Sinus rinse - is it my technique, or my anatomy that's wrong?
January 31, 2014 12:48 PM   Subscribe

Calling all Neti Pot/Sinus Irrigation I doing something wrong? Or is there something wrong inside my nose/sinuses? I've been trying a sinus rinse for the first time, with some good results, but also some bad, which includes drainage 10 or more hours after the fact. Long backstory and lots of snowflakey nasal details inside...

Back story: I first went to an ENT in 1978 (I was 17 at the time) after a lifetime of nasal stuffiness (I'd had to smear Vicks on my nose every night in order to breathe for years; I also had a history of very bad nosebleeds on occasion). The experience in that doctor's chair was hellish; without explanation of what he was doing or why, I was laid prone in a chair, told to repeat "K-K-K-K" and a nurse squirted water up my nose with what looked like a dentist's irrigation thingy. I felt like I was drowning, and they had to cut my "treatment" short, but the ENT told me that I had a deviated septum that I may want to have looked at "in the future, but nothing to worry about now" and said that I had chronic sinusitis. He gave me a prescription for Sudafed with 10 refills (it wasn't available OTC at the time).

I was diagnosed with Lupus in 1989, and a few years later it was determined that I also suffered from Sjogren's Syndrome, which suddenly made sense of my very dry skin, history of dental cavities, nosebleeds, etc. So flash forward to current day, and my nasal passages/sinuses are ever so dry... During previous winter months, a bottle of Ocean saline nasal spray plus Sudafed worked well enough. But this winter has been particularly brutal, for some reason. When I'm not congested and able to breathe, it burns a bit when I inhale, I guess because my nasal passages/sinuses are so dry...? Anyway, I'd read here on the green before about Neti Pots and despite my 1978 experience I bought the nasal irrigation squirt bottle thing I linked to above. I noticed that when I squirted up the left nostril (the left side is my most congested and the side where I always feel sinus pressure in my face) it drained freely out the right nostril. When I squirted up the right nostril, just a little bit drained out the left nostril and it felt like water was going into my right ear.

The overall effect of the nasal irrigation was good - the moisture was soothing, and I was able to breathe freely for a bit. But then when I laid down to sleep, eventually my nose got all stuffed up again, and sometimes when I inhaled it burned up inside my forehead (sort of like when you get water up your nose while swimming). Then about two days after the first (and only, at that time) time I irrigated, I was bending over at the waist to brush my hair and water started dripping rapidly from my left nostril. I stood upright and it continued to drip, almost run. I could only assume that some of the solution had been trapped somewhere in my head. Does that mean I'm not irrigating properly? Or could there be some sort of obstruction (the deviated septum?) trapping the rinse inside my sinuses? And why, if my left nostril is the one that's always more blocked up, does the right nostril give me trouble when I irrigate?

[I hesitate to go to the ENT again, mainly because the last one I saw, just two years ago, treated me extensively and expensively to no avail and then sent me to an allergist (who ran many tests, determined that I was allergic to everything from grass to the cat I'd owned for 14 years) for a chronic cough that ultimately ended up being a side effect of a drug I'd been prescribed by my rheumatologist (rheumy phoned me after getting an alert from the manufacturer).]

If nasal irrigation fluid is getting trapped somewhere inside my head (as it seems to be doing), is that dangerous? Is it a possible breeding ground for infection? Or am I not turning/poising my head correctly when irrigating for proper drainage? What's up with the left nostril blocked breathing-wise but solution flows freely (but not on the right side) thing? The moistening provided by the nasal irrigation does feel good on my dry nasal passages, but I don't want to be creating some sort of festering swamp inside my head!
posted by Oriole Adams to Health & Fitness (14 answers total) 4 users marked this as a favorite
Are you blowing your nose at all after you irrigate? You should do a series of short, light puffs on each side (close up the other nostril by holding it shut with your finger). This should remove excess saline. You don't want to blow too hard or you may end up clogging up your ear. It sounds like you may not be blowing your nose enough afterwards and you are getting some saline hanging out up there.

Also as a side note: the way you describe your sinus issues sounds exactly like my own, and I have mostly given up on nasal irrigation. Most of the time I'm too congested for the saline to do anything but drip right out of my nostril as soon as I squirt it in. Hot showers and steam rooms, on the other hand? Those are my BFFs.
posted by joan_holloway at 1:00 PM on January 31, 2014 [1 favorite]

I irrigate my sinuses every day. Twice a day when I have a cold. After I finish irrigating, I bend at the waist and hold my head to one side, then to the other side, then back and forth a few times, just to make sure my sinuses are all drained out. With a little experience, you'll figure out what gyrations are necessary to drain yours. For me, the daily irritations are totally worth it. It's the only reason I can breathe.
posted by OrangeDisk at 1:04 PM on January 31, 2014 [1 favorite]

sometimes when I inhaled it burned up inside my forehead (sort of like when you get water up your nose while swimming).

