Nasal Rinsing, or the Use of Neti Pots

The use of neti pots and similar methods of irrigating the nasal cavity is an old homeopathic remedy for sinus pressure and high levels of sinus mucus. Though the neti pot stems from ancient Indian Ayurvedic hygiene and wellness practices, doctors have recently been paying more attention to the method. What they have found is that it is both a safe and effective method for clearing the sinuses of mucus, and may also help to reduce inflammation by flushing small, irritation-causing particles out of the sinuses, as well as viruses and bacteria.

Usually a nasal rinse is some form of saline concentration. It is recommended that patients use an isotonic concentration, or a concentration that has saline levels similar to those in the human body. Patients can either purchase premixed salt packets for this or make their own at home. One common recipe calls for 2-3 teaspoons of iodine-free salt and 1/4-1/2 teaspoons of baking soda for one liter of sterile water. Including a small amount of baking soda in the rinse has been shown to yield better results than saline alone. Some patients prefer higher levels of saline concentration, but studies have shown that this can damage the nose’s cilia. Cilia are small, waving hairs that keep the nose clean. Increased salt levels in your nasal rinse can lead to increased nasal congestion and nasal swelling.

It is very important when flushing your nasal cavities that you use sterile water. Boiled, distilled, or well-filtered water are recommended. Do not use water from a wild or questionable source without appropriate filtration and sterilization. In very rare instances, amoeba present in a municipal water source has caused encephalitis in neti pot users. Encephalitis is a deadly brain infection. It is not common to find such amoeba outside of untreated water supplies, but the results are serious, so use caution and ensure your water is safe before using it in your sinuses.

In addition to sterile water, it is also important to use sterile equipment. To sterilize the bottle you are using, microwave it for two minutes in cold water. One study found this method more effective than a boiling water rinse. Using Milton’s antibacterial solution was also found to be an effective sterilization method.

Ideally, an effective nasal rinse will reach as much of the nasal lining as possible. There are a couple of factors in application that may improve the rinse’s effectiveness. First, when applying the rinse, place your head down. This can help the irrigation reach the top of the nose and forehead sinus. Second, a high volume of delivery tends to be more effective than a lower volume of delivery. The increased volume tends to result in the optimal coverage of the nasal lining.

There are a couple of treatments that can work in conjunction with nasal rinsing to improve patient results. One is sinus surgery. If there are nasal blockages present, surgery can lead to improved delivery and effectiveness of a nasal rinse. Another is medicated irrigation. In patients with chronic sinusitis who were using topical antibiotics or nasal steroid sprays, high volume rinses with diluted steroids improved their symptoms.

If you are having nasal issues, please call and make an appointment with one of the specialists at Nevada ENT and the Reno Tahoe Sinus Center. We can help determine the source of your symptoms and give you information on treatment options individually tailored to your circumstances.

Source: Nasal/Sinus Irrigation by Benjamin S. Bleier, MD

Award Winning Research

Nicholas Weseley, UNR 2nd year Medical Student, presented his summer research project “A Validated Model for the 22-item Sinonasal Outcome Test Subdomain Structure in Chronic Rhinosinusitis” at the Regional American College of Physicians Meeting on September 27th at the VA Hospital in Reno. He won first prize for the summer project he headed up in collaboration with Mass Eye and Ear and Harvard Medical School. He will present again October 13-14th at the Nevada State ACP Meeting in Las Vegas. Congrats to Nic on his win and all of his hard work! This research has furthered understanding of quality of life effects in patients with chronic sinusitis.

Josh Meier, M.D. F.A.R.S.

Nevada ENT and Reno Tahoe Sinus Center Collaborate with Harvard Medical School

Dr. Meier recently returned from Chicago where the paper “A Validated Model for the 22-item Sinonasal Outcome Test Subdomain Structure in Chronic Rhinosinusitis” was presented at the American Rhinologic Society’s Annual Meeting. This paper demonstrated that the 22 questions found in the SNOT-22 can be grouped into 4 subdomains (sleep, nasal, otologic/facial pain and emotional). Data was provided from 400 patients from Nevada ENT / Reno Tahoe Sinus Center and 400 patients from Harvard / Mass Eye and Ear. Dr. Meier and Dr. Killeen enjoyed collaborating without colleagues from Boston and look forward to future projects. Special thanks to our hard working, 2nd year UNR medical student, Nicholas Weseley, who performed the data collection.

