If your mother sent you off to school as a child with the admonition to “keep your nose clean,” she was unwittingly giving you sage advice that can help in your struggle with sinusitis.

Keeping your nose clean through a practice known as nasal irrigation can be a key to reducing sinusitis symptoms. Nasal irrigation (also known as nasal lavage or nasal rinsing) is easy and inexpensive and has no negative side effects.

I strongly advise people who suffer from nasal congestion and drainage to incorporate it into their daily hygiene routine. A popular option is to brush and flush; in other words, irrigate twice a day, right after brushing your teeth. Nasal irrigation washes out excess mucus that might otherwise lead to bothersome drainage or blocked breathing.

Along with the mucus, you’re also flushing out unwanted debris (including bacteria, mold, dust, and other irritants) that can cause nasal tissues to swell. So nasal irrigation really achieves two goals: it opens more room to breathe and clears obstructions that might predispose you to sinusitis.

Keeping It Simple

There are many tools for irrigating your nose, but I’m a fan of the KISS (keep it simple, stupid) principle. All you really need is a bulb syringe a common device used to clean newborn infants’ noses that looks like a cross between a lightbulb and a turkey baster (see Figure beow).

A bulb syringe costs under $5; some drugstores and most medical supply stores carry them. A small ear syringe, used to flush wax from the ear canal, also works, but I prefer the nasal version because its larger size allows for more efficient irrigation, and the tapered tip fits comfortably in the nostril.

While standing in front of your bathroom or kitchen sink, follow these steps:

1. Fill an eight-ounce glass with lukewarm tap water.

2. Stir in approximately one teaspoon of table salt. The exact amount is not critical; just make it slightly salty to taste.

3. Fill the bulb with the saltwater solution.

4. Lean over the sink, and with your head bowed slightly, insert the tip of the syringe just inside your nostril.

5. Gently squeeze the bulb. The solution will run up into your nose and then drain back out the nostril into the sink. Sometimes the water may run to the back of the nose and drain out the opposite nostril that’s not a problem. It’s also OK if some of the water drains into the back of your mouth just spit it out.

6. Refill the bulb and irrigate the other nostril the same way. It’s best to use one full bulb for each side of the nose.

You know you’re irrigating correctly if mucus is flushed out the front of the nose. You may need to blow your nose afterward to clear the loosened mucus. When you’re done, you’ll notice you can breathe much better through your nose.

Nasal irrigation may feel unusual the first time you try it kind of like getting water in your nose when you jumped into a pool as a kid. But once you get the hang of it, it’s very soothing.

Nasal Irrigation FAQs

Here are answers to frequently asked questions about nasal irrigation.

• Should I Inhale as I Squirt? Inhaling is not necessary; the pressure from the bulb is enough to force the water into your nasal cavity. But there’s no harm in inhaling if that’s your preference.

• Where Does the Water Go? Most of the water goes into your nasal cavity, including the middle meatus, and then flows right out. Unless you’ve had sinus surgery to enlarge your ostia, water does not usually enter your sinuses. But it’s not a problem if a little water does get into the sinuses; it just drains back out.

• I Feel a Burning or Stinging Sensation Can This Be Eliminated? Some people find nasal irrigation stings a little. Fine-tuning the saltwater solution in two ways may reduce or eliminate this sensation:

• Adjust salinity. You add salt to the water because the mucus in your nose is inherently salty, and you want to replicate mucus’s natural salinity. Believe it or not, irrigation would sting more if you used plain water.

Because individual salinity varies, you may need to play around with the salt level to find what works for you. Reducing the amount of salt to just half a teaspoon eliminates the burning sensation for most people.

• Adjust alkalinity. Mucus is slightly less acidic than water, and the imbalance can cause stinging in some patients. You can remedy this disparity by adding half a teaspoon of baking soda to the irrigating solution (in addition to the salt).

• Is It Preferable to Use Distilled or Boiled Water Instead of Tap Water? No. Although it does no harm to use water that has been purified or sterilized, it’s not really necessary. Regular tap water is clean enough that it will not introduce harmful bacteria. Remember, your nose and sinuses are not sterile to begin with.

• Do I Need to Use a Special Type of Salt? No. Although some doctors recommend using kosher salt or pickling salt for nasal irrigation because it’s purer than regular table salt, the same salt you use at your dinner table works fine.

• Can I Irrigate More than Twice a Day? Certainly. Twice a day, after brushing your teeth, is a good starting point. Ideally, irrigating just before you go to bed will enable you to breathe freely long enough to help you fall asleep.

But during the overnight hours, mucus will eventually build up, so you want to irrigate again upon waking to clear out what’s accumulated overnight. Feel free to add more irrigations throughout the day.

The beauty of irrigation is that no drugs are involved, so there are few or no side effects. Many people add a third irrigation, at lunchtime. Those whose sinuses produce an unusually large volume of mucus may irrigate even more frequently.

As long as you don’t get carried away and start rinsing your nose at movie theaters and wedding receptions, you can irrigate as often as you’d like.

