Best Nasal Irrigation Devices - Cost and Effectiveness

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Best Nasal Irrigation Devices - Cost and Effectiveness

Post by Genie » Fri Mar 31, 2017 4:20 pm

I saw in the post on chronic cough and sore throat that you mentioned one recommended way to address post-nasal drainage was through nasal irrigation. I'm wondering if there is any research on which methods are best? I've seen so many different machines and devices advertised that I'm not sure if it is worth spending the extra money for some of the more expensive machines? Does anyone have experience with using more than one method and can share what works best for them?

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Re: Best Nasal Irrigation Devices - Cost and Effectiveness

Post by DrDave » Fri Apr 14, 2017 11:28 pm

I'll update this post as I have time. I realized that if I waited until I had a complete response, it might be a while. So please understand this is a work in progress. I'll also add devices as I have time.

There are a ton of different sinus irrigation devices on the market and there is very little research available to compare them. There is some research however and I will try to cover evidence based information.

To start, the simplest and cheapest form of nasal irrigation. It isn't really irrigation as much as moisturizing I guess. That would be nasal saline spray. These sprays are considered a high pressure, low volume nasal rinse. You can buy a bottle of saline nasal spray for a few dollars and it'll last you a few weeks. The common brand name I'm familiar with is Ocean Spray, but they are all pretty similar. The contents include water, salt (typically a mix of sodium chloride and) and a buffering solution to bring the tonicity to be the same as normal saline (the same tonicity that your blood has) 0.9%

I find this works pretty well at keeping my nasal passages moist, is inexpensive, is easily available, and is easy to travel with. Studies show they are helpful, but not as effective as doing a sinus rinse, sometimes called sinus douche.

The next step up, which is more in line with real irrigation, would be a neti pot. A neti pot is a little tea pot looking thing (typically - they can be shaped differently) that you fill with salt water, turn your head to the side while leaning over the sink, push the spout against the top nostril, then tip the pot to pour the salt water into your top nostril. The water will fill your sinuses and then drain out the bottom nostril into the sink (assuming you don't have completely clogged sinuses, in which case the force of gravity may not be enough to get through). Most neti pots are inexpensive, around $10-$15 and come with the special salt packets to mix with water. While there are studies which seem to show that neti pots are more effective than nothing, the overall quality of the studies is poor. The best evidence seems to be that nasal irrigation following surgery with a hypertonic saline solution speeds healing more than other approaches, but that irrigation was done with a squeeze bottle rather than a neti pot. The rest of the claims don't seem to have good studies supporting them. Keep that in mind. In other words, at this point, if you find one of these devices helpful - great. If you don't find it helpful, don't keep doing it. If I become aware of better research, I'll update this thread.

A bit of a lengthy note about what water to use for a neti pot or other form of nasal irrigation: when I first used one about five years ago, I used tap water. It was simple to get warm water from the faucet. I also tried adding my own table salt to make a saline solution and would adjust the amount of salt up and down. Since that time, they now recommend you not use tap water without first boiling it because of infection risks. There is information on the FDA website:
Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”

Boiled and cooled tap water — boiled for 3 to 5 minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.

Water passed through a filter designed to trap potentially infectious organisms. CDC has information on selecting these filters.
The CDC website has a similar list of recommendations on water to use for sinus irrigation:
Take at least one of these actions to lower your risk of becoming infected with Naegleria during ritual nasal rinsing:

Boil: Use water that has been previously boiled for 1 minute and left to cool.
At elevations above 6,500 feet, boil for 3 minutes.

Filter: Use a filter designed to remove some water-loving germs.
The label may read "NSF 53" or "NSF 58."
Filter labels that read "absolute pore size of 1 micron or smaller" are also effective.

Buy: Use water with a label specifying that it contains distilled or sterile water.

Disinfect: Learn how to disinfect your water to ensure it is safe from Naegleria.
Chlorine bleach used at the right level and time will work as a disinfectant against this germ.
This new recommendations on the type of water to use are kind of a pain compared to tap water. The biggest issue for me is the temperature of the water. It is easy to get the temperature right with tap water. I guess if you have the right kind of filter, maybe you could essentially use tap water. For me, the easiest approach would be to use bought distilled water (expensive and cold) or boil water. The FDA website says boiled water is good to use for 24 hours, but I've seen other sources that say it can be used for up to 7 days, or longer if refrigerated (not something I'd want to do). Until I verify the other sources, I'd still go with the recommendation of boiled water being good for only 24 hours - which makes it not too practical for regular use. I'll be spending more time boiling and cooling water than I will rinsing my sinuses.

Interestingly, the recommendations for not using tap water were evaluated in a study. According to this study, about 50% of people use tap water for nasal sinus irrigation, in spite of the recommendation not to. Of those who do follow recommendations, 65% report that the process is either mildly or moderately inconvenient. 70% of people don't follow the recommendations on cleaning the sinus rinse devices.

The most commonly studies device for nasal irrigation is the squeeze bottle. Squeeze bottles have been shown to be superior (about 78% penetration) to saline nasal sprays (about 8% penetration) and syringe irrigation devices (about 68% penetration). I have yet to find a study showing that anything is better than the squeeze bottle, but I haven't seen scientific studies of devices like the Navage or the Sinupulse Elite.

I'm still working on the remainder of this review, but here are some areas I plan to add more information when I have time:

Squeeze bottle or similar pressurized device (Neilmed as the most common example) which seems superior to the neti pot and similar in cost.

Navage - a novel approach using suction instead of inward pressure. It is battery operated and you don't have to be over the sink as it has a compartment that collects the water that is suctioned out. One criticism is the expensive proprietary salt pods that are required for the machine to operate. People have apparently posted work-arounds online, so that may not be the deal breaker. I'll see if there is any evidence that their approach of suction works better than pressure inward.

SinuPulse Elite Advanced Nasal Irrigation System - this is essentially a water pik type device for the nasal passages. It uses a pressurized and pulsating stream of water which can be set to a mist setting or a heavier rinse setting. People who use it seem to love it and the company claims there is research to support it is superior to the squeeze bottle, but I haven't had a chance to look for that information yet.

For those that have used any of the above devices / approaches, feel free to share your experiences below. If there are other devices I have not mentioned yet, please also comment and I will add them to this post.

Hopefully I'll have time to keep adding more details and more useful information soon.

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