Talk:Nasal irrigation/Archive 1

Archive 1

Merge proposal: Jala neti into Nasal irrigation

Support. I proposed the merge because they are essentially about the same thing, but Nasal irrigation is the broader term. Jala neti would still be the main focus, but the merge would save duplication of material, and enable comparison to be mades with other techniques where relevant. --Singkong2005 21:24, 14 April 2006 (UTC) - Withdrawn

Having just read about traditional nasal cleansing in other cultures (see link under More citations, below), I can see that separate articles might be warranted, so I'll withdraw the proposal for now.

However, most Jala neti-specific material should be moved to Jala neti. --Singkong2005 22:02, 14 April 2006 (UTC)

In that case, I'm removing the merge tag. bobanny 03:24, 5 April 2007 (UTC)

I put the merge tag there and I haven't withdrawn it. That comment is from a year ago. — Omegatron 06:14, 6 April 2007 (UTC)

I don't know when the tag originally went in, but there's not much discussion on the issue, and if it's been there a year, it could be there forever. After reading through both articles, Jala neti seems to be a variation on the same thing. I'd suggest going ahead with the merge, and if someone comes up with verifiable info showing Jala neti to be qualitatively different beyond what a subsection can accomodate, a separate article could be recreated. As is, it appears "Nasal irrigation" is a general, descriptive term that could easily cover the two. bobanny 19:32, 6 April 2007 (UTC)

I count Not merge (2), merge (1) here above. Davin7 07:30, 3 October 2007 (UTC)

Merge. No need for two articles. Perhaps name it "Jali neti (water irrigation). A "history" heading could describe jali neti, another could discuss it's growing prevalence in western culture, another could discuss briefly how it's done. --—oac old american century ^talk @ 00:20, 22 May 2007 (UTC)

According to Talk:Jala neti, there's more to it than just the nasal irrigation. If true, we should merge just the stuff about irrigation into the other article, leave a "Main article:" tag, and cover whatever else there is. — Omegatron 01:03, 22 May 2007 (UTC)

I count Not merge (1), merge (1) here above. Davin7 07:30, 3 October 2007 (UTC)

Merge. The Jala Neti article should be a subcategory in Nasal irrigation, as one of the methods used to do the said activity. 24.177.128.131 16:47, 18 July 2007 (UTC)

Keep separate with cross-references. If the Mayo Clinic video is truly all that's meant by nasal irrigation, then the two topics are separate but related. Deuelpm 00:37, 31 July 2007 (UTC)

Evidence? Explanation? — Omegatron 03:05, 31 July 2007 (UTC)

I count Not merge (1), merge (2) here above. Davin7 07:30, 3 October 2007 (UTC)

Not merge There is a difference between the two techniques. Also the acceptance is different. Davin7 07:32, 3 October 2007 (UTC)

Not Merge Please observe the difference at the grassroots level. Jala Neti is a procedure in Yogic Kriyas. There are stipulations on how when and what for performing Yoga Asanas, Pranayama and Kriyas, Whereas Nasal irrigation is a free form prodecure. It could also be medically related. So there is no basis to merge the two. —Preceding unsigned comment added by 203.197.89.130 (talk) 10:05, 9 October 2007 (UTC)

Not Merge!! They are different. Neti pots are a specific way and nasel irrigation is not the same. Cailet

Not Merge Completely different techniques; Jala Neti has roots in ancient yoga practices and although similar to modern nasal irrigation, the overall philosophy is different. Spiral-architect 15:49, 10 October 2007 (UTC)

More citations

I found Nasal irrigation and Jala neti helpful, but could be improved further with more citations, in line with Wikipedia principles of verifiability. Btw, this link has some interesting suggestions, but it would be better to find original sources, e.g. about traditional use of nasal cleansing in Scandinavia. --Singkong2005 21:57, 14 April 2006 (UTC)

