BENEFITS OF PERFORMING NASAL IRRIGATION FOR ROUTINE NASAL CARE AND HYGIENE (DAILY RINSING IS BEST)

Chronic rhinosinusitis (CRS) is a surprisingly common, poorly defined, and notoriously difficult-to-treat disease. It has a complex pathophysiology that involves nasal or paranasal sinus infection by microorganisms such as bacteria, fungus, or mold. Anatomic variations that predispose the sinuses to obstruction may play a role but are not likely the sole causes of chronic disease. Other possible causative factors include allergic or nonallergic inflammation; immunodeficiency; or disruption in mucociliary dysfunction (which could be genetic or may happen from overly dry mucous membranes as a side effect of chronic use of decongestants, intranasal steroid sprays, or over-the-counter allergy pills).

Nasal/sinus irrigation is one of the more useful and natural non-drug treatments for chronic rhinosinusitis (CRS), particularly as an adjunct to other treatment. Its main benefit is not that it directly suppresses inflammation like a steroid does; rather, it reduces the things that perpetuate inflammation and improves the nasal environment.

How Nasal irrigation (aka Nasal rinse, Nasal wash, Nasal lavage, Nasal flush) can help:

1. Clears mucus and inflammatory debris. Chronic sinus disease can produce thick mucus and crusting that trap allergens, bacteria, contaminants, and inflammatory material. A high-volume rinse mechanically washes these out.
2. Reduces nasal congestion. Nasal rinsing can remove mucus and help the nasal passages function more normally and feel more open.
3. Improves mucociliary clearance. The nose normally uses microscopic cilia to move mucus toward the throat. Nasal irrigation helps restore this clearance when mucus is thick or there is inflammation of the mucosal lining of the sinus.
4. Reduces exposure to allergens, irritants, microbes. Pollen, dust, pollutants, and even microbes can be washed away rather than remaining on the nasal mucosal lining, which then decreases likelihood of persistent or repeated irritation that leads to subsequent chronic inflammation.
5. May reduce inflammatory burden. By repeatedly removing mucus, inflammatory secretions, and irritants, nasal irrigation can indirectly reduce the cycle of irritation and inflammation.
6. Can improve symptoms and quality of life. Evidence suggests that large-volume nasal and sinus irrigation can provide a meaningful benefit in some people with chronic rhinosinusitis, although the quality of the evidence is not particularly strong. Cochrane   Saline irrigation for chronic rhinosinusitis | Cochrane
7. Helps other nasal medications work better. If you're using an intranasal corticosteroid, rinsing first can clear mucus and allow the medication to contact the nasal mucosal lining more effectively.

Nasal irrigation vs. Nasal (intranasal corticosteroid) spray...

This distinction is important.

Nasal irrigation/rinse/wash/lavage/flush: primarily cleanses, hydrates, and mechanically improves mucociliary clearance (something that is difficult to achieve with a nasal spray alone). This secondarily reduces inflammatory burden by repeatedly sweeping out microbes, contaminants, allergens, irritants, and mucus; thus breaking the cycle of irritation and inflammation.

Intranasal corticosteroid: medication/drug that directly suppresses inflammation in the nasal/sinus mucosal lining.

For Chronic Rhinosinusitis, these are often complementary rather than competing treatments. Intranasal corticosteroids have evidence for improving symptoms such as nasal blockage, discharge, and loss of smell, although they can increase the risk of nosebleeds, can lead to thinning of the mucosal lining when used chronically over time, and is contraindicated in those with glaucoma. Discontinuing nasal steroids might lower intraocular pressure in glaucoma - PubMed

For that reason, a common recommended approach is:

Nasal/sinus rinse → allow the nose to drain → intranasal corticosteroid if necessary (rather than using the steroid immediately before or after the rinse)

Many people perform nasal irrigation once or twice daily, particularly during periods of significant symptoms such as allergy season or cold & flu season.

Mix contents of your favorite dry Nasal Rinse packet with SAFE water: use distilled water, sterile water, or water that has been appropriately boiled for 3-5 minutes then cooled until lukewarm, rather than ordinary untreated tap water or bottled drinking water, to create a nasal irrigation solution. Lukewarm is best for a soothing sensation, avoid irrigation solution that is too hot or too cold.

Formulation ingredients matter. Some brands add adjunctive ingredients that are natural such as Xylitol, which a low-permeability sugar alcohol recommended for the natural treatment of chronic rhinosinusitis (CRS) due to its ability to decrease liquid salt concentration at the upper airway surface, in addition to possessing hydrating qualities to counteract dryness brought on by over-the-counter sinus medications, thus secondarily restoring more normal mucociliary flow. Nasal irrigation with Xylitol significantly improves the subjective management of chronic rhinosinusitis on nasal outcome questionnaire scores (meaning symptoms improve). It can also provide additional postoperative-care benefit as well, when compared to saline irrigation alone. Role of Xylitol Nasal Irrigation in the Management of Chronic Sinusitis: A Systematic Review and Meta-Analysis - PubMed

More innovative but still natural options include the non-psychoactive cannabinoids Cannabidiol (CBG) and Cannabigerol (CBG). A 2021 scientific study was performed on guinea pigs who were administered CBG and CBG orally and in an intra-peritoneal fashion. This pre-clinical scientific study provided evidence that CBD and CBG formulated appropriately can exhibit anti-inflammatory activity. The conclusion was that these non-psychoactive cannabinoids may have beneficial effects in treating diseases characterized by airway inflammation, but future clinical studies will be required to determine if such benefit exists.  The anti-inflammatory effects of cannabidiol and cannabigerol alone, and in combination - PubMed

Although the majority of patients achieve long-term relief from CRS after successful endoscopic sinus surgery, a significant proportion do not and are likely to benefit from sustained postsurgical maintenance therapy such as a nasal care and hygiene regimen of daily nasal irrigation/rinse. Nasal irrigation done on a routine basis naturally washes out current contaminants, allergens, irritants, and microbes (bacteria or fungus/mold), while preventing future ones from adhering by hydrating and protecting the nasal mucous membranes. Medical therapy for CRS may also include treatment with medications such corticosteroids, antibiotics, antifungal agents, antihistamines, leukotriene modifiers, nasal decongestants, and mucolytics. However, these drugs may carry with them a side effect profile that may not be tolerated well by certain patients. Some of these medications may even have a drying effect on the nasal mucous membranes, which may further compromise the natural mucociliary clearance that effectively sweeps contaminants and irritants out of the nasal and paranasal sinus cavities. The selection of appropriate medical therapy is based on patient symptoms, endoscopic evaluation, sinus cultures, and CT scans. Evolution of medical management of chronic rhinosinusitis - PubMed