General Articles on Pulsatile Nasal
Irrigation & Sinusitis
Pulsatile Nasal Irrigation in Children
More Laboratory-Oriented Topics:
Having Nasal Surgery? Don’t You Become An Empty Nose Victim by Christopher
Sinus Relief Now: The Ground-Breaking 5-Step Program for Sinus, Allergy, and
Asthma Sufferers by Jordan S. Josephson, 2007
The Sinus Cure by Debra Bruce and Murray Grossan. 2007.
Harvard Medical School Guide to Healing Your Sinuses (Harvard Medical School
Guides) by Ralph Metson and Steven Mardon, 2006
Clinical Study and Literature Review of Nasal Irrigation, Davidson, T., Laryngoscope 110: July 00
Patients at the Nasal Dysfunction Clinic an Univ. of Cal. San Diego had excellent relief by daily irrigation with pulsatile irrigation for sinusitis, perennial allergy, seasonal allergy, postnasal drip, and associated fatigue. Very well accepted by patients.
The Complete Self-Care Guide to Holistic Medicine, Robert Ivker 1999
"[Pulsatile] Nasal Irrigation with salt water using a . . . nasal attachment to a pulsatile irrigator is extremely helpful for flushing infected sinuses or cleansing the membranes of the nose and sinuses."
Management of Sinusitis: Current Clinical Strategies, Michael Kaliner MD and David W Kenned, MD, in Sinusits Disease Management Guide. PDR 2000
"If the patient has recurrent disease he may buy a Pulsatile irrigator with the ... nasal adapter. ...particularly effective after surgery." page 121, "Treatment of Chronic Sinusitis - Nasal washing ...applied through the Pulsatile irrigator and [nasal] adapter twice a day is recommended. Page 122
Therapeutic Agents In The Medical Management Of Sinusitis, Mabry, R.L. In: Inflammatory diseases of the sinuses. Otolaryngologic Clinics Of North America, Volume 26, Number 4, pp 561, 1993.
Not only is the [pulsatile] Sinus Irrigator beneficial for patients with bothersome thick postnasal secretions, but is especially helpful for postoperative cleansing following nasal surgery.
Sinusitis: Acute, Chronic and Mangegeable, Rachelevsky G S, Slavin R G et all. Patient Care. Feb 28, 1997 Vol 131:4.
"A particularly helpful strategy is saline washing using a Pulsatile irrigator. Sinus irrigator is so effective in clearing the blocked passages that , if it is done regularly, some patients with persisitent or chronic sinusitis need no drug treatment at all.
A Device for Nasal Irrigation,Grossan M Transactions of the American Academy of Ophthalmology and Otolaryngology. 78: July 1974 279-280
An easy method of sinus treatment at home or office. With this device the patient can leave the office with the bacterial load reduced, hence requires less antibiotic and much greater patient satisfaction.
Sinusitis: Bench to Bedside, Kaliner MA et al. Otolaryngology June 97 116:6 Part 2 Study of Sinusits.
Pulsatile sinus irrigation is recommended as a treatment for sinusitis, and as a supplement to other treatment modalities.
A New Nasal Irrigator Device. Grossan M. The Eye, Ear Nose And Throat Monthly. March 1974
Application of pulsatile irrigation for post nasal drip and phlegm
A Device To Aid Nasal Mucociliary Flow, Grossan A.N.L. March 1976 pp 65-70.
In Japan there is a very high incidence of sinusitis requiring surgery. Pulsatile irrigation is helpful to avoid surgery.
Office Measurement of Nasal Mucociliary Clearance, Grossan, M. English: Otolaryngology 1994 Vol 2 ch 7
The saccharin test is an objective measure of one very important aspect of the respiratory defense system. Many diagnostic dilemmas are solved using this test. The nasal test reflects the chest condition. Using pulsatile irrigation, one can improve both.
