The Medical Consumer's Advocate

Nasal Irrigations and Oral Rinses

Douglas Hoffman M.D., Ph.D.

Nasal irrigation (also called "nasal lavage" or "nasal douching") is an ancient and widespread practice. There are many areas of the world where nasal irrigation is every bit as commonplace as the western practice of brushing one’s teeth.

Relative to nasal irrigation, oral rinses (gargles, mouthwashes) are a good deal more common in the western hemisphere. Unfortunately, most commercial rinses (such as Scope or Listerine) are formulated with the taste buds in mind, and are injurious to the mucosal lining of the mouth and throat. Listerine, for example, contains 26.9% alcohol (that’s nearly 54 proof!) In addition to alcohol, many commercial rinses contain a sweetener such as saccharine, and some contain detergents similar to what is used in toothpastes. Commercial oral rinses are probably not harmful if you are in good health, but if you are having problems with your throat, commercial rinses are not helpful and may contribute to your sense of discomfort.

 

Benefits and risks of nasal irrigation/oral rinses. These practices are most commonly prescribed for one of three purposes: to reduce tissue swelling (edema), to help clear tenacious mucus from the throat and/or nasal cavities, and to reduce dryness.

There are no known risks associated with oral rinses, other than the possibility of allergic reaction to one of the components (unlikely for one of the saline rinses, but certainly possible in the case of a commercial rinse, or if a formulated prescription is used– for example, an antibiotic rinse.)

Nasal irrigation can alter the environment of the nasal cavities and sinuses, making them more conducive to the growth of certain water-loving bacteria such as Pseudomonas. Also, irrigation should not be performed if you are suffering from acute sinusitis (an acute bacterial infection of the sinuses), since it could facilitate spread of the infection to the other sinuses, the eyes or throat. For these reasons, you should NOT irrigate your nose unless instructed to do so by your doctor.

 

How to do it. Commercial oral rinses cannot be used for nasal irrigation, with one exception (Alkalol, which is discussed below.) You can easily prepare an appropriate rinse/irrigant at home, and I have included a few recipes (below.) If possible, gargling and irrigating should be performed using a solution that is as warm as (or a bit warmer than) body temperature, but this is not essential.

Gargling should be done "deeply" so that the rinse penetrates deep into the throat. One way to do this is to vary the pitch of the sound you make while gargling (high, low, high, etc.) You will soon find a method that allows deep penetration into the throat. Don’t worry if you swallow a bit of the rinse– none of these solutions are harmful.

Nasal irrigation can be accomplished by a variety of means. In cultures where nasal irrigation is a routine daily practice, people "snuff" (inhale through the nose) the irrigant from a cupped hand. You could also purchase a small bulb syringe; these are sold in pharmacies and are usually used to aspirate mucus from the nostrils of infants, or to help irrigate wax from the ear canals (don’t use it for wax removal without talking to your doctor first!) The goal is to inhale (or squirt) the irrigant deeply enough that you thoroughly wash your nasal cavities. Once again, if a bit goes down the back of your throat don’t be concerned. This merely indicates that you have successfully lavaged the full length of your nasal cavity.

 

RECIPES and other options

For do-it-yourself solutions, mix the ingredients, boil, and store the solution in a clean, air-tight container. A glass container with a screw-on cap is ideal (if you use a Tupperware-type container, the solution may take on an unpleasant plastic odor.) Home-made solutions should be discarded after one week (then prepare a fresh batch.) If the solution looks cloudy, or if you see particulate matter floating in it, do not use it– make yourself a fresh batch.

 

Isotonic saline (salt water that is about as salty as your body fluids) 1 teaspoon salt (table salt is fine) 1 teaspoon baking soda (NOT baking powder!) 1 pint of water (use distilled or filtered water if you have any concerns about the quality of your tap water.) Comment: baking soda (sodium bicarbonate) improves the mucus-solvent properties of the irrigant. You can purchase sterile saline (available in the contact lens care section of any grocery store or pharmacy) but this is more expensive, of course, and does not have sodium bicarbonate.

 

Hypertonic saline (salt water that is saltier than your body fluids) 2 teaspoons of salt 1 teaspoon of baking soda 1 pint of water Comment: this solution is well-tolerated as an oral rinse, but you will find it to be more irritating than isotonic saline if you use it as a nasal irrigant. Nevertheless, it is safe and very effective as a nasal irrigant. In warm coastal communities (for example, Florida or other Gulf Coast states), many folks with sinus problems find that swimming in seawater helps them to heal faster. "Getting a noseful" of seawater is key– you don’t have to swim! In our area, the waters are too frigid for most people to tolerate a quick plunge in the ocean. This hypertonic saline irrigant is a very crude (but effective) approximation of seawater.

 

Alkalol

Alkalol is a commercially available solution which can be used as an oral rinse or nasal irrigant. It is made by The Alkalol Company (Taunton, MA) and can be ordered by your pharmacist. It is fairly inexpensive (about $3.50 per pint, on average.) The active ingredients are salt (sodium chloride), alum (an astringent), and baking soda (sodium bicarbonate.) Alkalol also contains a number of natural extracts such as menthol and eucalyptol which, as far as I can tell, are present primarily for flavor.

The label says that Alkalol can be used at half or full strength, but I recommend that it be used at full strength. It can be safely used as a nasal irrigant or oral rinse.

 

What about plain water?

Salt follows water, and water follows salt. Anyone who has ever seen the effect of salt on a snail knows what happens to the snail. Hypertonic saline will tend to draw a small amount of water from the tissues it contacts; this is desirable if the tissues are swollen (edematous.) Plain water, on the other hand, will tend to enter the tissues, thereby increasing swelling (edema.) When you sit for a long time in a bath, your fingertips wrinkle because the water content of the skin is increasing, so the skin must "buckle" to accommodate the extra water.

This recommendation against plain water as an irrigant or rinse would seem to contradict another piece of advice that doctors give very frequently: drink more fluids! The current recommendation for adults is to drink eight to ten 8 ounce glasses per day of noncaffeinated, nonalcoholic beverages (at the high end, this translates to 10 cups, or 2.4 liters per day.) There is no contradiction, however. Assuming that you are otherwise healthy, your kidneys will handle this volume of fluids very well, and your body’s concentrations of various salts will vary hardly a bit. (With certain illnesses, such as kidney failure or congestive heart failure, aggressive hydration can be very harmful. Discuss the question of fluid intake with your physician if you have any doubts about the safety of drinking 10 cups of fluids daily.)

 

How often should I use an oral rinse or nasal irrigant?

Moderation in all things; for most problems, two to three times per day will be sufficient.

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