Nasal irrigation
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* Wilhelmina J. Rietsema

Little and colleagues show a modest effect of nasal irrigation in people with recurrent or chronic sinusitis.1 Participants used a neti pot, which delivers the irrigation fluid to the lower part of the nasal cavity.

However, the openings of the sphenoid, ethmoid and frontal sinuses are located at the top of the nasal cavity. Irrigation can only reach these openings when the head is positioned upside down. This can be achieved by instilling the irrigation solution from a syringe, with the head in supine position and then tilted backward into nearly an upside down position, over the edge of a bed or over an exercise ball. When the person sits up, the liquid is drained into a bowl, aided by a vigorous outbreath through the nose. A 60-mL syringe allows for five instillations of c. 12 mL each in a few minutes.

This procedure can be repeated daily when sinus symptoms are present. Liquid spilled over the face needs to be wiped quickly, before it reaches the eyes, lest purulent nasal material cause conjunctivitis. Water should be chlorinated or boiled and cooled to prevent infection, including amoebic meningoencephalitis.2

## References

1.  Little P, Stuart B, Mullee M, et al. Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial. CMAJ 2016;188:940–9.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTg4LzEzLzk0MCI7czo0OiJhdG9tIjtzOjI0OiIvY21hai8xODgvMTUvMTEwNy4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Centers for Disease Control and Prevention. Notes from the field: primary amebic meningoencephalitis associated with ritual nasal rinsing — St. Thomas, U.S. Virgin Islands, 2012. MMWR 2013;62:903.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=24226628&link_type=MED&atom=%2Fcmaj%2F188%2F15%2F1107.2.atom)