This could be a useful starting point for research: Abstracts of Medical Studies and Testimonials on the Benefits of Nasal Cleansing - but note that it's a commercial site. It would be best to look up the research referred to here, then cite it directly. --Singkong2005 00:53, 15 April 2006 (UTC)

this doesn't work

Pulsatile irrigation has the support of over 40 published medical reports only a few that have been listed in this article. Pulsatile lavage has been well studied and peer reviewed from the Journal of Otolaryngology to NIH. While much of the discussion on this page surrounds the use of neti pots which are anecdotally helpful as a cleansing hygiene product. It is disturbing that the citations referencing the efficacy of pulsatile lavage have been edited to state “The manufacturer of one irrigation system claims several published medical reports”. The citiations referenced in the article are listed with active links to the published medical reports supporting the efficacy of pulsatile irrigation and its advantages over non pulsating irrigation and 40 more can be listed as well. The current quailifier for the citations listed for pulsating irrigation is not fair and does a diservice to those that are tryinng to evaluate nasal irrigation products and their respective performance and documented claims. There are no qualifiers for the citations of the neti pot which has not had nearly as much clinical or peer review studies performed as to the efficacy of the product as has been performed on pulsatile devices which date back to the 1960's. —Preceding unsigned comment added by Grockl (talk • contribs) — Grockl (talk • contribs) has made few or no other edits outside this topic.

When all the studies can be traced back to a single sponsor it is fair to note that regardless of how many studies were generated and by how many different authors and minor institutions. This especially true when any infomercial statistician can tell you that "give me a company with a dozen employees, their immediate families, $500 signing fee per random academic or occupational authority per study -- and I can generate a dozen plausible sounding, legally safe, small studies based on the antedotal testimony of those employees and their families." Now if you can cite more studies that include multiple manufacturers of similar products, hundreds of participants unrelated to anyone in the business with a randomly selected control group, and studies by major critical institutions which received no grants from any of the manufacturers...then you can talk.

But Dude it is currently all witch doctor level, word of mouth medicine - including the so-called studies. When they put the biochemistry and physics together then we can get critical about fairness of one treatment over another. Many of today's so-called medical "studies" are little more than clever infomercials with little critical logical examination or scientific controls - no different than political campaign or Coke over Pepsi surveys. Yes medical journals for the general practicianer have been guilty of this for a long time. In the 1800s they literally published studies supporting snake oil rememdies and the publishing standards of simply passing the current occupational "group think" have not changed. That is not to say some real science is not in such journals, simply saying that true science which includes proposing and testing mechanisms in a controlled and logically critical manner is not required. To some extent many popular medical journals are partially rags for occupational gossip and memoirs. General practice doctors tend to require more impressive memories than reasoning abilities.

This lack of objectivity is confirmed by the section where this article mentions that the mechanism by which irrigation helps and the disease exist is not understood...as in almost not at all. Informally the primary reason for the lack of understanding and rigorous scientific (rather than sales oriented) study is that the disease is not considered a serious medical problem and most people are willing to accept traditional irrigation home remedies dating back 5000 years (ancestors of the Neti pot). It is simply not a "sexy" area for true medical science. 65.26.139.168 (talk) 20:18, 22 January 2010 (UTC)

Cleanup

Hopefully I haven't harmed anything in the major cleanup I just performed. Highlights of what I did:

• Removed a commercial link and a dead link
• Removed/reworked awkward/redundant wording.
• Used standard reference template

Some remaining work:

• The sinus irrigation section could still use a lot of work to sound like an encyclopedia instead of a howto.

Pursuant to policy on Wikipedia not being an Instruction Manual, I decided to Be Bold and removed the how-to information and placed what the methods are -- irrigation of the nasal and sinuses cavities. If someone can expand on those methods without turning it into a how-to article, that'd be great. Pyrogen 15:53, 2 December 2006 (UTC)

• I identified an assertion that could use a reference
• One article was referred to by two different links, so I standardized on the Pubmed link.
• Avoid so much text quoting especially in the lead section. Paraphrase and citing sources is classier and easier to read, and still correctly attributes its sources.
• Find a more scholarly source than seniorhealth.about.com. Nothing against the site, but it's shy of the appropriate source for a Wikipedia article, especially one with a medical component to it.
• Pictures or diagrams would be great

-Quintote 05:00, 23 November 2006 (UTC) You can easily wash your nose at a bathroom sink using just your hands and plain fresh water works pretty well compared to salt water

No discussion of FDA or possible health hazards

Any research on potential hazards? Does the FDA have any stance on this type of therapy?