Odontogenic (Dental) Sinusitis

Odontogenic sinusitis is a persistent infection of the sinuses that arises from a diseased upper tooth root – usually a molar. Odontogenic sinusitis comprises 5-10% of chronic sinusitis. The dental infection will cause a periapical abscess (pus collection around the root of the tooth) which is commonly located in the cheek sinus. This will cause foul-smelling, purulent unilateral drainage that usually is refractory to antibiotics. The bacteria are usually anaerobic bacteria that are common dental flora. Antibiotics do not work because there is so much pus in the sinus, they can not penetrate to the middle of the collection. Occasionally the cheek sinus infection spreads to the ethmoid and frontal sinuses. Sometimes extraction of the infected tooth can cure the infection, but usually endoscopic sinus surgery is required. Once the sinus has been opened and the diseased tooth has been removed the patient’s sinus issues resolve. Endoscopic sinus surgery is curative, by draining the sinus.

Another cause of odontogenic infections in the maxillary sinuses are dental implants. Dental implants are being used more commonly for dental restoration, and most patients do quite well. Rarely the implant can penetrate into the maxillary sinus and this results in a path for dental bacteria to travel into the sinus, resulting in a chronic sinus infection that is refractory to antibiotics. Once again, endoscopic sinus surgery will cure the infection, and the implant does not need to be removed.

Josh Meier, M.D. F.A.R.S.

Chronic Sinusitis and Other Nasal Complaints

Nasal complaints are common in northern Nevada. While there are many conditions that can cause nasal symptoms, high altitude, allergies and lack of humidity are some of the factors that can lead to nasal symptoms. Fortunately the majority of nasal complaints can be resolved with simple, economical solutions, many of which are available over the counter.

The bulk of patients we treat at Nevada ENT and the Reno Tahoe Sinus Center have chronic rhinosinusitis (CRS). CRS is a chronic inflammatory disease, similar to asthma. Just like asthma there is no single cure for CRS, but there are many treatments that can improve the patient’s quality of life. Symptoms can include nasal obstruction, drainage, smell loss and facial pain or pressure. Nasal steroids and rinses are the first line therapy for CRS. If they fail, a visit to an Otolaryngologist can be helpful. If a patient continues to have symptoms despite medical therapy, then a CT scan is usually ordered. Nevada ENT and the Reno Tahoe Sinus Center offer a brand new cone-beam CT scanner for this reason that allows point of care service, image quality, as well as 1/10th of the radiation as a conventional sinus CT scan. If the CT scan shows abnormalities, and if the patient has failed medical management, then endoscopic sinus surgery is an option, however the majority of patients have significant improvement with medical management and do not need surgery.

There have been significant advances in endoscopic sinus surgery (ESS) over the last 30 years. Improved techniques, optics, and instruments result in minimally invasive surgery, and significantly quicker recovery times. New techniques and advanced rhinologic training make the use of nasal splints or packing after surgery unnecessary, resulting in minimal postoperative pain for patients.

Other common nasal complaints in northern Nevada include the following:

Nasal dryness – This is extremely common in our area. The role of the nose is to warm and humidify air as it enters the body. This job is more challenging if the baseline air humidity is 10-20% as it is here. Symptoms from too much dryness include nasal obstruction, burning, and crusting in the nose. This can be effectively treated using over the counter saline gel, Neilmed® saline rinses and a humidifier.

Allergic rhinitis – Symptoms of allergies include nasal obstruction, clear nasal drainage, and smell loss. Watery and itchy eyes may also be seen. Topical nasal steroids such as Flonase® or Nasocort® can be purchased over the counter. Saline rinses can help as well. Oral antihistamines can be added to help eye symptoms.

