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HyperTonic Saline Nasal Irrigation

(HTS Nasal Irrigation)


  • Enhances the natural self-cleaning mechanism of the nose (mucociliary clearance)
  • Decreases congestion, stuffiness and improves the natural drainage from the sinuses
  • Rinses away pollen, dust, pollutants, irritants, excess mucous and crusting
  • Research has shown HTS irrigations can decrease the need for medications in patients with chronic allergies, sinusitis, the common cold and other upper respiratory problems

Methods to deliver HTS irrigation

  • Neil Med® Sinus Rinse Bottle (Available in adult and pediatric kits at our offices and area Pharmacies). Follow directions in the box.
  • Water pic with or without nasal adapter
  • Bulb syringe (discard and replace weekly)
  • Neti Pot
  • For nasal moisturizing or cleansing there are pre-made OTC (preservative free) salt sprays in pressurized cans: Neil Med®, Simply Saline® (Isotonic and Hypertonic), and Entsol®. Avoid OTC salt water sprays that have preservatives (i.e. Benzalkonium Chloride)
  • For infants and toddlers: MAD® or "MADdy® the Blowfish syringes, available at our offices OR Refill an over the counter (OTC) nasal spray bottle with the homemade saline recipe

Homemade Saline Recipe

  • Take a clean 1 quart glass jar with a cover, not a plastic container
  • Fill with distilled water or previously boiled water. The safety of water types from highest to lowest: sterile water, purified water, distilled water, filtered water (depending on how it is cared for), municipal tap water, spring water, well water
  • Add 1 Tablespoon of pickling/canning salt, kosher salt or sea salt. A pure salt. DO NOT use table salt; it contains anti-caking ingredients and/or iodine
  • For pediatric or sensitive patients, start with half Tablespoon and increase to 1 Tablespoon as tolerated.
  • Add 1 teaspoon of baking soda (not baking powder)
  • Shake or stir before each use. Pour the amount you plan to use into the irrigation container - DO NOT contaminate your original solution. Store at room temperature. Discard after 1 week, clean the jar and start again.
  • Warming the solution to body temperature before instillation may be more comfortable
  • Alternative: Purchase packets of Neil Med® pre-measured nasal irrigation ingredients (salt + baking soda). Use as directed on container and your Provider.
    Blue packages = isotonic, Green package = hypertonic, OR 2 blue packages = hypertonic

How to use

Use over sink or in shower; lean forward, tilt head down and keep mouth open. Gently instill solution in one side of nose. Solution will drain out of either nostril and/or out of the mouth. Don’t inhale through the nose or sniff solution up while irrigating. Avoid swallowing solution. Repeat instillation, alternating sides, until container is empty. Gently blow nose, one side at a time. Blocking both sides of nose may put excess pressure on the ears.

If post surgery, DO NOT blow your nose until you have checked with the surgeon at your post op visit, but you may gently sniff mucous to the back of the throat and spit it out.

  • Discard any unused solution in irrigation container and use fresh solution for each rinse (if using packets)
  • If you have been prescribed a nasal spray, wait 10-20 minutes after using the nasal irrigation before using your nasal spray
  • Starting 1 week after sinus surgery you should tilt your head to each side (with ear parallel to the ground) to empty the irrigation solution out of the sinuses

Maintaining your Device:

  • Manually remove any debris from container using a small brush or pipe cleaner with tepid water. Then wash with hot soapy (dish soap) water. Air dry and cover with clean towel. Read package insert.
  • Additional methods for cleaning the Neilmed® Sinus Rinse Device includes the use of full strength white vinegar or isopropyl alcohol, followed by cleaning as per package directions.
  • Dishwasher safe ONLY if directed on package for your device.

Side Effects

Mild burning may occur initially until you become accustomed to irrigating. Increased burning or discomfort may occur if using the incorrect salt, too much or too little salt, or if the water is too cold or too hot. You may dilute the solution if it continues to cause burning. Discontinue use if experiencing severe pain and discuss with your Provider.


Discuss frequency with your Provider. Many people use it as a daily routine when they brush their teeth. Everyone has different needs and more frequent use may be required, especially when symptoms increase or after having surgery.


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