I'll try and see what I can find.OccludedFuture 07:29, 14 April 2007 (UTC)

I'd be surprised if you can find any evidence of negative side effects. We're not talking about some new, untested pharmaceutical, after all, we're talking about plain old salt water. I suppose if people are swallowing the stuff instead of letting it drain out their nose, they might get high blood pressure as a result.  ;) But still, the idea is to use water with a salinity about the same as human blood. No other chemicals or anything are involved. Toroca (talk) 02:32, 26 February 2008 (UTC)

Powered nasal irrigators (pulsatile) are considered class 1 devices which do not require FDA approval or premarket certification but are FDA registered. They are extremely effective with many published medical reports supporting their efficacy. —Preceding unsigned comment added by Grockl (talk • contribs) 01:56, 26 February 2009 (UTC)

Saline solution prep section

As kosher salt generally contains no additives, I removed it from the disclaimer at the bottom of the section. Likewise, in the paragraph describing how to prepare the solution, it referred to coarse salts as being "kosher or sea", but sea salt contains the aforementioned impurities, so I removed that remark. Whoever reverted my earlier edit to this end please take note and respond if you take issue. 72.196.104.129 06:41, 30 April 2007 (UTC)

Neutral point of view

This article reads like a sales pitch for the practice of nasal irrigation. It claims a large number of benefits without referencing any evidence. I'm therefore flagging it with a POV-check. (Incidentally, the POV of the Jala neti article seems to be better.) RPTB1 15:37, 22 May 2007 (UTC)

While some citations are provided, it is clearly POV advocating its use. Example:

It can be used by patients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge), and one study has even reported that nasal irrigation was “just as effective at treating these symptoms as the drug therapies.”[4][dubious – discuss]

which points to an article from about.com - clearly failing WP:RS. Saying "it can be used" is meaningless without saying the efficacy. How about citing the study itself? Beyond that, one study that "even reported" is not conclusive. Toddst1 (talk) 16:55, 21 August 2008 (UTC)

Major edit

I've edited this article substantially to deal with referencing and NPOV issues. Mainly, I've deleted a lot of the information about how to actually do nasal irrigation because it wasn't actually referenced for the most part. Moreover, it is much more professionally and clearly spelled out in the reference links - I think it's better to leave medical advice to WebMD and MayoClinic.com rather than Wikipedia! Gosolowe 16:54, 19 July 2007 (UTC)

"Jala" probably means "water" and maybe we should mention that

In Wiktionary it says that "jala" means water in Pali which is a South Asian language as far as I know. In Wikipedia searching jala also led to "water". I couldn't find "neti" in Wiktionary. "Sutra neti" which has an article in Wikipedia is a nasal cleaning practice that involves string. In Wiktionary it says "sutra" means thread or string. If I hadn't found the meaning of "jala" (water) I might assume after reading the article that "jala" means "nasal". Perhaps "jala neti" more acurately translates as "water nasal cleaning".

Removed video link

While it was marginally funny, I removed the link Neti pot use video as it is a joke video and not appropriate as an instructional tool. —Preceding unsigned comment added by Estreya (talk • contribs) 00:58, 14 February 2008 (UTC)

Removed links

I notice that te Himalayan Institute or a fan of theirs keeps putting their links in here. This is a store selling a product and has no place here. The photo used in the article currently is also theirs, but I've left that for now. If I find a better non-branded image, I will put that in here instead. —Preceding unsigned comment added by Hypersigil (talk • contribs) 22:05, 16 March 2008 (UTC)

Yes this section needed cleaning up but Orangemike, you removed some links relative to research and left trendy news articles? I revised it bringing back the relevant links and also added a wikibook link which replaces the function of all the other links that attempt to satisfy the how to goals of the removed links.--66.169.91.5 (talk) 21:05, 21 March 2008 (UTC)

Study referred to in Sinusitis Treatment: What Is New Is Old

First it says:

A study from the University of Wisconsin, School of Medicine demonstrates that an easy and inexpensive treatment is just as effective at treating these symptoms as the drug therapies.

