hydromed@adelphia.net (Murray Grossan) wrote:

I've recommended cold water irrigation, for years on this group.   ...I
tend to get sinus induced headaches, centred  beneath an eyebrow, or
between the eyes. ...The cold water works wonders towards clearing this
up. ...It's not really painful, but you find your eye muscles are a
little slow to react, for a few minutes afterwards.

It was the cold water irrigation that helped clear a major sinus
infection I had about 6 years ago. ...I went for 3 days feeling lousy,
like I had a cold or flu. ...My head was pounding, and I felt nauseated.
I irrigated with cold water, and lay face down on an ice-pack. ...10
minutes later, I irrigated again with the cold/salty water, and flushed
out masses of green and yellow crap.  ...Within seconds, my headache,
nausea, and cold-like symptoms were completely gone.  ...It was amazing.  

..I assume the cold water was able to settle the inflammation just
enough, to permit the infected material a drainage route.

Whenever I irrigate now, I use either lukewarm (room temp.) water, or,
if I feel a flare-up coming on: water as cold as I can get it.  

..The only thing you can't do with the cold water, is suck it in
through the nostrils (as you can with warm water, while irrigating).
..It immediately zips right through your nasal passages, and down your
throat.       ...Jon

What chemicals? I would imagine it matters whether your tap water is
well water or municipal--treated water. I boil the water to kill any
water loving bacteria, and don't boil it down to the point I woud be
concentrating any chemicals.
 You've said any bottle water is fine, but municipal water actually
has sterility standards while bottled water has none.
Here is a copy of the comments of an ENT from Pittsburgh, in response
to an article in Annals of Family Medicine about irrigation: I found it
extremely informative:

Berrylin J Ferguson,
Pittsburgh, USA
M.D., University of Pittsburgh School of Medicine
Send response to journal:
Re: Commentary on: "Qualitative Aspects of Nasal Irrigation Use by
Patients With Chronic Sinus Disease in a Multimethod Study"

Email Berrylin J Ferguson

The authors report on the quality of life improvements and reflections
of over two dozen individuals utilizing hypertonic saline nasal
irrigation on an as needed basis. The findings provide validation of
the anecdotal experience of many rhinologists. Unique to this study was
an apparent added benefit of group training and discussions, which gave
these sufferers an additional benefit conferred from "group
support", a benefit acknowledged in many disease states from cancer
support groups to chronic debilitating diseases. I had not previously
considered that this kind of group support might be helpful for chronic
rhinosinusitis, but from the interviews it appears that it is indeed
appreciated by the participants.

I can think of no way to perform a blinded controlled study of nasal
irrigations, but that doesn't mean they are not effective. In fact,
the efficacy of the irrigation frequently overshadows the efficacy of
any number of added ingredients including antifungals, antibacterials,
and topical steroids.1 The irrigation serves to remove nasal debris in
noses that are not self-cleaning, which is particularly a problem in
patients with nasal polyps or who have undergone extensive sinus/nasal
surgery.

Nasal irrigation can also be helpful as a rinse to remove mucus before
the application of a topical steroid or antibiotic. I commonly
recommend a commercial nasal lavage kit, of which there are a half
dozen or so available to assist with compliance. There are many
commercially available nasal irrigators.2 I also provide our patients
with a "recipe" so that they can make their own saline irrigation.
Patients should be warned to use filtered or boiled water, and to make
sure the device used for irrigation is cleaned frequently to prevent
iatrogenic inoculation with water loving microbes such as Pseudomonas
and Serratia.

The debate of hypertonic versus normal saline irrigation is sure to
continue.3 I usually provide the patient with the recipe for hypertonic
saline and suggest that they reduce the amount of salt they add, if
they find that the hypertonic mixture is irritating. Interestingly,
hypertonic inhaled saline has been shown to be beneficial in cystic
fibrosis.4 Seven percent of patients with chronic rhinosinusitis carry
a mutation for cystic fibrosis compared to 2% of normal controls. Thus
there may be a variance in response to hypertonic versus isotonic
saline irrigations, depending on the cause of the patient's
rhinosinusitis.5

Finally, the authors capture in a qualitative manner the relief that
patients feel with this technique. I still recall the words of a
patient on her return visit, "I can't believe I've been suffering for
30 years with the sinus condition when relief was as easy and
inexpensive as this salt water wash." A trial of hypertonic or isotonic
saline nasal rinse is inexpensive, does not promote bacterial
resistance, and safe. Saline irrigations should be a therapeutic
alternative offered to any patients suffering from chronic
rhinosinusitis.

References

1. Ferguson BJ. Antifungal Nasal Washes for Chronic Rhinosinusitis:
What's Therapeutic -- The Watch or the Antifungal? J Allergy Clin
Immunology 2003;111(11)37-8.

2. Tomooka LT, Murphy C, Davidson TM. Clinical Study Literature Review
of Nasal Irrigation. Laryngoscope 2000;110(11)89-93.

3. Garavello W, Romagnoli M, Gaini RM. Hypertonic or Ice Tonic Saline
for Allergic Rhinitis in Children. Pediatric Allergy and Immunology
2005;16:91.

4. Elkins MR, Robinson M, Rose BR, Harbour C, Moriarty CP, Marks GB,
Belousova EG, Xuan W, Bye PT. National Hypertonic Saline in Cystic
Fibrosis (NHSCF) Study Group. A Controlled Trial of Long-term Inhaled
Hypertonic Saline in Patients with Cystic Fibrosis. N Engl J Med
2006;354:229-240.