Treatment of Sinusitis in the Next Millennium, Kaliner, M. Allergy and Asthma Proceedings, 19:181-4, 1998
Saline irrigation using a pulsating stream and sinus adaptor is an effective non-drug treatment for sinusitis
Nasal Hyperthermia and Simple Saline Irrigation for Perennial Rhinitis, Changes in Inflammatory Mediators, Georgitis JW. Chest 106:1487 - 82, 1994
Saline irrigation with Pulsatile irrigator and . . .[nasal] adaptor reduces significantly the presence of mediatiores of inflammation in the nasal exudate six hours after treatment.
Sinus Survival, Ivker R., Putman Publication 1995.
Pulsating irrigation is shown to remove pus and allow for natural, holistic healing.
A Device for Nasal Irrigation, Grossan, M. Transactions of the American Academy of Ophthalmology and Otolaryngology. 78: July 1974 279-280.
Nasal irrigation is found to be an easy method of sinus treatment at home or office. With this device the patient can leave the office with the bacterial load reduced, hence requiring less antibiotic and producing greater patient satisfaction.
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.
A New Nasal Irrigator Device, Grossan, M., The Eye, Ear Nose and Throat Monthly, March 1974.
Application of pulsatile irrigation for post nasal drip and phlegm is described.
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.
Irrigation of the Child's Nose, Grossan, M., Clinical Pediatrics, March 1974 13:3 229-231.
Children with sinusitis, post nasal drip or nasal blockage use pulsatile nasal irrigation at age 5 or older. By removing discharge, adenoid and tonsil hypertrophy were reduced. Irrigation was also found to be an aid to clearing the ear.
Geriatric Rhinitis: What it is, how to treat it. By Jennifer A Jordan, Geriatrics: June 98.
Pulsed irrigation of nasal passages may be performed using a [pulsating] device equipped with the . . . nasal tip applicator.
RhinitisAnd Nasal Obstruction, Lucente, F.E. In: Nasal Obstruction. Otolaryngologic Clinics Of North America, Volume 22, Number 2, pp 307, 1989.
The Pulsatile irrigation device with the ... nasal irrigator tip is an efficient system for irrigation . The irrigant is instilled as a pulsating stream into one nasal cavity and drains out through the other side. [Pulsatile irrigation] effectively loosens crusts.
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 pulsatile 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 noseblowing 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 for removal of offending particles and restoring normal ciliary flow.
Allergic or Non Allergic Rhinitis, Meltzer EO, In Allergy: Principles and Practice, editors: Middleton and Reed. Vol 2 pp 1181, 1992
It has been shown in many patients with chronic rhinitis that mucociliary transport is markedly increased after two weeks of one or two times a day irrigation using the Pulsatile irrigator with the [nasal] attachment.
Rhinitis, Allergy: Principles and Practice, 3rd edition. Middleton E. CV Mosby Company Ch 17, 1988
All forms of allergy rhinitis are benefitted by saline irrigation with the Pulsatile irrigator and nasal attachment.
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 microforeign bodies 5. Augments tissue repair 6. Reduces forceful noseblowing 7. Improves olfaction.
Atrophic Rhinitis, deSouza, F.M.: Chapter 14N English: Otolaryngology 1996.
The Pulsatile irrigator dental irrigation device with the... nasal irrigator tip is shown to increase the efficiency of saline nasal douches.
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 Pulsatile irrigator dental irrigation device with the . . .nasal irrigator tip has increased the efficiency of saline nasal douches."
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.
Allergies and Asthma for Dummies by William E Berger, MD
"use a Pulsatile irrigator with nasal attachment to irrigate with warm saline solution to relieve pressure and congestion in your nasal passages "
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.
Allergies and Asthma for Dummies by William E Berger, MD - see above in Asthma
Current Review of Allergic Diseases 2001 edited by Michael A Kaliner
[Pulsatile] Irrigation is recommended for nasal problems.
