General Articles on Pulsatile Nasal Irrigation & Sinusitis

Radiographic Comparison of Three Methods for Nasal Saline Irrigation, Laryngoscope 112: 1394-1398, August 2002, David E. Olson, M.D., Barry R. Rasgon, M.D., Raymond L. Hilsinger, Jr. M.D.
"Positive Pressure Irrigation (Sinus Irrigator) irrigates the sinuses more consistently and reliably than other methods. Of the three methods studied positive pressure irrigation distributed solution reliably to the ethmoid and maxillary sinuses and to the bilateral maxillary sinuses in the majority of subjects studied. Negative pressure irrigation (spray bottles and lavage bottles) Negative pressure irrigation is the simplest least expensive irrigation method and is maintenance free, However, delivery with this method is difficult to control and has the disadvantage of preferentially irrigating the side of the nasal cavity. It tends to irrigate one maxillary sinus or the other but not both. Distributes saline solution reliably to the ethmoid and maxillary sinuses. Rinoflow nebulizer: The system uses technology previously applied to oral nebulizing devices for delivery of drugs to the bronchopulmonary system. It is comfortable and easy to use but is expensive ($159), time intensive requiring nearly 10 minutes per treatment. Of the three treatment methods, the nebulizer gave the poorest results. Saline distribution was the lowest and the nebulizer method did not distribute the solution reliably.

"Sinusitis: Acute, Chronic and Manageable, Rachelevsky G S, Slavin R G et all. Patient Care. Feb 28, 1997 Vol 131:4.
"A particularly helpful strategy is saline washing using the Sinus Irrigator is so effective in clearing the blocked passages that , if it is done regularly, some patients with persistent or chronic sinusitis need no drug treatment at all.

Sinusitis: Bench to Bedside, Kaliner MA et al. Otolaryngology June 97 116:6 Part 2 Study of Sinusitis.
Pulsatile sinus irrigation is recommended as a treatment for sinusitis, and as a supplement to other treatment modalities.

Treatment of Sinusitis in the Next Millennium,
Kaliner, M. Allergy and Asthma Proceedings, 19:181-4, 1998
Saline irrigation with the Sinus Irrigator is an effective non-drug treatment for sinusitis

Sinus Survival, Ivker R., Putman Publication 1995.
Pulsating irrigation is shown to remove pus and allow for natural, holistic healing.

Pulsation Irrigation: a Simple, Safe Effective Treatment of Many Nasal Complaints,
Pope, A., O.R.L. Digest August 1974 15:8 pp 3638.
Pulsatile nasal irrigation is recommended as a simple safe treatment for many sinus, ear and allergy complaints. High patient acceptance and enthusiasm is reported.

Pulsatile Nasal Irrigation in Children
Pediatric Sinusitis, Manning, Scott, C., In: Inflammatory Diseases of the Sinuses. Otolaryngologic Clinics of North America. Volume 26, Number 4, pp 623-638 (1993).
Pulsatile irrigation works for children, even without antibiotics

Rhinitis
Atrophic Rhinitis, Goodman, Wilfred S. English: Otolaryngology Vol 2 Ch. 14 1984
Atrophic rhinitis varies in severity and is difficult to cure. Dr Goodman recommends Pulsatile irrigation for symptomatic relief and treatment.

Medical Management of Rhinitis, Fadal R. English: Otolaryngology Vol 2:Ch 13 
The principal benefits from saline irrigation include: 1. Augments mucociliary flow 2 Liquefies tenacious mucus 3. Soothes irritated tissues 4. Removes crusts and microforeign bodies 5. Augments tissue repair 6. Reduces forceful nose blowing 7. Improves olfaction.

Chronic Rhinitis, a Practical Approach to Diagnosis And Treatment, 
Zeigler, R. Shatz , M Part 2 Treatment. Immunology, Allergy Practice 1982. 4:3 pp 26-36 
Good allergy management includes use of irrigation to remove particles & restore normal ciliary flow.

Rhinitis, Allergy: Principles and Practice, 3rd edition. Middleton E. CV Mosby Company Ch 17, 1988
All forms of allergy rhinitis are benefited by saline irrigation with the Sinus Irrigator.

Medical Management of Rhinitis, Fadal R. English: Otolaryngology 1996, Vol 2:Ch 13.
The principal benefits from saline irrigation are shown to include: 1. Augments mucociliary flow 2 Liquefies tenacious mucus 3. Soothes irritated tissues 4. Removes crusts and micro foreign bodies 5. Augments tissue repair 6. Reduces forceful nose blowing 7. Improves olfaction.

Atrophic Rhinitis, Goodman, Wilfred S., Otolaryngology Vol 2 Ch. 14 1984.
Atrophic rhinitis varies in severity and is difficult to cure. Pulsatile irrigation is recommended for symptomatic relief and treatment.