Then it describes the study:

All participants were over the age of 18 and had to have at least 2 symptoms of chronic sinusitis (see above). All participants were instructed to continue using whatever medication they were using for sinusitis for the duration of the study.

Now how can they conclude that it's just as effective as medication when all the subjects are continuing whatever medication they were using? Pocopocopocopoco (talk) 03:31, 22 March 2008 (UTC)

There are a couple of options. One is that you compare pre-treatment to post-treatment measurements. This gives you evidence like, "I've taken this allergy pill for six months, and it didn't seem to do much good. Now I'm taking the allergy pill plus the nasal irrigation, and I feel that it (has/hasn't) improved." The other is that you keep everyone on their regular meds, but only do nasal irrigation in half of them. Then you can say that the meds alone group had this experience, and the meds+irrigation group had that experience. (This is particularly helpful if the sinusitis is affected by seasonal allergies, like hay fever.) WhatamIdoing (talk) 23:27, 28 March 2008 (UTC)

Scientific evidence

The Wall Street Journal had a story today on the neti pot, A Pot, Short and Squat, To Clear Your Nose Out By LAURA JOHANNES May 13, 2008; Page D2

Even more significantly, the WSJ story mentioned a Cochrane Collaboration study. (And the Cochrane Collaboration abstracts, unlike the WSJ, is free online.) That settles it, as far as I'm concerned. As far as I know, every major medical journal accepts the Cochrane Collaboration as the most reliable, non-commercial source of scientific medical information in the world.

Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006394. DOI: 10.1002/14651858.CD006394.pub2

Nasal irrigation with saline (salt water) for the symptoms of chronic rhinosinusitis.

The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. It is often prescribed as an adjunct to other treatments such as intranasal steroids or antibiotics. However, there is significant effort involved in preparing and delivering the solutions. This review summarises the evidence for the effect of saline irrigations in the management of the symptoms of chronic rhinosinusitis. There is evidence that they relieve symptoms, help as an adjunct to treatment and are well tolerated by the majority of patients. While there is no evidence that saline is a replacement for standard therapies, the addition of topical nasal saline is likely to improve symptom control in patients with persistent sino-nasal disease. No recommendations can be made regarding specific solutions, dosage or delivery. There are no significant side-effects reported in trials.

Nbauman (talk) 12:45, 13 May 2008 (UTC)

Request to experienced wiki editors to cleanup redundancy

Currently there are 4 different references to the Rabago article on the efficacy of saline irrigation. These could be consolidated but my lack of wiki editing experience prevents me from doing it myself. If you are good with editing citations in wiki, please take a look at the references and consolidate them. Much appreciated.--72.150.188.159 (talk) 20:54, 31 July 2008 (UTC)

 Done. There are actually two different Rabago articles. WhatamIdoing (talk) 19:29, 1 August 2008 (UTC)

Neutrality disputed

We have a POV tag currently being added to the article. There is some discussion from months ago which we see above but that was resolved. This new tag requires supporting talk here because the POV issues are not obvious and cannot be addressed without specific details. The tag itself says to see this talk page for details and so should not be used without such clarification. I will continue to remove this tag unless and until details are provided. Colonel Warden (talk) 16:16, 21 August 2008 (UTC)

Doesn't look like it was resolved. You've now reverted two different editors. Please seek consensus instead of trying to WP:Own this article. Toddst1 (talk) 16:56, 21 August 2008 (UTC)

