Nasal irrigation

Nasal irrigation is a personal hygiene practice which involves flooding the nasal cavity with warm saline solution. The goal of nasal irrigation is to clear out excess mucus and particulates and moisturize the nasal cavity. The practice has been subjected to clinical testing and has been found to be safe and beneficial, with no apparent side effects (for reviews of the literature, see ).

History
Nasal irrigation is an ancient technique, originating from the Ayurvedic practice of Jala neti (literally: "water cleansing"), which involves regularly flooding the nasal cavity with warm salty water.

Methods
Nasal irrigation can be performed in the privacy of one's home using, for example, a fluid-filled syringe. An appropriate solution can be purchased or home made using a salt and water mixture.

Jala neti
The Sanskrit term Jala neti refers to an ancient Ayurvedic cleansing technique, meaning literally "water cleansing," where the practitioner rinses out the nasal cavity with water (typically mixed with salt to form a saline solution for comfort) using a neti pot. The irrigation-specific elements of Jala neti are starting to be recognized by Western medicine under the term nasal irrigation to treat a variety of conditions.

Jala neti, though relatively less known in Western culture, is a common practice in parts of India and other areas in South East Asia, performed as routinely as brushing one's teeth using a toothbrush. It is performed daily, usually as the first thing in the morning with other cleansing practices. It may also be performed at the end of the day if one works or lives in a dusty or polluted environment. When dealing with problems of congestion it can be performed up to four times a day.

Description of method
A typical method utilizes an isotonic saline solution. This roughly matches the concentration of salt found in the blood and natural tears. A warm saline solution is prepared to a 0.9% salinity (9g of salt (about 1 1/2 teaspoons) per litre of water). Non-iodized salt is better. The water should feel slightly warm to the touch. It is important to stir the mixture thoroughly in order to dissolve all the salt.

Recent research has indicated that a hypertonic saline solution may be effective. This is a solution in which the concentration of salt is higher than that found in the blood. A typical concentration used in these studies was 3% salt. At this higher concentration of salt, a buffering agent is usually added to the solution to make it more comfortable.

If a home-made solution is used, the quality of the salt is important. Some practitioners recommend using Kosher salt, which has no added iodine. Fine cooking salt often contains anticaking agents that may cause irritation. Coarse sea salt is generally a good choice. Specially prepared non-iodized nasal wash salts are also available commercially. Baking soda can also be used in its place or even in conjunction with the salt. Baking soda will soften the salt so it is not as irritating to the mucus membranes.

The Jala neti technique has three stages, however only stage one is usually performed. Although a summary is presented here of each stage, it may be easier to learn with help from someone who has experience with Jala neti and can demonstrate the technique for you. Many yoga instructors are able to teach Jala neti and if they don't teach it themselves they will most likely know someone who does. Many people can learn the technique in one brief session with a qualified teacher.

Stage One Many people only practice stage one of Jala neti. This stage should always be performed whether it is the only stage you do or if you plan to do any of the more advanced stages. Each stage should eventually use about 1/4 litre (8 US fluid ounces) per nostril though a person may have to work up to this.


 * Lean over a sink and tilt your head to the side and slightly down toward the sink. Ideally, the chin and the forehead should be level with each other.
 * Place the spout of the neti pot in the upper nostril creating a complete seal and allow the saline solution to flow into that nostril, through the nasal passages, and out the lower nostril.
 * Continue to breathe deeply through the mouth. This allows the water to flow from one nostril to another without dripping into the mouth.
 * When the pot is empty, refill it and repeat on the other side. Beginners may prefer to use only half a pot on each side.
 * If the water seems to be blocking, switching back and forth several times may be needed.
 * If you will be doing only Stage One, follow the instructions under "After Stages are completed" to clear the nasal passages of remaining water.

Stage two Since stage two washes the deepest parts of the nasal passage, it should only be performed after a round of stage one. If infections or large obstructions are present in the outer nasal cavity and not cleared by stage one, they could be driven deeper into the nasal cavity.

Beginners should use stage one only for the first few weeks to make sure they are comfortable with the process and to make sure that major blockages are clear.

Stage two involves lightly sniffing the water through each nostril and spitting it out the mouth. It is important not to swallow the water which is why personal guidance is best when learning to do this.