Are you using saline solution, just to confirm?

Then about two days after the first (and only, at that time) time I irrigated, I was bending over at the waist to brush my hair and water started dripping rapidly from my left nostril. I stood upright and it continued to drip, almost run. I could only assume that some of the solution had been trapped somewhere in my head.

I have had solution get trapped and run freely after bending over, although never after such a long period of time. If you bend over immediately after irrigating (for at least 30 seconds), do you still have signs of water being trapped later on?

The moistening provided by the nasal irrigation does feel good on my dry nasal passages, but I don't want to be creating some sort of festering swamp inside my head!

On the moistening front, my ENT has recommended coating the inside of my nostrils with pure lanolin, available at health foods stores in the personal care aisle. I generally use a Q-Tip to apply daily. It has definitely reduced the incidence of my sinus infections. (However, I don't have Sjogrens; might be worth checking with your rheumatologist before you try this.)

I can't answer anything on the structural front -- that's more an ENT/imaging question. On the ENT front, I had very bad luck with a couple ENTs before finding a great one. It might be worth trying again if you can get a good recommendation from someone you trust.

Also, pseudoephedrine is generally quite drying, and it can turn on you if you use it too many days in a row; have you asked your doctor about other options? I find Mucinex less drying, personally, but it varies from person to person.
posted by pie ninja at 1:06 PM on January 31, 2014 [3 favorites]

I am a big fan of the sinus rinse bottle you linked to and have not experienced anything similar. However, I remember having a steep learning curve when I first started using a neti pot. Are you opening your mouth while you rinse? For me, it was a combination of realizing that I have to open my mouth slightly, plus get my head angled just right. I watched a LOT of youtube videos, which you could also try.
posted by chocotaco at 1:06 PM on January 31, 2014

Though (I am pretty sure) I don't have the same sinus issues you have, I have low-grade allergies to a whole host of things, so I rarely have really clear sinuses. I've tried a neti pot a couple times, with mixed results, including some of the delayed drainage you mention. But my worst experiences were when I got fevers the following day, which I assumed was because I flushed infectious material elsewhere in my sinuses.

But I continue to use the neti pot, when I can breathe through both nostrils. This improves the amount I can drain out by tilting my head, and if water doesn't drain out my nose or the back of my throat, I stop.

Then I lean over a toilet, because I can lower my head more than tilting my head over a sink, and I wait for more water to drain out. Then I stand up and look straight up, which allows some water to drain down my throat, and when that happens, I lean down over the toilet again, turning my head every so often.

After all that, I'll blow my nose very lightly, not blocking either nostril, because I don't want to force water elsewhere.

For me, I'll flush my nose well before I go to sleep, because I'll continue to drain a bit after flushing my nose.

I personally prefer a neti pot to the NeilMed Sinus Rinse Starter Kit you linked to, as the neti pot doesn't add additional force behind the flow of the water, but I've heard good things about all the NeilMed products, FWIW.
posted by filthy light thief at 1:08 PM on January 31, 2014

I use (and really like) the NeilMed system, after having used a neti pot for years. According to NeilMed,

To Avoid Unexpected Drainage After Rinsing:
In rare situations, especially if you have had sinus surgery, the saline solution can pool in the sinus cavities and nasal passages and then drip from your nostrils hours after rinsing. To avoid this harmless but annoying inconvenience, take one extra step after rinsing: lean forward, tilt your head sideways and gently blow your nose. Then, tilt your head to the other side and blow again. You may need to repeat this several times. This will help rid your nasal passages of any excess mucus and remaining saline solution. If you find yourself experiencing delayed drainage often, do not rinse right before leaving your house or going to bed.
posted by janey47 at 1:30 PM on January 31, 2014 [2 favorites]

I use Neilmed (and the walgreens generic version) frequently in the winter and don't have this issue. My ENT said to point the the nozzle of the squirt bottle away from my face while squeezing and this seems to work well for me. That is, as if you were pouring a bottle of wine into a glass, not drinking from a glass of wine.

If you're concerned with bacteria, be sure you're using distilled or pre-boiled water, not tap water (I am guilty of not always...or ever...following this rule).

If you haven't been to an ENT in 20+ years I definitely recommend going again. [Edit:disregard, just saw that you went 2 years ago, nevertheless, maybe see a different one?] There are non-rebound-congestion-causing sprays now as well as a host of other treatments available. I had a balloon sinuplasty done a few years ago due to chronic congestion and it was life-changing.
posted by melissasaurus at 1:42 PM on January 31, 2014 [1 favorite]

Chronic sinusitis-suffer and dedicated irrigator here. I definitely have to bend at the waist and do a few gyrations with gentle nose-blowing afterward, and sometimes I still get a surprise stream of water falling out of my face later on.