Chronic Rhinitis, a Practical Approach to Diagnosis and Treatment, Zeigler, R. Shatz , M Part 2 Treatment. Immunology, Allergy Practice 1982. 4:3 pp 26-36. 
Good allergy management is shown to include irrigation for removal of offending particles in order to restore normal ciliary flow.

Atrophic Rhinitis, DeSouza F.M.: Chapter 14N, English: Otolaryngology 1996. 
"The Sinus Irrigator has increased the efficiency of saline nasal douches."

Asthma
Sinusitis and Bronchial Asthma, Slavin RG: J Allergy and Clinical Immunol 66:250-257, 1980 
Slavin presents three mechanisms re sinusitis causing asthma. Clearing sinusitis is important in asthma.

Allergy

Inhibition of The Seasonal Ige Encrease To Dactylis Glomerata by Daily Saline Nasal - Sinus Irrigation During The Grass Pollen Season, Journal of Allergy and Clinical Immunology. In press 

Pulsatile irrigation works for allergy by removing the IgE so that the pollen doesn't cause symptoms. 

Post-Operative Care
Perioperative Care in Functional Endoscopic Sinus Surgery, Sonkens JW, Miller R.J. Highlilghts of the Instructional Course. Ed Lucente, editor Chapter 24. pp267-277 
Pulsatile irrigation should be done 1-3 times a day postoperatively until no further benefit is achieved.

Endoscopic Paranasal Sinus Surgery, Rice, D., Ravens Press 1993. 
Pulsatile irrigation before sinus surgery is recommended to reduce infection and after surgery to restore ciliary function and reduce patient's symptoms. 

Cystic Fibrosis
Management Of Sinusitis In Cystic Fibrosis, 
Moss RB, King W. Arch Otolaryngol Head Neck Surg. 1995;1 21:566-572. 
Stresses the use of irrigator with nasal adaptor. Recommends antibiotic irrigation of sinuses.

Management of Chronic Sinusitis in Cystic Fibrosis, Davidson, T., Laryngoscope 105:354 April 1995. 
Cystic fibrosis is commonly associated with sinusitis due to mucociliary system failure. Patients may benefit by lung transplant. Pre-op pulsatile saline irrigation is found to be successful in clearing the sinus of disease.

More Laboratory-Oriented Topics
Ciliary Function & Mucociliary Clearance
Mucociliary Clearance and Buffered Hypertonic Saline Solution,
Talbot A, et al Laryngoscope 107:April 1997
Stresses the importance of saline irrigation for Mucociliary Clearance for patients with acute and chronic sinusitis, and post operative functional endoscopic sinus surgery. Finds close correlation with the saccharin test to other methods of measurement.

Sinusitis: Complications And Sequelae: An Otolaryngologist's Perspective,
Fairbanks, D.N.F.: Pediatr Infect Dis J 4 (Suppl 6) 875-878 1995
Shows that radiographic material placed in the nose before bedtime is found in the tracheobronchial tree in the morning. Thus sinus secretions can contaminate the tracheobronchial tree causing infection and bronchospasm. Hence the value of irrigation to remove offending material.

Ciliary Beating Frequency in Chronic Sinusitis,
Nuutinen J, Arch Otolaryngol Head Neck Surg 119:645, 1993.
After diseased mucosa is cleared of thick mucus and bacteria, ciliary function is shown to return.

Irrigation Fluid & Salinity
Physiologic and Hypertonic Saline Solutions Impair Ciliary Activity in Vitro,
Boeck,Wilbert. Keles, Nesil. Graamans, Kees, Laryngoscope March 99 No 3, p.396.
Certain hypertonic saline solutions cause ciliostasis (the cilia stop functioning) from which the cilia may not recover. If cilia are permanently damaged, the ability to fight infection is lost.

Pulsatile Action
Using Pulsatile Pressure Saline/Antibiotic Irrigation,
Betts N. et al. Compendium Contin Educa Dent, 17(9): 871 1996.
The efficacy of pulsatile saline irrigation has been demonstrated in orthopedics, surgery & dental literature too.

Evaluation Of Wound Irrigation by Pulsatile Jet and Conventional Methods,
Brown LL; Shelton HT. Ann Surg. 1978 Feb, 187:2, 170-3
Comparison with pulsatile irrigation versus bulb syringe - only pulsatile irrigation about significant reduction of bacteria. Conclusion: pulsatile irrigation removed bacteria from experimental wounds more efficiently than conventional procedures.

The Efficacy of Various Irrigation Solutions in Removing Slime Producing Staphylococcus,
Anglen, J. J., Orthop Trauma 1994 Oct;8(5):390-6.
In an orthopedic research project, it is shown that pulsatile irrigation is 100x more effective in removing bacteria from a site than simple irrigation, and is even more effective than some antibiotic solutions in tests for clearing infection.