Stopping Runny Noses

A regular nasal rinse can help relieve chronic sinusitis in children

by Hana R. Solomon, M.D.

Pediatricians evaluate and treat many conditions and without a doubt, nose woes are the most common issue presented in the clinic. A greater understanding of nose and sinus anatomy and function can help you make common sense yet informed decisions regarding treatment and prevention. The nose is the body's filter. The nasal cavity is lined with mucus membranes. This lining is covered with cilia, little hairs which function to filter any impurities we breathe. Impurities include but are not limited to pollen or any allergen (particles that can trigger an allergic response), bacteria, virus, smoke, pollution, chemicals. The nasal lining has goblet cells, which produce mucus. These secretions entrap impurities so they can be removed by blowing out or swallowing into the acidic contents of the stomach.

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Exposure to irritants cause the cilia to get clogged and to not function as intended; the goblet cells produce excessive, thicker mucus which is difficult to remove; the nasal linings swell and block the inner ear opening, the sinus opening and the nasal airway. All of these events result in plugging of the drainage system, post nasal drip, sore throats, ear problems, sinus pressure, excessive nasal discharge, coughing and the inability to smell.

No matter what the inciting event is, the end result often leads to the need for over the counter and prescription medications. Medication use has increased to a whooping 276 million dollars per year. More than one third of preschoolers are give an over-the-counter medication in any given month. There are over 800 over-the-counter cold and sinus preparations but only 6-10 different ingredients in varying combination. There is doubt if any of the medications actually are actually beneficial. The overuse of antibiotics is contributing to the development of bacterial resistance and this is a serious threat. The CDC has estimated that treatment of infections due to resistant bacteria costs more than $4 billion annually. Allergy treatments cost 1.8 billion dollars annually. Each year over 850 million dollars are spent on physician visits and 639 million dollars are lost on productivity. This trend is truly amazing and frankly very scary.

As a mother and a doctor, washing the nose makes sense to me. Over the years, thousands of patients have told me what I instinctively knew, washing helps. If done daily, patients reduce the number of allergy or infection episodes each year, and if done at the first sign of nasal irritation, washing can reduce the duration and intensity of the illness. If done with medication, it reduces the amount of antihistamines, antibiotics and steroid nose sprays needed. Hypertonic solution has a greater salt concentration as compared to the body's salt concentration without side effects and tolerable, even for children. The cost in nasal washing is pennies for each rinse.

Little Brianna used to come in 3-6 times per year, from toddler years to elementary school. She would often need nasal steroids and oral antihistamines to control her allergy symptoms, secondary ear and sinus problems. I began teaching Brianna about washing the nose by encouraging her to fill it with water and squirt it while in taking her daily bath. This helped her get the feel of the pressure needed to spray water out the tip. Both mom and I would applaud her efforts, give her stickers and brag about her efforts while in my office. Next we suggested to her that if she tried to squirt just a bit of water in her nose during bath time, it would help her blow her nose clean. Again, with any of her efforts, we applauded her, told her how proud we were of her and how she is helping keep her nose clean. The next step was to play a game and ask if she could make the water come out of the other nostril. 'Sure' she said, and showed me just how this little girl could accomplish this task. Her mother was instructed to begin adding small amounts of the salt mixture (1/4 tsp per 8 ounces of fluid) and advance the dosage as tolerated. My patients tell me it takes about 4-7 days, depending on ones age and tolerance level. Over a 2 year period, Brianna was able to wash her nose out on her own, just like brushing her teeth. Her office visits decreased in number as she perfect her nasal washing technique.

Four year old Sophie had similar problems, although her speech was affected because of her recurrent ear problems stemming from allergies. Of course we looked at environmental controls and her parents did as much as they reasonably could. Sophie was 'trained' much like Brianna. Sophie, now age five, will sometimes wake up with a stuffy nose and ask for 'Dr Hana's wash'. She steps up to the sink, washes her nose on her own, blows, grunts like a grandpa and walks away saying, 'Now that feels good, I can breathe'. The secret to teaching children is a slow introduction, giving the child all the control, praising them frequently for little steps and asking them to demonstrate their technique for me (or dad or anyone else). I always learn something new from each child.

We preach the importance of washing your hands to prevent the spread of germs, we preach that brushing your teeth prevents cavities, we wash dirty wounds prior to antibiotics ointment is applied. So why don't we wash our noses? Not glamorous? Not advertised? It is just habit we should get used to, similar to swimming with your eyes open or learning how to place in contacts. Perhaps it is more akin to changing the clothes dryer filter or your cars filter to ensure proper functioning of the machine.

Of course, if your nose works well for you, don't wash it. If you have nose problems, why not try the simple safe and ancient old technique of washing first. There is an old saying in medicine, 'first do no harm'. Nasal washing does no harm but may produce great benefit.

I invite you email me: drhana@nasopure.com with comments, suggestions or ideas.

Be Well, Dr Hana

Dr Hana R. Solomon MD 3-13-04
Copyright 3-13-04

First Published: March, 2004
Updated: February 2007

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