Atrophic rhinitis – This is more common in the elderly, when the nasal mucosa cannot humidify the nose properly anymore. The main symptom from this is clear nasal drainage, intensified with eating and exercise. Fortunately there is a simple prescription medication that can reduce the drainage – Atrovent® nasal spray.

For more information or if you are having nasal issues, from simple to complex, please call and make an appointment to see physicians at Nevada ENT and the Reno Tahoe Sinus Center.

Josh Meier, M.D. F.A.R.S., is the Director of the Reno Tahoe Sinus Center. He specializes in complex and revision endoscopic sinus surgery cases. He graduated from medical school from the University of Southern California and completed an Otolaryngology residency and Rhinology fellowship at Harvard Medical School. Dr. Meier is board certified by the American Board of Otolaryngology and his training also allows him to endoscopically manage disorders of the anterior skull base and orbit.

(775) 322-4589

Dr. Meier Featured in Canyon Vista Living

Dr. Meier authored an article on chronic sinusitis and nasal health for the October issue of Canyon Vista Living – the local magazine for Somersett Reno.

Please click below to download the PDF

Thank you to Canyon Vista Living for the great opportunity


Revision Endoscopic Sinus Surgery for Maxillary Recirculation

Chronic sinusitis is, as the name implies, a chronic disease. There is no permanent cure for chronic sinusitis, but there are many treatments that can improve patients’ symptoms. The first step in treatment of chronic sinusitis is using a topical nasal steroid, like Flonase (now over the counter) and a saline rinses. If patients continue to have symptoms despite medical therapy, and they have an abnormal sinus CT (available in our office) then endoscopic sinus surgery is an option. Unfortunately patients may require more than one operation. A large part of my practice is revision sinus surgery. This can be due to polyp regrowth with symptom recurrence or due to scar tissue or incomplete prior surgery.

A unique indication for revision endoscopic sinus surgery is maxillary recirculation. This occurs when the natural ostium (hole) of the maxillary (cheek) sinus is not connected to the surgical opening that was made at the previous sinus surgery. The cilia in the sinus beats the mucus out of the natural ostium, and it falls back into the surgical opening in the maxillary. Then it goes around and around from maxillary sinus to the nasal cavity. Eventually it falls out into the nasal cavity, and patients describe usually unilateral thick post nasal drainage. It can be a source of recurrent infections as well, since bacteria frequently infect the thick mucus that resides in the maxillary. Nasal steroids and rinses can decrease symptoms, however definitive repair requires revision surgery.

By connecting the two openings in the maxillary sinus the recirculation ceases. I have had many patients that had decades of “allergies” resolve after the revision surgery. Convincing patients that had previous endoscopic sinus surgery in the 1980s or 90s is challenging, but fortunately the techniques have improved that do not require packing anymore. Without packing there is minimal pain.

I encourage you to visit where dozens of patients have described their experiences after revision endoscopic sinus surgery for chronic sinusitis.

If you had endoscopic sinus surgery in the past and you have symptoms similar to those list above, please make an appointment; with a few diagnostic tests I can ascertain if your would benefit from revision surgery.

Josh Meier, M.D. F.A.R.S.

Director Reno Tahoe Sinus Center

Dr. Meier Gives Grand Rounds at Renown Regional Medical Center

Dr. Meier lectured at Renown Regional Medical Center Grand Rounds on August 10th, 2017 on “Chronic Sinusitis and Other Nasal Complaints”.

In addition to the audience present in the Mack Auditorium, there were remote attendees from Ely and Bishop.

Dr. Meier was happy to meet his referring doctors, and to answer everyone’s questions about nasal health.

Dr Meier Lectures at Plumas District Hospital

Dr. Meier lectured on “Advances in Endoscopic Sinus Surgery” at Plumas District Hospital in Quincy, CA on July 31st.

He was pleased to meet many of his referring providers, and educate the staff on cutting edge treatments for chronic sinusitis.

Congratulations to Dr. Van Duyne!

Nevada ENT was proud to sponsor “Outrunning 50” – the winner of the Senior Women Division of the Reno Tahoe Odyssey.

Congratulations to Dr. Van Duyne who participated.