The spring pollen has flown in and is already swirling around the air like a hurricane. The cilia of the nasal passage are geared up and working tirelessly to capture the invading pollen while the mucosa-associated lymphoid tissues have gathered their armies of macrophages mast cells T and B cells. Cytokines and complement proteins are activating the inflammatory pathways releasing histamines and ramping up the infamous department of mucus secretion. Altogether the human victim of this battle is plagued with an itchy nose sneezing rhinitis sinusitis watery eyes coughing and a general feeling of misery.

Seasonal allergies aren’t the only triggers of this nasal war. For too many people this same conflict rages on an annual basis triggered by air pollutants pet dander dust mites airborne microorganisms and mold spores. Upper respiratory tract infections and/or conditions with associated rhinosinusitis have similar pathology to allergic rhinitis triggered by allergens and pollutants and therefore joins the host of irritating nasal wars.

Nasal irrigation offers a simple holistic opportunity for relief from a raging immune response. Its roots are based in ancient Ayurvedic medicine but its benefits are now enjoyed by many especially those who are susceptible to allergies or other inflammatory conditions of the nasal mucus membranes.

Nasal irrigations are thought to directly cleanse the ciliary of thick mucus crust debris allergens and pollutants. This improves ciliary action and motility which in turn improves the ability to capture and clear future allergens and pollutants. Nasal irrigation can also reduce the surface quantity of inflammatory mediators and thereby temporarily reduce inflammation of the nasal passage. It has been suggested that irrigation by spray application may stimulate neuronal changes in the immunologic process and offer additional support.

In a systematic review and meta-analysis routine nasal irrigation improved the symptoms of allergic rhinitis by 3 to 71 percent with an average symptom improvement score of 28 percent. It also showed routine nasal irrigation increased mucociliary clearance time by 32 percent reduced the need for additional therapies (such as pharmaceutical antihistamines and nasal steroids) by an average of 62 percent and improved quality of life by an average of 28 percent.

In these same studies isotonic saline solutions proved to be more effective than hypertonic solutions and the use of specialty salts such as seawater salts or Dead Sea salt fail to show any additional improvements. It was suggested that an isotonic solution with a neutral pH was more effective since mucociliary transport only occurs in a neutral pH. Newer nasal solutions include xylitol which is a natural antimicrobial and decreases the ability for allergens pollutants and microorganisms to attach to mucus membranes aiding in their clearance. One pilot study found a xylitol based nasal irrigation solution to result in greater improvement of chronic rhinosinusitis symptoms compared to a normal saline solution. However all forms of nasal irrigations and saline solutions can provide a cost-effective means of reducing symptoms associated with allergic rhinitis and associated conditions.

Various forms of nasal irrigation have been utilized including nasal sprays neti pots squirt bottles and gravity-based pressure devices. Questions often arise regarding the benefits of one form of nasal irrigation over another. In one randomized controlled trial of 127 adults with chronic nasal and sinus symptoms a 60% improvement in symptoms was noted when using large volumes of saline solution with a low-pressure device. In contrast saline sprays only delivered a 40 percent improvement score. Other research has indicated that low pressure irrigation devices seem to deliver superior results for chronic rhinosinusitis when compared to alternative delivery systems. In children a squeezable bottle for nasal irrigation produced better improvements when compared to a nasal irrigation syringe. Generally studies seem to favor delivery systems that utilize larger volumes of solution with gentle pressure. Specialized low-pressure devices are the best option followed by squeezable bottles and finally neti pots. If convenience is a greater factor nasal sprays still offer greater benefits that abandoning the idea of nasal irrigation altogether. 

Nasal irrigation is clearly a beneficial practice for individuals suffering from various upper respiratory conditions that include chronic rhinosinusitis. Routine use can improve symptoms decrease the need for additional treatment and improve quality of life. Finally routine nasal irrigation may be a smart preventative exercise when allergy and cold seasons are lurking.