This Solution to Pollution is Dilution
|Isaac Namdar, MD, FACS
Board Certified Otolaryngologist
Managing Partner, Head & Neck Surgical Group
About the author: Dr. Isaac Namdar M.D. completed his undergraduate studies at State University of New York at Stony Brook. He graduated valedictorian of his entire undergraduate class. There, he was accepted into the early-decision medical program and he enrolled in medical school within the same facility. Dr. Namdar was then accepted into Manhattan Eye, Ear, and Throat Hospital, which is considered to be one of the top ranking specialty training hospitals in the nation. Some of the premier academic institutions that participated in his training include Memorial Sloan-Kettering Cancer Center, Cornell Medical Center, and Columbia Presbyterian Medical Center.
The solution to pollution is dilution. They taught me this during residency about the hygiene of the sinuses, way before Oprah made Neti pot fashionable. It was true then, and it is most certainly the newest thinking in sinus care.
As the primary entrance of air into our body, the nose and sinuses are prone to all kinds of irritants landing there and causing a reaction. Allergens cause a cascade of chemical inflammatory changes that lead to congestion and runny nose. Viruses and bacteria can also land in the nasal passages and cause various degrees of infections. Even our own nasal secretions can sometimes collect, cause blockage, and even get infected.
Irrigation of the nasal sinuses is not a new concept. It has been described in various historical texts throughout the ages. For a good part of the beginning of the 20th century, this kind of irrigation was performed routinely by ENT doctors in an office setting. Patients used to come almost daily for a visit and lavage of the sinuses with power instruments. That added up to a whole bunch of visits very fast.
A more user-friendly and actually more effective way of irrigating the sinuses is to do it at home with better frequency. I typically recommend that most patients with sinus issues should irrigate at least once a day for maintenance. If they feel that the sinuses are starting to feel more sensitive, they can increase the frequency of irrigation to two or three times a day. Some experts also recommend increasing the concentration of the saline solution to 3% once an infection is suspected. The extra salt concentration ideally would kill the bacteria in the sinuses as well as flush them out.
The Neti pot device has been the staple of delivering the irrigation fluid to the sinuses. Its use depends on the concept of using gravity to pull the water from one nostril into the sinuses on the same side to the sinuses on the opposite side, and out the opposite nostril. For those who find this rather challenging, the squeeze bottle and the pressurized cans designed for large volume nasal irrigation are legitimate alternatives.
The ability to actually get the irrigation fluid into the sinuses depends on having rather open nasal passages. Unfortunately, many patients with sinus disease have deviation of their septum, enlargement of the turbinates, or rather narrow sinus drainage pathways that got them into trouble to begin with. With any of the above anatomical predispositions, irrigation might not lead to the desired improvement. Some sinus patients might actually benefit from undergoing corrective surgeries to establish more open sinus openings in order to allow for better irrigation in the future. Candidacy for this kind of surgery is best established through a visit to your ENT specialist, as well as supportive tests, most commonly a CT scan of the sinuses.