5. Wang X, Moylan B, Leopold DA, Kim J, Rubenstein RC, Togias A, Proud
D, Zeitlin PL, Cutting GR. Mutation in the Gene Responsible for Cystic
Fibrosis and Predisposition to Chronic Rhinosinusitis in the General
Population. JAMA 2000;284:1814-1819.

Competing interests:   None declared

Please note her rationale for hypertonic saline, and the advice to use
boiled or filtered water.

Judy
Here's the URL
http://www.annfammed.org/cgi/eletters/4/4/295

Pulsatile vs. Non-pulsatile nasal irr

That can't be a universal finding, as tap water varies considerably if
it is from well or municipal water. Municipal water has standards,
bottled water has no standards for sterility.

I personally found this article, and the subsequent letter from Dr.
Ferguson to be very informative re: boiled or filtered water, and the
rationale for hypertonic saline. From the Annals of Family Medicine.
http://www.annfammed.org/cgi/eletters/4/4/295
Berrylin J Ferguson,
Pittsburgh, USA
M.D., University of Pittsburgh School of Medicine
Send response to journal:
Re: Commentary on: "Qualitative Aspects of Nasal Irrigation Use by
Patients With Chronic Sinus Disease in a Multimethod Study"

Email Berrylin J Ferguson

The authors report on the quality of life improvements and reflections
of over two dozen individuals utilizing hypertonic saline nasal
irrigation on an as needed basis. The findings provide validation of
the anecdotal experience of many rhinologists. Unique to this study was
an apparent added benefit of group training and discussions, which gave
these sufferers an additional benefit conferred from "group
support", a benefit acknowledged in many disease states from cancer
support groups to chronic debilitating diseases. I had not previously
considered that this kind of group support might be helpful for chronic
rhinosinusitis, but from the interviews it appears that it is indeed
appreciated by the participants.

I can think of no way to perform a blinded controlled study of nasal
irrigations, but that doesn't mean they are not effective. In fact,
the efficacy of the irrigation frequently overshadows the efficacy of
any number of added ingredients including antifungals, antibacterials,
and topical steroids.1 The irrigation serves to remove nasal debris in
noses that are not self-cleaning, which is particularly a problem in
patients with nasal polyps or who have undergone extensive sinus/nasal
surgery.

Nasal irrigation can also be helpful as a rinse to remove mucus before
the application of a topical steroid or antibiotic. I commonly
recommend a commercial nasal lavage kit, of which there are a half
dozen or so available to assist with compliance. There are many
commercially available nasal irrigators.2 I also provide our patients
with a "recipe" so that they can make their own saline irrigation.
Patients should be warned to use filtered or boiled water, and to make
sure the device used for irrigation is cleaned frequently to prevent
iatrogenic inoculation with water loving microbes such as Pseudomonas
and Serratia.

The debate of hypertonic versus normal saline irrigation is sure to
continue.3 I usually provide the patient with the recipe for hypertonic
saline and suggest that they reduce the amount of salt they add, if
they find that the hypertonic mixture is irritating. Interestingly,
hypertonic inhaled saline has been shown to be beneficial in cystic
fibrosis.4 Seven percent of patients with chronic rhinosinusitis carry
a mutation for cystic fibrosis compared to 2% of normal controls. Thus
there may be a variance in response to hypertonic versus isotonic
saline irrigations, depending on the cause of the patient's
rhinosinusitis.5

Finally, the authors capture in a qualitative manner the relief that
patients feel with this technique. I still recall the words of a
patient on her return visit, "I can't believe I've been suffering for
30 years with the sinus condition when relief was as easy and
inexpensive as this salt water wash." A trial of hypertonic or isotonic
saline nasal rinse is inexpensive, does not promote bacterial
resistance, and safe. Saline irrigations should be a therapeutic
alternative offered to any patients suffering from chronic
rhinosinusitis.

References

1. Ferguson BJ. Antifungal Nasal Washes for Chronic Rhinosinusitis:
What's Therapeutic -- The Watch or the Antifungal? J Allergy Clin
Immunology 2003;111(11)37-8.

2. Tomooka LT, Murphy C, Davidson TM. Clinical Study Literature Review
of Nasal Irrigation. Laryngoscope 2000;110(11)89-93.

3. Garavello W, Romagnoli M, Gaini RM. Hypertonic or Ice Tonic Saline
for Allergic Rhinitis in Children. Pediatric Allergy and Immunology
2005;16:91.

4. Elkins MR, Robinson M, Rose BR, Harbour C, Moriarty CP, Marks GB,
Belousova EG, Xuan W, Bye PT. National Hypertonic Saline in Cystic
Fibrosis (NHSCF) Study Group. A Controlled Trial of Long-term Inhaled
Hypertonic Saline in Patients with Cystic Fibrosis. N Engl J Med
2006;354:229-240.

5. Wang X, Moylan B, Leopold DA, Kim J, Rubenstein RC, Togias A, Proud
D, Zeitlin PL, Cutting GR. Mutation in the Gene Responsible for Cystic
Fibrosis and Predisposition to Chronic Rhinosinusitis in the General
Population. JAMA 2000;284:1814-1819.

Competing interests:   None declared

Judy

Dear Murray Grossan:

This poster was starting with (presumably) tap water, which already
contains a locally variable (and sometimes seasonally variable) amount
of salt and hardness.  I agree with your presecription... for distilled
water.

!Brain Freeze!  ;>)

David A. Smith