Though this stage is more difficult, it has a much deeper effect. People with chronic sinus infections may not see major improvement until this method is used.

Stage three Before this stage, a round of both stage one and two is performed. It involves actually taking the water in the mouth and directing it out the nose. Very few yoga instructors know how to do this and it is only a marginal improvement over the benefits of stage two.

After stages are completed Once jala neti has been performed, it is important to eliminate any remaining water from the nose. The techniques may vary but it usually involves bending over from the waist to let the remaining saline solution drain out, breathing quick breaths out the nose in quick repetition, and gently blowing the nose. It is important not to close off one nostril or squeeze the nose in any way as this may cause water to be forced into areas that do not dry easily. A tissue may be used but is just held lightly surrounding the nose.

Benefits and uses
The saline solution irrigation and nasal flush promotes good nasal health. It can be used by patients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge), and one study has even reported that nasal irrigation was “just as effective at treating these symptoms as the drug therapies.” In other studies, “daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis, ” and irrigation is recommended as an “effective adjunctive treatment of chronic sinonasal symptoms.”

Nasal irrigation is reputed to help prevent colds and otherwise promote good nasal health by cleaning out the nasal passages and helps alleviate stuffiness, dryness, nosebleeds and the symptoms of allergies.

For those who suffer from chronic sinusitis, nasal irrigation is a quick and inexpensive way to promote ciliary function and mucus turnover, decrease edema, and improve drainage through the sinus ostia.

To summarize, nasal irrigation can purportedly:


 * Clear out sticky, persistent mucus and help reduce nasal congestion
 * Cleanse and rid the sinus cavities of allergens, irritants, and contaminants
 * Treat chronic sinusitis
 * Treat allergic rhinitis
 * Prevent common colds and flu
 * Relieve nasal dryness
 * Treat empty nose syndrome (a crippled nose caused by over-aggressive turbinate resection)
 * Improve breathing
 * Temporarily reduce symptoms of post nasal drainage
 * Reduce cough caused by post-nasal drip
 * Temporarily reduce symptoms of phantosmia
 * Treat acute bacterial rhinosinusitis

Jala neti benefits
Proponents claim that jala neti has numerous benefits including:


 * reduction of allergy problems
 * improvement to breathing
 * elimination of post-nasal drip
 * elimination of sinusitis or chronic sinus infections
 * moistening of dry nasal passages
 * temporarily reduces symptoms of phantosmia
 * common colds are either avoided or the duration greatly shortened
 * general improvement to sinus health.

Yogic breathing practices known as pranayama are greatly enhanced by the practice of jala neti since many of them involve deep breathing through the nostrils.

Other benefits practitioners may notice:


 * vision is clearer. Jala neti will clean the tear ducts, enabling better cleaning and moistening of the eyes.
 * improved sense of smell
 * improved sense of taste
 * deeper more relaxed breathing

Though no research has been done, jala neti may help some people with sleep apnea.

Potential problems

 * Some people may have hardened blockages. These may be eliminated gradually over several attempts but may be due to a deviated septum in which case a minor surgery may be needed.


 * Some mild blockages may also be removed with sutra neti when Jala neti is unsuccessful.


 * Burning or irritating the nasal lining. This can feel similar to irritation one may experience from the chlorine in a swimming pool.  This is usually due to water being at the wrong temperature and/or salinity, but can also be due to the salt containing additive. If the salinity is correct and the water is at body temperature, try using a different type of salt.


 * A person may feel sharp pains due to pressure on the sinuses. They should stop immediately and consult a doctor.


 * If a person experiences ear discomfort when performing Jala Neti, they should be sure to blow their nose more gently after the wash. If the problem persists, the openings of their Eustachian tubes may be particularly wide and they may need to discontinue neti pot use.

Jala neti links

 * Library of Neti research papers by Swami B. Saraswati and Dr. Steve Rabone
 * Online article about Jala Neti
 * Stainless steel vs. ceramic neti pot comparison
 * Background info and instructions for Neti practice
 * Free Online Book On Jala Neti
 * Got a Runny Nose? Flush It Out! Morning Edition, NPR, February 22, 2007

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