coincide with the disease process. Doctors think they are clever and funny, and sometimes they are.
The Snot 20 is 20 questions that ask someone how they feel about an intervention. Study subjects take one at the beginning of the study and one at the end, to see if there is a difference. The Snot 20 has sections that deal with nasal symptoms and general quality of life issues as well, because doctors want to make sure not only your symptoms are better, but you feel better.
Objective tests are the data that can be examined and include the physical exam and all the tests that can be ordered. The patients physical exam can include if nasal tissues are less swollen, is there less drainage, are the secretions more clear, is the temperature gone. Tests include sampling the tissue, measuring the mucociliary clearance (how the ciliary flow works), testing the components of the secretions, looking for changes in the chemical mediators, seeing if the X-rays or CT scan improves and determining the airflow through the nose with flow measures called acoustic rhinometery.
Medical Research Improves Medical Treatments
So all theses measurements combined let doctors know how you are doing. Researchers then use statistics to see if the intervention we do, like saline irrigation improves these parameters, whether that is your symptoms, your signs or your tests. You may know when you are feeling better, but that feeling does help doctors recommend or not recommend an intervention to other patients based on how a group of people did. With every intervention, there is a risk to benefit ratio. If some things have no significant risk to cause harm, are cheap, easy to use and might make you better, why not try it. If some things are expensive, may make you better but have significant risk, you may need to think about it.
Additionally, when something is significant in medical language it can mean a lot of things. Statistics are based on the number of people in a study as well as the number of people who get better. So if you have 1000 people in each arm of a study and 100 get better in one group compared to 50 getting better in another group, that may say that intervention was statistically significant. That still means 900 people did not get better.
And many times we recommend something because the majority get better, such as 70% of the time. That means 3/10 people who try it will not get better. So you have to know that as the patient and the consumer.
The Medical Benefits of Saline
So back to saltwater. The 60 scientific studies looked at all the parameters discussed – concentration of salt, delivery system, buffering with bicarbonate and temperature of water. It also looked at the disease it was used in, such as an upper respiratory tract infection, allergies, a sinus infection, or chronic sinus condition. Even though doctors can’t always tell what is exactly occurring when you have a runny nose, the doctors involved in designing the studies have tried to do as good as job as they can to differentiate these conditions, even though there could be some overlap.
The most common disorder kids get are colds, or what doctors like to call URIs- upper respiratory illnesses. That term is slightly generic and effectively lumps together nasal symptoms that could be related to an infection of the nose, like sneezing, nasal congestion, runny nose, cough and fever. However, it does not really tell us if it is a virus or bacterial infection. And it may not matter what you call it if the symptoms go away on their own.
If your body fights it off without antibiotics, your body did its job whether it was a bacteria or a virus causing the symptoms. Doctors do believe, based on some scientific evidence in bacteria infections of the ears and sinuses that bacteria sinus infections may be cured by the body’s defense mechanisms up to 40% of the time. So helping your body fight the bacteria or virus by irrigating it out of the nose and helping clear the cilia so they can work is a good thing.
Viruses do spread much easier than bacteria so the likelihood is that your symptoms would be related to a virus. The average preschool age child has 6 to 10 colds a year and the average adult has 2 to 4.
Because nasal symptoms of infection are much more likely to be caused by a virus, the American Academy of Pediatrics has recommendation for your pediatrician to not treat the symptoms with an antibiotic for 7 to 10 days to allow your body to kill the virus and even the bacteria (if present) by the effort of your own immune system. Unless your child spikes a fever or complains of significant facial pain, your doctor may wait to prescribe antibiotics, because you probably won’t need them. But you can still take something to make you feel better, and saline irrigation has been shown to be beneficial.
Using Saline Irrigation Solutions at Home as a Nasal Treatment
So the most gentle application would be an isotonic saline mist such as in the squeeze bottle spray or aerosolized can. Isotonic means the same salt concentration as our body already contains, 0.9%. That is called a 1 molar solution. This category also includes studies of the medical machines such as the like the rhinotherm that will atomize the saline into the nose, or creating steam over your stove and inhaling it, that are recommended on certain websites.
The studies are varied in defining the benefit you obtain from these saline mist treatments. Some studies say they help, some studies say they don’t.
Some studies say the heated mist like in the rhinotherm is better, some report they are equal. It is interesting that the studies in North America show no benefit and the studies in Europe show a positive effect. There is laboratory evidence that the cold virus may be sensitive to heat greater than 109 degrees Fahrenheit, which the rhinotherm generates.
The warm saline might kill or hamper the virus and the extra moisture could help the cilia beat like they should. The only side effects of rhinotherm were local discomfort and ruining of make-up. In one study, it made the nose a little stuffier. All the studies were in adults. Bottom line, it should not cause you significant harm, if it is not too hot.
Nasal Saline Irrigations
The next category of saine delivery are the irrigations, and these can be negative pressure (sniffing from you hand) and positive pressure, squirting it into your nose with a squeeze bottle or Neti pot.
The Neti pot may be more of gravity drainage, but it is grouped in with positive pressure irrigation. These are the most studied in all diseases – i.e respiratory infections, allergies and chronic sinus problems. The studies all show this is superior to the mist.
The studies have looked at x-rays, like CTscans, measurements of nasal patency, like rhinomenometry, physical exam, measurements of ciliary flow and validated questionnaires, like the SNOT 20 both pre and post treatment. Most all show benefit with the positive and negative irrigation. And these studies have looked at kids and adults, with a URI, allergies and chronic sinus infections.
The water for your irrigation that is mixed with the salt should be distilled water or boiled tap water and then cooled to room temperature. The concentration of salt has been studied as well. Pure water has been compared to isotonic and hypertonic salt solutions.
The hypertonic solutions have had both twice and three times the concentration of salt. In these studies, there is a good, better and best treatment. The three times concentration is better than the two times concentration is better than the isotonic concentration. All seem to be good. The plain water without salt is actually bad for you.
But the tolerability is just the opposite. Isotonic is more tolerated than two times concentration than three times concentration, which is a factor when using the saline irrigation options. Some participants in studies complain of nasal burning with more concentrated salines.
Buffering the solution with sodium bicarbonate has been studied as well. The altered the pH. Ph’s of 6,5. 7.6 and 8.9 have been studied. The optimum pH is for function and benefit seems to be 7.6, which is closest to the body’s physiological pH of 7.4.
These solutions must be mixed up daily since they can be contaminated with bacteria and fungus. And studies have shown cross contamination if used by more than one person and not cleaned.
Are Nasal Saline Irrigation Treatments Right For You?
So overall, saline irrigation is good. Some are better than others, but all can be beneficial. So if one does not work for you, you can try the next level. There have not been any significant reported adverse effects, so this is definitely something you should try. If you have sinus problems would like to learn more about saline irrigation in Frisco, TX and the surrounding areas, contact Dr. John McClay’s office today by calling 214-494-4150 to set up an appointment!