• User:Gosolowe made a major edit which addressed the previous concerns - see the section Major edit above. Your specific detail seems to concern the material based upon the article at About.com. That article is based upon a study conducted by the University of Wisconsin and About's coverage was reviewed by a medical panel. It therefore seems to be reliable source and so this objection is without foundation. Do you have any other points to support this tag? Colonel Warden (talk) 17:09, 21 August 2008 (UTC)

The entire "Benefits and uses" section is written like an advert and is poorly sourced. It needs to be rewritten. Regarding about.com, I don't agree with your asserion of reliability at all. Often they copy Wikipedia pages. The UW study would be useful, but not About.com. Toddst1 (talk) 17:20, 21 August 2008 (UTC)

The UW study would be a primary source and we prefer secondary sources which demonstrate notability and are more appropriate for a general readership. The article is already superior to comparable articles such as flossing and toothbrushing and does not merit this level of intrusive tagging but I shall make an editing pass through the article to tighten up the text and sourcing. The general tone will remain positive since this seems to be an accurate summary of what the sources tell us. If you are here to attack the practise of nasal irrigation then you need to find some sources to justify your POV. Colonel Warden (talk) 09:58, 22 August 2008 (UTC)

Again, this is not your article. Wikipedia's policy is to be NEUTRAL - not "tone will remain positive" as you assert you will make the article. Thank you for confiming the Positive POV nature of the article. I have no interest in nasal irrigation and no WP:COI. I'm going to refrain from adding content to this article so your concern is not an issue, but I will monitor it for POV - especially now that it is confirmed. Toddst1 (talk) 14:03, 22 August 2008 (UTC)

Per WP:NPOV, The acronym NPOV does not mean "no points of view". The elimination of article content cannot be justified under this policy by simply labeling it "POV".. So, insofar as the sources report that nasal irrigation is a useful form of hygiene and is helpful for sufferers of particular conditions, then the article will continue to report these facts. If there are contrary opinions and studies out there too then we can include them too, subject to WP:UNDUE but my impression is that the balance of opinion is favourable and so our article will present the matter accordingly. This is what I mean by positive. Colonel Warden (talk) 14:17, 22 August 2008 (UTC)

That's my point - this comes across as an advocacy piece. N stands for "Neutral" in NPOV - not "No" and certainly not "advocacy". Toddst1 (talk) 15:16, 22 August 2008 (UTC)

Aside from the unexplained removal of the {{nofootnotes}}, the changes look much better. Toddst1 (talk) 20:53, 23 August 2008 (UTC)

I removed that tag because it is not appropriate - please read what it says. The points in that paragraph seem uncontroversial. Please see WP:When to cite, especially, Challenges should not be made frivolously or casually, and should never be made to be disruptive or to make a point. Editors making a challenge should have reason to believe the material is contentious, false, or otherwise inappropriate.. Better to use the fact tag if you think there's something dubious there or, if you really must use a blunderbus, use the unreferenced tag instead. Colonel Warden (talk) 21:20, 23 August 2008 (UTC)

It's WP:OR or at least fails WP:V without references. Toddst1 (talk) 21:26, 23 August 2008 (UTC)

Y The issue of the NPOV tag seems resolved now. The remaining issue concerns the quality of sources which is addressed below. —Preceding unsigned comment added by Colonel Warden (talk • contribs) 16:17, 29 October 2008

Use of About.com as a reference

About.com has been discussed on Wikipedia:Reliable_sources/Noticeboard and consensus is find another source. Toddst1 (talk) 15:33, 29 October 2008 (UTC)

• In the brief discussion referred to, there was no clear consensus and so the matter is not marked as resolved. A variety of sentiments were expressed such as use commonsense and it depends upon the context. So far as our usage is concerned, the information in question does not seem controversial, is based upon a clinical study, is subject to peer review and a code of conduct. If editors wish to add further sources to our article, they are free to do so, but there doesn't seem to be much of a problem requiring such attention. Colonel Warden (talk) 16:17, 29 October 2008 (UTC)

