Tuesday, March 9, 2010

Long-term nasal saline irrigation linked to increased risk of infections: Wrong conclusion?

An ENS sufferer sent me an e-mail that discussed a study suggesting too much irrigation can lead to more infections. I have been using irrigation, nose and throat, every day for several years. I wrote the following ezine article in 2007:
http://ezinearticles.com/?Why-You-Must-Do-Pulsatile-Nasal-Irrigation-Even-If-Youre-Healthy&id=751410. I still believe it to be true today. I believe that the authors of the study came to the wrong conclusion. Keep reading to see why. Fact is hundreds of research articles document the benefits of daily nasal irrigation, but only one suggests to the contrary.

The following links discuss a research study that suggests long-term use of nasal irrigation can lead to more infections, not less:

http://www.medscape.com/viewarticle/712146
http://www.medpagetoday.com/MeetingCoverage/ACAAI/16870

One doctor's perspective on this study:
http://www.medhelp.org/user_journals/show/138531

This doctor wrote: My feeling is that if you feel better and you don't get as many infections, keep doing it. After a few weeks or months, you can experiment by stopping the irrigation and see what happens. I agree with this doctor's statement. Furthermore, this is just an abstract, it only addresses acute sinusitis, and ringer's lactate solution has been found to be more effective than plain saline for increasing mucociliary clearance when doing rinses; it's too bad the study didn't use Ringer's lactate.

Here are some questions I thought up in light of this study (that I'll try to answer):

Question: Is cleanliness of the irrigation apparatus part of the reason for increased infections over long-term use?

Answer: I happen to believe this is really the key issue. It's important to clean the irrigator regularly, no matter which one you use. With the neti pot or neilmed (or a bulb syringe), you get backwash, which increases the potential for bad bacteria to multiply very quickly. You don't get backwash with the HydroPulse, for example. Devices that don't prevent backflow will become contaminated very quickly, so the patient reinfects themselves. Bottom line: by using an unclean irrigator, you reinfect yourself. Clean it regularly and don't use a device that allows backflow. Use the HydroPulse.

Question: Is there a potential for mild dryness and a rebound effect with irrigating too frequently?

Answer: Breathe-ease XL irrigation solution is in fact hydrating and, according to Dr. Grossan, it is the exact same solution as used in IV in a hospital for hydration. So I wouldn't worry about mild drying and a potential rebound effect (as you get from Afrin), if you use Breathe-ease isotonically, and twice per day. I have been using Breathe-ease XL everyday and doctors have noted my nose is somewhat moist, considering it's an empty nose. If you use plain salt water, on the other hand, then you might get mild drying and a rebound effect over long-term use. Just go for Breathe-ease XL and avoid using products that have additivites or preservatives, such as benzalkonium chloride.

Question: By irrigating too regularly, such as daily, can you potentially reduce the immune products - enzymes, beneficial bacteria, antibodies - in the nasal mucus?

Answer: From what I am told by some medical professionals, the body regenerates the defense products regularly, so you would need to irrigate hourly or more to reduce the immune products in the mucus, ultimately lowering the immune system. My immune system has improved over the years and I use an irrigator daily.

Question: What would be an effective strategy to keep infections at bay when irrigating? I piqued Dr. Grossan's brain on this one and below are his thoughts:

Xylitol is available on the net for less than 5 dollars a pound. The xylitol in Breathe ease XL is less than 1% so it isn’t so much to get rid of bugs, it is for restoring the cilia. Bugs get serious indigestion with Xylitol . So if you start with a 1% solution you can gradually increase it to 5% to see how that feels. You still need one tsp of salt to make saline or the breathe.ease XL

Again 2 tsp to 500 cc of saline is 1%
4 tsp to 500 cc of saline is 2%
And up to 10 tsp of Xylitol gets to 5%

Below are two articles written by Dr. Grossan that I thought I would share:

Nasal Irrigation:
http://www.ehow.com/how_5694507_use-nasal-irrigation-sinus-problems.html?shared=true

Throat irrigation:
http://www.ehow.com/how_5800211_wash-away-tonsoliths-halitosis.html?shared=true

2 comments:

Cara said...

I have been doing sinus irrigation for years using the nasopure system and my nose is clear and moisturized. The key is the buffered salt!

Heather said...

I find that nasal saline solutions are my one saving grace! I tend to use it in the morning when I first wake up, and just before I go to bed, since build-up occurs most often during the night. I try not to use it excessively as the salt can leave a burning sensation inside my nasal cavity. I truly doubt that excessive irrigation can lead to more frequent infections. Rather, I would agree with your statement that it is the cleanliness of the apparatus that is the real issue. Cheers! Heather of Sinus Infection Remedies

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