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Medical Forum / Diseases and Disorders / Sinusitis / January 2005Head to the side when irrigating
Writers raise a good point re head to one side while irrigating vs head dead center. Most of the "pot" irrigation systems require you to hold your head to the side. Ths places the solution at the "bottom" where the eustachian tube is located. We regularly see patients with solution in the ear from this. With pulsatile irrigation it is the flow past the sinus and eustachian openings that is therapeutic. Actually, pulsatile irrigation is recommended for patients with chronic eustachian blockage/ with serous otitis as that helps to clear the sinus and eustachian swelling. People vary as to the shape, size, opening , etc of the Eustachian tube. Fortunately most persons have no problem with the head to the side methods. But the reason head centered is recommended for pulsatile irrigation is that this is the position it works best in . Re the statement: more comes out when the head is to the side: Pulsatile irrigation is NOT a hose stuck into the sinus cavity. It is a means of getting the nasal / sinus cilia moving so they will drain the sinuses in a natural manner. Murray Grossan, M.D. http://www.ent-consult.com > Writers raise a good point re head to one side while irrigating vs head dead > center. > > Most of the "pot" irrigation systems require you to hold your head to the side. True, most irrigation systems throughout history have necessitated that the head be held to the side. The Neti Pot is thousands of years old, and still in use today, and it involves holding the head to the side. If there were frequent problems with the ears and eustachian tubes as a result, its use woud not have continued. Same thing with using an ear syringe to irrigate the nose. Or an injection syringe. Same with most squeeze bottles to irrigate the nose. The Neilmed bottle comes with a tube, which means you can use it upright. (I took the tube out, because I prefer head to side.) But most other such bottles do not come with such a tube, and require head to side, like that expensive nasal wash bottle from Germany (I forget the name of it), and I believe even your own nasal wash bottle, Dr. G. (Not sure of the latter. Does it come with a tube for upright irrigation?) So although some people might have had problems with irrigating with head to side, such as a poster who wrote about it, it seems that the vast majority of people who irrigate their nose, throughout history, have not had such problems. > We regularly see patients with solution in the ear from this. "Regularly"? Come on, don't exaggerate. I would also assume that you convince most of your patients to use your device, following your directions. But you "regularly" see people who have problems from head to side irrigating? How often is "regularly"? Once every decade? > Fortunately most persons have no problem with the head to the side methods. Agreed. > But the reason head centered is recommended for pulsatile irrigation is that > this is the position it works best in . What evidence is there for that? Were there comparative tests of irrigation with the head in different positions? Care to post a URL showing that comparative research study? Sometimes it seems that you invent "facts", and expect people just to believe them, because you said it. > Re the statement: more comes out when the head is to the side: > Pulsatile irrigation is NOT a hose stuck into the sinus cavity. It is a means > of getting the nasal / sinus cilia moving so they will drain the sinuses in a > natural manner. I definitely get out more of the sticky gunk that fills up my sinuses with my head to the side, as I described. No doubt about that. I am only speaking for myself, cannot speak for everyone. I do doubt the theory that irrigation gets the "cilia moving to drain the sinuses in a natural manner. If that were the case, people who irrigate could eventually stop irrigating, as their cilia would then "drain the sinuses naturally". Sure hasn't happened with me, after decades of irrigation. Same thing for many regular writers here, who have been irrigating for years. Irrigation is helpful in washing the gunk out of the nose and sinuses, but I certainly haven't seen evidence that many people have been "cured" due to their "cilia being restored". Anyone here been "cured" by irrigation? You are correct, I only see the patients who are sick, have failed regular Rx and have ear problems. I don't see the patients who don't have fluid in the ear from irrigating to the side, only the one's who do. You are correct, once the cilia are normal again, there is no further need to continue irrigation. That is in the directions that comes with the Hydro Pulse. Murray