Prospects for ancillary treatment of rhinosinusitis in the 1990's, Zeiger RS. , J Allergy Clin Immunol 1992;90:478-495
Recommends pulsatile irrigation to reduce or eliminate allergy symptoms.
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 to 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.
Rhinoplasty Edited by Rolin K Daniel, M.D. 1993 Chapter 2 by Geroge Meredith.
Four days after nasal surgery start to use the Pulsatile Irrigator . Almost all patients find the cleaning provided by pulsatile irrigation a great source of comfort. It significantly improves mucociliary transport in the first few weeks postoperatively
Evaluation of methods of Sinus Nasal Irrigation Irrigation Post Sinus
Surgery, Cenjor, C. Gutierrez, R. Congress of Spanish Society of Otolaryngology and Cervical Facial Pathology. Las Palmas de Gran canaria, 12- 16 Octubre de 1998
"Pulsatile Irrigation is the preferred method of treatment after endoscopic surgery. Highly accepted by patients.
Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis.
Ricchetti A, Landis BN, Maffioli A, Giger R, Zeng C, Lacroix JS.
J Laryngol Otol 2002 Apr;116(4):261-3
Rhinology Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Geneva University Hospital, Switzerland.
Recent studies have suggested that allergic fungal rhino-sinusitis could be involved in the development of nasal polyposis. The aim of this study was to evaluate the response of anti-fungal nasal lavages. Patients performed nasal lavage with 20 ml of a one per one thousand amphotericin B suspension in each nostril, twice a day, for four weeks. In addition, all patients continued their saline nasal lavage and their conventional topical corticosteroid spray. This study included 74 patients, with a mean age of 46 years (range from 19 to 73). Before anti-fungal treatment, the distribution of nasal polyposis, according to Malm, was: 13 patients in stage I (17.5 per cent), 48 patients in stage II (65 per cent) and 13 patients in stage III (17.5 per cent). After anti-fungal nasal lavages, the total disappearance of nasal polyposis was observed in 29 patients (39 per cent). Eight patients were stage I, 21 stage II, and none stage III. In patients who have had previous endoscopic polypectomy and functional endoscopic sinus surgery,
total disappearance of nasal polyposis was seen in 24 patients (47 per
cent). Hyper-reactivity to fungal organisms could be one of the mechanisms underlying the development of nasal polyposis. A direct effect of amphotericin B suspension on the integrity of the cell membrane of the polyps' epithelium could not be excluded.
Effects of Aspergilis fumigatus and Alternaria on human ciliated epithelium in vitro
Cody,DT 2nd,Mcaffrey, TV. Kern,E Laryngoscope.1997. Nov:107 1511-4
Nasal cilia are inhibited by toxins from Fungi. Inhibition of the cilia can reduce the effectiveness of natural healing.
Management Of Sinusitis In Cystic Fibrosis, Moss RB, King W. . Arch Otolaryngol Head Neck Surg. 1995;1 21:566-572.
Stresses the use of pulsatile irrigator with nasal adaptor for home use. Recommends antibiotic irrigation of sinuses.
Pulsatile irrigator Irrigation with [Nasal] Adaptor is used for CF, Cystic Fibrosis Currents Volume 11, No 4
Method For Rapid Evaluation Of Topical Of Topically Applied Agents To Cystic Fibrosis, Wine JJ, King W, Lewiston NJ Am J Physiol. 1991261 (Lung Cell Mol Physiol. 5):L21 8-L221
Pulsatile isinus irrigation makes an ideal vehicle for local administration of antibiotics and other products.
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 a successful means of clearing the sinus of disease.
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.
Enhancing The Mucociliary System, Grossan, M. Advances for respiratory care practitioners.. April 17, 1995 8 pp12-13
Coughing, wheezing, respiratory complaints may be significantly benefited by use of the pulsatile saline irrigator. Removing pus from the sinus via simple irrigation can significantly speed healing and prevent spread of infection from the sinus to the lungs. Daily removal of pus by the patient at home is beneficial.
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.