However, if I do my irrigating while showering, I don't get the delayed nose-faucet effect. Not sure why this is, but it's been a consistent phenomenon, so, okay.

The burning feeling sounds like you're not putting enough salt in your solution. Too much salt burns, but not enough actually burns worse.
posted by desuetude at 2:07 PM on January 31, 2014 [1 favorite]

Perhaps you should also do nasya to lubricate your nose more afterwards. You don't need a special nasya oil, you can just use organic, cold pressed sesame.
posted by Blitz at 2:37 PM on January 31, 2014

That's the rinse I use, you definitely have to lean over while doing it, and gently blow your nose afterwards. You also should not do it if you are going to be lying down within the next hour.

Did you have a CT scan the last time you went to an ENT? If you're always more congested on one side and your sinuses aren't draining right, there could be something underlying going on, like nasal polyps.
posted by inertia at 3:30 PM on January 31, 2014 [1 favorite]

I did nasal irrigation on and off for years, but eventually I started to get ear infections every time I started irrigating. I think there may have been trapped water issues. No ear infections since I gave up on irrigating.

So I'm fairly convinced that nasal irrigation is not always benign, but it obviously varies a lot from person to person.
posted by ssg at 4:11 PM on January 31, 2014

I have been rinsing my sinuses daily since having sinus surgery a few months ago, and I experience that water up your nose burning thing when the water I'm rinsing with isn't warm enough. Per my ENT, I only use plain boiled or distilled water, so it's definitely not related to salinity in my case.
posted by camyram at 4:26 PM on January 31, 2014

I have the same issue with irrigation, in that it will flow through from one side, but tends to back up to my ear from the other side. This was over many uses, with proper water/salt combos, with a neti pot or with a fancy irrigation system.

Using Sudafed so often is really a major culprit for the painful dryness. You mentioned that you saw an allergist who found a lot of allergens through testing (I'm assuming skin prick testing). I wouldn't be so quick to write that off, even if it wasn't related to the cough. I've had horrible sinus problems since my teenage years, which I've recently been able to bring under control with certain allergy meds (QNasl was one of the newer ones) but then also starting immunotherapy. I hardly ever have really stuffy days anymore, and so don't need to treat those symptoms.
posted by bizzyb at 6:13 PM on January 31, 2014

Thanks for the responses thus far! A few additional/clarification points: I've been following the instructions on the NeilMed box to the letter - using only distilled water and adding the saline packets provided, warmed slightly in the microwave. Sometimes the burning I get is like (as I mentioned) when water gets up your nose, other times when my nasal passages are clear enough to breathe through, they hurt (maybe "burn" is not the right term)....I can best describe it as the feeling when you go outside into very, very cold winter weather and inhale. That may be due to the Sjogren's dryness. I have some OTC nasal gel (in fact, the ENT I saw in '78 also gave me a script for ointment because he said my nose was dry) that alleviates that "inhaling harsh air" feeling a bit. But it also seems to "trap" anything that wants to drain and I end up waking up after an hour or so of sleep having to blow my nose. However, I have been using the nasal irrigation just prior to sleeping, which inertia mentions is not good (and now that I read it more closely, so does the NeilMed insert). I will try irrigating an hour or so before sleep time to see if that helps.

As far as the allergist, even though my skin tests reacted to certain things, my nasal congestion has never coincided with any particular trigger; I don't suffer from "hayfever" in the spring, pollen season has never stuffed me up, nor did petting our cat when we first got him in 1980. I've had nosebleeds serious enough to require a trip to the ER since I was in the third grade, and they always seemed to occur at night - I'd wake up from a deep sleep at 3AM gasping for air with the front of my pajamas soaked. I'll never forget the one doctor, as he continually stuffed long strings of gauze up my nose and removed them saying to me "I see nail marks in there" (without gazing inside my nose with so much as a nasal speculum) as I protested that I didn't pick my nose (the very thought grossed me out then as it does today). He said "Maybe you do it in your sleep." My Mom told me on the way home that he'd probably just noticed my long fingernails (I've always been able to grow long nails with no effort and polished them with Smartee red - 39 cents a bottle - even as a youngster.) Um, not that I'm still bitter about that groundless accusation all these years later or anything....

Anyway, I have never suffered any traditional allergy symptoms - no runny eyes, sneezing, hives, anything like that. I'm not saying the skin tests were wrong, but I just that that despite my reaction to them is not necessarily the source of my nasal difficulties. I guess a return trip the ENT is warranted....I'm just wary, due to my past experience, of being constantly "upsold" on an array tests and recommendations to other specialists.

Thanks again everyone for your comments and advice - it is much appreciated!
posted by Oriole Adams at 1:03 PM on February 1, 2014

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