Nasal irrigation can be an effective therapy for chronic rhinosinusitis, provided patients—especially children—are shown safe and proper irrigation techniques. Here are several education and training tips to use with patients:
- Match the nasal irrigation device to the patient. Julie L. Wei, MD, an associate professor of otolaryngology-head and neck surgery at the University of Kansas School of Medicine in Kansas City, said that in her experience, younger children often do not take well to neti pots. “The minute you tilt your head to the side, which you have to do with neti pots, and the nasal passages begin to fill up with water, kids tend to feel like they’re drowning,” she said. “I’ve had much better results teaching them how to use ‘Sinus Rinse’ [NeilMed] squeeze bottles.”
- Give children a feeling of control. Dr. Wei also stressed the importance of helping children feel in control of the process. “Kids need to take charge of these devices, or they freak out and become traumatized,” she said. “So I let them, as young as four years of age, hold the squeeze bottle, play with it, and then I just have them lean forward before using it.”
- Reach out to very young patients. James W. Schroeder, Jr., MD, an attending physician in otolaryngology at the Ann and Robert H. Lurie Children’s Hospital of Chicago, conducted a recent study of compliance with and tolerance of nasal irrigation, which showed, not unexpectedly, that only 28 percent of parents surveyed thought their children could make nasal irrigation a daily part of their routine for managing sinus symptoms (Int J Pediatr Otorhinolaryngol. 2012;76(3):409-413). To boost that number, Dr. Schroeder and his colleagues developed a detailed training and education initiative using a YouTube video tutorial of a child actually doing the rinse. “We also have a trained nurse going over the video with the patient and the family,” he said, “and then they do a live demonstration using a saline rinse bottle.”
In the study, the researchers divided patients into three age groups: five years of age and younger, six to 12 years of age and 13 years of age or older. “The surprise was the remarkable number of children in all of the age groups—87 percent overall—who not only tried nasal irrigation despite their parents’ initial reluctance, but actually continued to use it on a PRN basis,” Dr. Schroeder told ENT Today. “There was no statistically significant difference in tolerance between the three age groups.” - Post-op success comes with pre-op training. When Dr. Schroeder has a child scheduled for sinus surgery, he talks to the parents a few weeks prior to the procedure so they understand the benefits of nasal irrigation. “We teach them proper nasal irrigation technique, and then we have the child start doing irrigation three to four days later,” he said. “This way they can do the nasal rinses correctly and clear the nasal cavity post-surgery, which is so important to recovery.”
Not taking such an approach, he warned, is a recipe for failure. “I can’t tell you how many times I‘ve seen families who have brought nasal irrigation products home from the pharmacy, opened the box, read the instructions and tried to use it, and the saline gets down the kid’s throat, it tastes gross and they hate it. They’re just never going to do it again. But with proper expectations, in contrast, they tolerate it well.” - Heed the warnings on contaminated tap water. Recent reports linking rare but lethal infections to infected tap water used for nasal irrigation (main article) have prompted the FDA to issue some guidelines on safe use of the therapy. They recommend using only distilled or sterile water, boiled and cooled tap water or tap water that has been passed through a filter with a capacity of one micron or smaller. For more information on the FDA alert, direct patients to www.fda.gov/forconsumers. The CDC has information on specific types of filters that can be used at www.cdc.gov/healthywater/drinking/travel/household_water_treatment.html.
- Use multiple teaching aids. David Rabago, MD, an assistant professor of medicine in the department of family medicine at the University of Wisconsin in Madison runs a website that offers several videos, handouts and other materials.—DB