17/02/2024

Nasal Irrigation:
Preventive and Complementary Therapy

apt. Hadi Sumarsono, M.Farm.

Learning Objective …

Memahami manfaat dari cuci hidung sebagai pencegahan

maupun terapi pelengkap farmakologis dalam mengatasi
gejala pada hidung

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Outline …

• Hidung dan fungsinya

• Gangguan umum pada hidung

• The nasal hygiene: efficacy & safety

Nose

• Part of respiratory system

• Allows air to enter your body

• Filters and cleans air to remove

particles and allergens

• Warms and moistens air so it can

move comfortably into your
respiratory system

• Provides a sense of smell

• Contributes to how you look and

how you sound when you speak

Choanal Atresia and Craniosynostosis: Development and Disease. 2018

https://my.clevelandclinic.org/health/body/21778-nose

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• Bone
• Hair and cilia: Hair and cilia (tiny, hairlike structures) inside your nose trap dirt and particles.
Then they move those particles toward your nostrils, where they can be sneezed out or wiped
away
• Nasal cavities → Lined with mucous membranes
• Lateral walls (outer walls)
• Nerve cells
• Nostrils (nares)
• Septum
• Sinuses
• Turbinates (conchae) Choanal Atresia and Craniosynostosis: Development and Disease. 2018
https://my.clevelandclinic.org/health/body/21778-nose

Problems can affect the nose ...

• Common cold
• Rhinitis (Allergic rhinitis, Rhinosinusitis)
• Deviated septum
• Nasal polyps
• Nosebleeds
• Nasal fractures

https://medlineplus.gov/noseinjuriesanddisorders.html

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Rhinitis ...

Japanese guidelines for allergic rhinitis 2020

How can I keep my nose healthy?

• Avoid smoking or breathing in secondhand smoke

• Don’t remove nose hairs, or do it carefully, because they
filter dirt and debris
• Drink plenty of water
• Keep your home clean to reduce the amount of dust and
other allergens you may breathe in. Wash your
bedsheets to remove dust
• Squirt saline into the nasal cavities to keep them
clean and moist
• Use a humidifier at home to keep the air moist

https://my.clevelandclinic.org/health/body/21778-nose

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Nasal Irrigation

• Nasal irrigation (NI) is an old practice of upper

respiratory tract care that likely originated in the
Ayurvedic medical tradition. It was adopted by
Western medicine in the late 19th century, and since
then, it has continued to gain popularity worldwide

• It is used alone or in association with other therapies

in several conditions, including chronic rhinosinusitis
(CRS) and allergic rhinitis (AR) which characterized
by increased nasal secretions and / or congestion.
Moreover, particularly in children, it has been
prescribed to treat and prevent upper respiratory
tract infections (URTIs)

• They’re also used to moisten nasal passages

exposed to dry indoor air

Nasal Irrigation: An Imprecisely Defined Medical Procedure. 2017

The Nose as a Route for Therapy: Part 1. Pharmacotherapy. 2021
neti-pots-safe
https://www.fda.gov/consumers/consumer-updates/rinsing-your-sinuses-

Management of Allergic Rhinitis

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update

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Mode of Action Benefits

• Humidifies and moisturizes the nasal mucosa and
hypertonic saline may reduce mucosal edema

• Removes particles, allergens, air pollutants leading to less

interaction with the mucosa and, probably, less
inflammation mediators such as histamine, prostaglandins
and leukotrienes

• Saline seems to make the mucus thinner and more easily

expelled and, in turn, mucociliary clearance is improved

• In a postoperative setting, the removal of thick crusts,

clotted blood and debris may result in faster wound
healing

https://www.sterimar.co.id/apa-itu-nasal-hygiene/#kebersihan
https://www.sterimar.co.id/artikel/kebersihan-hidung/
The Nose as a Route for Therapy: Part 1. Pharmacotherapy. 2021

Be careful!! Improper use of nasal irrigation

devices can increase your risk of infection

Rinse only with distilled, sterile or previously

boiled water

https://www.fda.gov/consumers/consumer-updates/rinsing-your-sinuses-
neti-pots-safe

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Limitations of syringe as nasal irrigation device:

• It does not allow a good connection with the nostril

→ Reduces the efficacy of the nasal irrigation
because part of the solution may leak from the
nostril before reaching the nasal cavity

• Pressure can be quite different according to the

force applied by the operator and, in some cases,
may be too strong, which causes discomfort or too
light, resulting in an ineffective application

• When high volumes are needed and a relatively

small syringe is used, it should be filled several
times with the risk that the operator does not use
the correct volume

Nasal Irrigation: An Imprecisely Defined Medical Procedure. 2017

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Solutions for Nasal Irrigation

• The activity of nasal irrigation seems further increased by the addition to
the solution containing ions different from Na+ and Cl- because they can
exert a relatively positive effect on epithelial cell integrity and function

• Isotonic saline (0.9%) and hypertonic saline (1.5% to 3%)

• Hypertonic solutions are better than normal (iso-osmotic) saline →

Mucociliary clearance is increased

• Solutions with NaCl concentrations higher than 3% are not recommended,

although the emergence of adverse events due to hypertonicity—such as
sensations of pain, blockage, and rhinorrhea

• pH values varying from 4.5 to 7

• Solutions that are either too cold or too hot can cause problems of
tolerance
Nasal Irrigation: An Imprecisely Defined Medical Procedure. 2017
The Nose as a Route for Therapy: Part 1. Pharmacotherapy. 2021

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To increase the mineral content, several commercial

products containing seawater diluted with distilled water to
obtain an isotonic or slightly hypertonic solution with neutral
or slightly alkaline pH are on the market. Although diluted,
these products include a greater amount of minerals
compared to NaCl and Ringer’s solutions

Nasal Irrigation: An Imprecisely Defined Medical Procedure. 2017

Manganese is important in the control of allergy, as it manages the

release of proinflammatory mediators, such as histamine in the
respiratory tract, and has a scavenger activity of promoting superoxide
dismutase (SOD)

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Safety of Nasal Irrigation

• Minimal and mild side effects → Compliance is high

(Epistaxis, nasal and / or aural burning or irritation and
middle ear effusions occasionally occur especially with
large volume, high pressure, hypertonic solutions)

• In general, nasal irrigation benefit far outweighs risk

Nasal Irrigation: An Imprecisely Defined Medical Procedure. 2017

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Take Home Messages

• Apoteker memiliki kontribusi dalam mengidentifikasi

pasien yang memerlukan irigasi nasal serta memberikan
edukasi terkait dengan penggunaan irigasi nasal di
kehidupan sehari – hari

• Irigasi nasal bermanfaat untuk membersihkan dan

melembapkan rongga hidung serta dapat digunakan
sebagai alternatif terapi baik secara tunggal maupun
kombinasi farmakologis dalam mengatasi gejala pada
hidung

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Terima Kasih

Soli Deo Gloria

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