Grossan, M.D. http://www.ent-consult.com > You are correct, I only see the patients who are sick, have failed regular Rx > and have ear problems. I don't see the patients who don't have fluid in the ear > from irrigating to the side, only the one's who do. Highly unlikely. You yourself said that most people do not have problems with head to side irrigating. Of course you see patients who are sick, that is why they come to see a doctor. But I guess your statement above is somewhat of an attempt at sarcasm, although not very funny. I guess if you cannot reply to the facts, reply with sarcasm. > You are correct, once the cilia are normal again, there is no further need to > continue irrigation. That is in the directions that comes with the Hydro Pulse. According to your theory, that should be the case. But my question is: how often does that actually happen, that someone is "cured" after irrigating a while, and never needs to irrigate again. If that has ever happened, my guess is it would be a very rare occurrence. Many writers to this newsgroup have irrigated (using your suggested "pulsatile" irrigation) for years and decades. So I'll ask them--have any of you been "cured" by irrigation, so your nose and sinuses behave as normal ones, and you do not need to irrigate any more? It's a nice-sounding theory, but I have doubts about whether it really works that way. People (myself included) feel better after irrigating, because it washes out the thick gunk clogging up one's nose, sinuses, and throat, and therefore allows one to breathe better, but I really haven't heard of anyone who has been "cured" due to irrigation. Sure hasn't happened to me, after decades of irrigation. So I'll ask them--have any of you been "cured" by irrigation, so your nose and sinuses behave as normal ones, and you do not need to irrigate any more? Among my own patients the majority do not have the need to continue pulsatile irrigation after they are cleared. Pulsatile irrigation can be recommended for many different conditions. for example simple post nasal drip. The majority stop after 3 weeks. Of course the condition can reoccur and then they need to use the pulsatile irrigator again. Patients I see from 10 years ago tell me that they reuse the pulsatile irrigator about once a year. But the patients that have no functional cilia - like Empty Nose do have to continue use daily to replace or act as a clia function. The doctors who require pulsatile irrigation of their patients post Fess find that they don't need to continue past one month or 6 weeks. But this doesn't apply when the patient is having a second or third surgery. To answer your question, how many persons using pulsatile irrigation are cured and don't need to use it any more, it depends on the condition, the amount of viable tissue present and of course the immune system. Among my own patients, more than 50% stop after 4-6 weeks. Once the nose is normal, don't need to be more normal. Among non patients of mine who use pulsatile irrigation I don't have statistics, but the fact that our biggest source of referral is word of mouth suggests that it helps a lot of sinus patients. Murray Grossan, M.D. http://www.ent-consult.com A few months ago, I reduced my irrigations down to once a day. (been irrigating for about 5 years now). ....Four days ago, I tried eliminating the irrigation completely and just use the flonase. ...Today I'm plagued with some flared up sinuses (and a sore throat), so it's back to three times a day. ...Jon That's interesting. Just different from my own experience, and that of posters I have read here. Many have been irrigating daily for many years, and have not been "cured". Also, of the many ENTs and allergists I have been to, some have recommended irrigation, while others have not, some actually recommending that I stop it. Of those who recommend it, I haven't heard one say it could "cure" my problem, that I could stop irrigating after my cilia become "restored", etc. Just a matter of washing out the junk. I am glad that many of your patients have been "cured" (or partially "cured") due to irrigation though. > So I'll ask them--have any of you been "cured" by irrigation, so > your nose and sinuses behave as normal ones, and you do not need to irrigate [quoted text clipped - 26 lines] > Murray Grossan, M.D. > http://www.ent-consult.com > That's interesting. > [quoted text clipped - 73 lines] >>Murray Grossan, M.D. >>http://www.ent-consult.com Irrigating works for me. I'll need to go back to using it after a cold or sometimes during allergy season to clear up some post nasal drip. But I put the Hydro Pulse away for months at a time and only take it bac k out and use it when I begin to have some problems (like now). Susan |
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