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.
