Rhinosinusitis: Cold Shower for Therapy

1. February 2010

A nose douche is a no-go for esthetes but might free a snot nose from mucus. So many people suffering from chronic rhinosinusitis help themselves. And do more damage than good say researchers: Nose douches over months increase the risk for infections significantly.

The nose douche does not require any “chemistry” and even the ancient Indians used to know about it by the name “Jala Neti“. There it was supposed to provide a steady flowing breath thus making mediation during Yoga easier. This made the allegedly “natural” nose douche a popular household remedy to clean snotty noses from disgusting mucus. Not only pharmacies offer a broad range of nose douches including the according salts by now. The basic principle is simple: Solve a pinch of salt in water preferably body temperature and enter the solution by means of a douche in one of the nostrils. If the body posture is right, the fluid including the body own mucus dissolved in it will flow out of the other nostril.

According to the Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie (German Association for ENT, Head- and Throat Surgery), the mechanism is “to improve the mucociliar clearance by liquefaction of the nasal secretion.” In addition, the lukewarm sludge supposedly constricts the vessels thus working detumescent. The professional association recommends the nose douche in its “Guidelines Rhinosinusitis” as a non-pharmacological therapy option for this clinical picture.

Studies prove benefits of short-term application

Up to now, scientific studies have covered this recommendation for application over several weeks. Just a few weeks ago, a systematic review showed that nose douches over a period of twelve weeks or more can reduce symptoms of the chronic rhinosinusitis for up to 64 percent. On the other hand the benefits for allergic rhinitis and infections in the upper respiratory tract are less clear. Perhaps you should not use the saline solution over a longer period of time after all.

A study introduced by Prof. Dr. Talal M. Nsouli of Georgetown University Hospital School of Medicine at this year’s “American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting“ in San Diego/USA points in this direction. 68 patients, all daily nose douche takers with chronic rhinosinusitis, participated in this study. For twelve months they savored this procedure twice a day, followed by another twelve months of complete nose douche abstinence. 24 additional patients served as a control group, each of them taking a douche with saline solution once a day over a period of twelve months.

Regular douching damages nose hygiene

Different than expected, the number of test persons without nose douche suffering from acute rhinosinusitis is significantly lower: The number of episodes decreased from 544 (nose douche twice a day) to 204 in twelve months without nose douche. Thus the frequency declined by 62.5 percent to an average of three episodes per year and test person (p smaller than 0.001). In the control group (nose douche once a day) the number was about 50 percent higher (p smaller than 0.001).

The allergist Nsouli has a simple explanation: Not only is the nasal mucosa a source for mucous congestion but also serves as the first combat defence line against intruding pathogens. If you wash this mucous off twice a day with saline solution you will rob your nose these defence troops – as the head of the studies at the ACAAI congress is quoted. In his opinion there is nothing to be said against taking a nose douche daily or even twice a day over a period of several weeks – but not over a long period. Nsouli’s team now plans a larger study to back up those results.

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