Evaluation of methods of Sinus Nasal Irrigation Irrigation Post Sinus Surgery, Cenjor, C. Gutierrez, R. Congress of Spanish Society of Otolaryngology and Cervical Facial Pathology. Las Palmas de Gran canaria, 12- 16 Octubre de 1998
Pulsatile irrigator irrigation with ... sinus adaptor is the preferred method of treatement after endoscopic surgery. Highly accepted by patients.
Office Measurement of Nasal Mucociliary Clearance, Grossan, M., English: Otolaryngology 1994 Vol 2 ch 7.
The saccharin test is shown to be an objective measure of one very important aspect of the respiratory defense system. Many diagnostic dilemmas are solved using this test. The nasal test reflects the chest condition. Using pulsatile irrigation, one can therefore improve both chest and sinus problems.
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.
Mucociliary Flow in Otolaryngology Practice, Grossan M., Insights in Otolaryngology. August 1993 8 :2-8.
Many noxious exposures can inactivate mucociliary clearance, including smog, exhaust fumes, chlorine, chromium, etc. The sooner normal ciliary activity is restored, the sooner the natural physiology of the defense system can ward off illness. Hot tea, chicken soup, iodides, and pulsatile irrigation are shown to be important aids to the natural defense system.
The Saccharin Test of Nasal Mucociliary Function, Grossan, M., Eye, Ear, Nose and Throat Monthly 1975 54:(11), pp 415-417.
An objective test of mucociliary clearance is described. This test is useful for measuring cilia function before and after pulsatile nasal irrigation to objectify degree of improvement.
Nasal Mucociliary Flow - A Clinical View, Grossan, M., Amer Acad of Otol and Ophth Scientific Presentation Dallas 1975 (certificate of merit award).
How to effect improvement of mucociliary clearance.
Classification of Cilio-Inhibiting Effects of Nasal Drugs. Paul Merkus. Laryngoscpe: 111 April 2001 pp595 - 601
Use of Locke-Ringer's formula is best for enhancing cilia. On a 1-100 scale, Locke-Ringer's is 100.
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.
Ringer-Lactate solution versus isotonic saline solution on mucociliary
function after nasal septal surgery.
Unal M, Gorur K, Ozcan C.
J Laryngol Otol 2001 Oct;115(10):796-7
Irrigation with isotonic saline is one of the most frequently used solutions after nasal surgery. However, the effect of saline solutions on mucociliary clearance is not well known. In a previous study, it was found that isotonic saline solution had a negative effect on ciliary beat frequency but Ringer-Locke solution had no effect in vitro. In this study we compared the effects of Ringer-Lactate solution and isotonic saline solution on mucociliary transport time before, and after, nasal septal surgery in patients with nasal septal deviation. We found that patients who used Ringer-Lactate solution as irrigation after surgery had a significantly better mucociliary transport time than the patients using isotonic saline solution (p < 0.05). In conclusion, it is better to use Ringer-Lactate solution instead of 0.9 per cent saline solution for nasal irrigation. (Breathe.ease XL is a modified Ringer Lactate product)
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 and 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.
A Mechanical Throat Irrigator, Grossan, M., Transactions of the American Academy of Ophthalmology and Otolaryngology. 77: January 1973.
Throat irrigation is shown to significantly reduce the need for antibiotics, and to possibly reverse the need for tonsillectomy. It is also shown to be specifically valuable to prevent the spread of infection within the family.
An Instrument for Throat Irrigation, Grossan, M., The O.R.L. Digest July 1972 39:7 pp10-13.
A method to replace gargling is presented that is safe and pleasant. Gargling may cause laryngitis and has been shown to be ineffective.
Irrigation Treatment of Throat Infections, Grossan, M, The Eye, Ear, Nose and Throat Monthly. August 1972 51:8 pp302-305.
Irrigation of the throat is shown to bring blood to the area, encourage lymphatic drainage, and remove bacteria on the surface and in the crypts.