8532 W. Capitol Drive, Milwaukee, WI 53222

LINDA J. DINDZANS, MD Office: 414-536-7000

JODI M. KORNAK, MD Fax: 414-536-7001

HOW TO DO NASAL WASHES

Introduction:

Flushing or washing out the nose restores the normal flow of mucus and clears away crusts from inside the nose. Routine nasal washes may help to clear infections, keep infections from starting, control nasal odors, decrease nasal stuffiness or promote healing after nasal or sinus surgery. You may need special tools to do this well. It may seem like a weird thing to be doing at first, but soon it will feel as normal as brushing your teeth or combing you hair! Think of it as a shower for you nose!!

Solutions Used for Nasal Washes: Be sure to ask which solution and flushing method is best for you.

A. Salt Water (Saline)

1. The Salt – Pickling (“canning”) salt or Kosher salt are best because they are free of iodine and other preservatives. Regular table salt is OK if you cannot get pickling salt.

2. The Water – Tap water or well water that is drinkable is acceptable for people who are not immune suppressed.

3. The Temperature – Use the saline at body temperature (98.6 F or 37 C) or slightly warmer, NOT HOT. Short microwave heating may be an easy way to warm it or get it warm out of the tap.

B. Home Recipes

1. Isotonic Saline: Used after surgery and in most other situations

Mix 2 teaspoons Salt + 1 quart (liter) water

2. Hypertonic Saline: For stuffy noses.

Mix 2-3 heaping teaspoons Salt + 1 quart (liter) water

3. Buffered Saline: For dry noses.

Mix 2 teaspoons Salt + 1 quart (liter) water + 1 teaspoon baking soda

4. Moisturizing flushes: For dry noses.

Number one or two above plus 100cc (6-2/3 TBSP) Karo syrup

5. Antiseptic flushes: For infected or runny noses

Number one or two above plus 5cc (1 tsp.) white vinegar.

C. Commercial Solutions

1. Saline drops, spray or mist, from the local drug stores (Breathe Free, Salinex, or Pretz are good brands. Avoid ones with alcohol or thimerisol in them).

2. Pretz irrigation – Lubricating Solution in an 8 oz. Bottle with irrigating spout and large refills (from Parnell Pharm. 1-800-457-4276).

If you mix large amounts of solution for multiple uses, store in a new or clean airtight bottle at room temperature. Make a new batch every 7 days. (Daily after surgery.)

Bulb Syringe Method:

Buy a small rubber bulb syringe (these are packaged as 2,3 or 4 oz. Ear syringes, $5) from you local drug store. Fill it with the solution and place into your nose while leaning over a sink. Squeeze the bulb to flush your nose. The saline will flow back out from the nose and mouth. If the force of fluid seems too weak, you can use scissors to trim back the syringe tip and widen its opening. This will make the flushing more forceful when you squeeze. Trim off just a little piece of the syringe tip at a time until you find the right amount.

Water Pik Method:

Use a regular dental water pik (about $50.00 from you local drug store). Instead of the dental tips that come with the water pik, use a special nasal tip (see below). Mix the irrigant in the water pik basin or fill it from a storage container. Set the water pik on LOW. Put the nasal tip into the nose while holding over a sink or basin with you chin tipped down nearly touching your chest, then turn on the water pik. Slowly increase the force of flow until debris comes out in the returns. The saline will flow into your nose then back out from you nose and mouth.

Where to get Nasal flushing tips for the water pik (No prescription is needed):

1. Ethicare Products (sells water piks and many varieties of tips). These have soft thin flexible plastic tubes on hard plastic connectors. They are easy and comfortable to place well up inside the nose to reach trouble spots. (P.O. Box 5027, Fort Lauderdale, Florida, 33313, 1-305-742-3599.

2. Grossan nasal irrigator tip. Rigid plastic arm with hard bulbous rubber tip on a curved head which fits just inside the nasal opening. Order from Hydro Med, Inc. (Los Angeles, CA, 1-800-560-9007, e-mail is hydromed@Westworld.com).

How much should I flush and for how long?

For all methods, keep flushing one side of the nose until the returns are clear. Then switch to the other side and flush until the returns are clear. The whole session should last about 10-15 minutes.

Some Do’s and Don’ts while flushing:

-Do breathe through your mouth or hold your breath while flushing.

-Do take the tip out of your nose if you have to sneeze or cough.

-Do not speak or swallow during the flushing. This could change the pressure in your ears or nose and could cause infectious mucus to be drawn into the sinuses or middle ear.

Clean up: Keep the devices very clean, especially the tips used in the nose.

After each use:

1. Wash the tips and flush the devices through with hot soapy water.

2. Flush them with plain water to remove the soap.

3. Be sure all the water is drained out of the device.

4. Allow it to air dry.

Once a week:

1. Flush the device and tip with full strength hydrogen peroxide or a weak bleach (Clorox bleach to 100 parts water) to disinfect it.

2. Follow steps 2-4 above.

3. Flush the device and tip after every use for the first two weeks after surgery.