• Can I Irrigate During a Sinus Infection? Yes. To compensate for the increased mucus production during an infection, you may even want to irrigate more often than you usually do.

• Should I Clean the Bulb? Yes. It’s a good idea to wash the bulb weekly with soap and water to clean off any debris and excess salt that accumulates. You can also boil the bulb for a few minutes once a month, to clean the inside. With regular use and cleaning, eventually the bulb will start to crack. When this happens, toss it and buy a new one.

• Can I Stop and Start Irrigations? Yes. It’s perfectly acceptable to irrigate only when you feel the need. Many people rinse their nose exclusively when mucus builds up and congestion develops, such as during allergy season or an infection.

Even if you opt for daily irrigation, there are no major drawbacks from occasionally skipping a day. Just be aware that thick mucus can dry up and form crusts, which may be more difficult to clean once you resume irrigating.

Alternatives to the Bulb Syringe

The bulb syringe works fine for most people. I recommend it because it’s easy to obtain and use, and it’s inexpensive. However, an ever-growing array of products exists for nasal irrigation (see Figure and Table below).

Product Category	Availability	Advantages	Disadvantages	Cost*
Bulb syringe	Drugstores, medical supply stores	Low cost	Need for periodic replacement	$
Squeeze bottle	Drugstores, Internet	Convenience	Need to reorder salt packets or solution	$$
Neti pot	Drugstores, catalogs, Internet	Durability	No water pressure, so may not be effective for thick mucus	$$
Waterpik and other motorized irrigators	Drugstores, department stores, Internet	High water pressure benefits people with very thick mucus and crusts	High cost	$$$ (irrigator plus attachment)

Some offer advantages in terms of convenience; others provide more efficient methods to clear thick mucus. All these products are effective when used properly, so as long as they work for you, you really can’t go wrong.

• Squeeze Bottles - Several companies make plastic squeeze bottles specifically designed to squirt water up your nose. The technique is similar to using a bulb syringe.

Some squeeze bottles come prefilled with saline solution, and others come with packets of salt that you add to warm water. These products may include the words “isotonic” or “hypertonic” on their labels; isotonic means the water is intended to be as salty as your mucus, while hypertonic means it’s even saltier.

I recommend the isotonic variety. Some people believe hypertonic solutions may work better for very thick mucus, but I haven’t found that to be the case among my patients. In addition, the label may say “buffered” this means baking soda has been added to adjust the solution’s alkalinity.

The advantage of spray bottles is convenience; assuming the solution does not sting, you never have to worry about adding too little or too much salt or baking soda.

The disadvantage is expense. The initial purchase is costlier than a bulb syringe, and there’s the additional expense of having to buy refills of solution or packets.

• Neti Pots - Neti pots are small cups that look like a genie’s lamp, with a handle on one end and a spout on the other. The name comes from jala neti, a centuries-old yoga practice in which these pots are used for nasal irrigation. You fill the neti pot with salt water and tilt your head sideways.

While breathing gently through your mouth, you pour the water into the top nostril. The water flows through the nasal cavity and drains out the bottom nostril. Then you tilt your head the other way and repeat the procedure, pouring the salt water through the other nostril.

Neti pots used to be hard to find in the United States, but in the past few years they have become widely available, in ceramic, stainless steel, or plastic.

An advantage of the neti pot is that it’s more durable than a bulb syringe; as long as you boil it occasionally, you can use the same one for years. The disadvantage is that it lacks the force of a bulb syringe, so it may not be so effective if you have very thick mucus.

• Waterpik and Other Motorized Devices - A number of plug-in devices are available for those who prefer a high-tech approach to nasal irrigation. The most well-known is the Waterpik, which is commonly used to clean the gums and teeth.

Most stores that carry this unit also sell an attachment called Gentle Sinus Rinse (also known as a Grossan tip) for nasal irrigation. You add salt to the water reservoir and hold the tip of the irrigator to your nostrils.

Because the Waterpik delivers a relatively forceful, intermittent stream of salt water, many individuals find these devices very helpful to clear thick mucus and crusts.

• Alkalol - No matter what type of irrigation device you use, if you have very thick mucus, it may be helpful to add a mucus-thinning agent to your saltwater solution.

One example of such an agent is a liquid called Alkalol. It contains several ingredients designed to thin mucus and soothe nasal passages, including alcohol, baking soda, eucalyptus, menthol, and camphor.

Alkalol is available over the counter at drugstores and via the Internet. Although the directions recommend using it at full strength or mixing it fiftyfifty with the usual saltwater solution, many of my patients find it works well when mixed at one-quarter strength, and it lasts longer that way.

Whatever product you choose, you’ll be amazed at how much of a difference nasal irrigation can make. Many people find this simple technique provides tremendous relief from sinusitis symptoms and reduces the frequency of infections.

But bulb syringes, squeeze bottles, and neti pots aren’t the only simple purchases that can make a difference in your struggle with sinusitis. Next, we’ll look at some sinuses products available at most drugstores including humidifiers, nasal tape, and saline sprays that may also help.