A Review of Popular Nasal Irrigation Systems

Introduction: After endoscopic skull base surgery, patients are frequently encouraged to rinse their nose with large volume, low pressure saline rinses to soften crusting and remove organized blood clots. Numerous products exist for purchase over the counter which are used by patients. This study aims to review commonly used nasal irrigation systems to educate providers about the different devices and their mechanisms of action.

Methods: Six nasal irrigation systems were acquired based on availability at local drug stores and on Amazon.com. The systems investigated are as follows: (1) NeilMed Sinus Rinse (NSR), (2) NeilMed Sinugator (NS), (3) NeilMed Neti Pot (NNP), (4) HailiCare Nose Cleaner (HNC), (5) Nasopure Nasal Wash (NNW), and (6) Navage Nasal Irrigation (NNI). These devices were compared based on objective measures of cost (both of the devices as well as supplemental saline packets) and volume of fluid dispersed per use. Objective measures of water pressure were also recorded.

Results: All devices required home preparation of saline solution. Instructions were included to create an isotonic solution using proprietary solute packets measured into a specified amount of distilled or boiled water. Packet contents were identical across all products, consisting of pH-balanced sodium chloride and sodium bicarbonate. The only exception was the Navage SaltPods, which contained only sodium chloride and purified water. The total amount of solution delivered from one use was 240 mL for all devices except for the HNC, which delivered 500 mL. All devices operated via the flushing of saline rinse up one nostril and out the other. The NNP operates using gravity to flush the solution. The NSR, HNC, and NNW generate pressure by hand squeezing the bottle. The NS utilizes a motor to deliver the solution in a pulsatile fashion and the NNI utilizes a motor to generate both positive pressure in one nostril and negative pressure suction in the other to circulate the solution through the nasal passages.

Conclusion: When encouraging patients to use saline irrigations after surgery, it is important that physicians understand what type of device they are using. While commercially available irrigation systems are typically positive pressure, the NNI system also utilizes negative pressure to encourage saline flow and may not be ideal in the immediate post-operative period for patients with skull base repair.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022