Specifically "Is a better source available?" In the case of About.com, the answer is almost always yes" Toddst1 (talk) 16:22, 29 October 2008 (UTC)

Finding the best possible source is a nice-to-have, not a requirement. The issue here is more whether About.com is a questionable source which we should not use. It does not seem to be a dubious source of that sort. Colonel Warden (talk) 16:31, 29 October 2008 (UTC)

About.com appears to get some of its material from Wikipedia. I have sometimes found text on about.com that is a word for word copy of a Wikipedia article. If about.com does get material from Wikipedia, it cannot be a reliable source on the grounds of circular referencing. -- B.D.Mills  (T, C) 05:45, 30 December 2008 (UTC)

I have heard the BBC use a description of a musical matter which was word-for-word the same as Wikipedia. Since Wikipedia is now so well-used, such examples are insufficient reason to dismiss an source which is generally reliable such as the BBC. In this case, About.com provides the source of its information - a medical study by a university - and so we see that they did not get the information from Wikipedia. Colonel Warden (talk) 13:18, 30 December 2008 (UTC)

Pulsatile irrigation

Pulsatile irrigation is one of the few irrigation methods that has actually been clinically evaluated for performance and effectiveness in over 40 published medical reports. Its efficacy on bacterial removal and its increased performance as a lavage technique over non pulsating methods has been well documented. In contrast much of the evidence on non pulsating methods including the use of neti pots have been anecdotal and not peer reviewed. Edits by some on this board including --Mgcsinc to remove content designed to educate and inform all of which have been fully substantiated is simply a deceiptful or biased effort by some to distort or undermine accurate reporting with regards to the efficacy of the respective irrigation methods being discussed. —Preceding unsigned comment added by Grockl (talk • contribs) 23:34, 12 November 2008 (UTC)

I wish the folks that edit this section had some degree of understanding or have a medical background. I think it is best to leave it to the professionals that do and have referenced published medical reports to support the efficacy of the claims submitted. There are examples throughout the nasal irrigation topic, especially with regard to the neti pot which is replete with annecdotal references at best that is worthy of edits but instead we have folks like --User:JaGa that are continuously editing the section on pulsating irrigation where the clinicals are clealry the most detailed and support the efficiacy of the application.

You changed the meaning of a cited paragraph without changing the citation or explaining your change. If that paragraph is incorrect, explain how and bring in a ref of your own. --JaGa^talk 20:17, 1 December 2008 (UTC)

To clarify, pulsatile nasal irirgation IS positive pressure irrigation just as nasal wash bottles just more effective because of the leverage of the intermittant pulse technique which has become a lavage standard for many applications including sugery, wound debriment, and bacterial removal. Neti pots inversely are negative pressure irrigation. There is no need for more references which would only serve to be redundant --Grockl

Dr. Grossan, what you are putting on this page is pure bull. The studies supporting your methods are not just inaccurate; they are completely unrelated. Quacks like you give the majority of otolaryngologists a bad name. Stop posting here. It is 100% shameful self-interest, and doctors like you disappoint me.

I am not Dr. Grossan and your edits to silence free speech and remove information on a proven application is truly shameful. I dont know if you are a disgruntled patient of grossan or just another doctor with a godlike mentality but your baseless dribble and censorship has no place in a public forum. Rather you need to go educate yourself about pulsatile lavage and its various applications including nasal irrigation and the many published peer reviewed medical reports that support its efficacy. Several of the references cited in the article besides those referenced in the section on pulsatile irrigation actually used pulsatile devices (i.e. water pik) in their study these include 5; 10; and 19. —Preceding unsigned comment added by Grockl (talk • contribs) 02:03, 26 February 2009 (UTC)

Note: The tone of this conversation has become unacceptable, from both sides. (Specific examples: "quacks like you" and "silence free speech". These are just the worst examples, not a complete list.) We have rules that describe what is and what is not acceptable on an article talk page, see WP:TALK. Please read them and follow them, both of you. Thanks. Moreover, it is never acceptable to engage in speculations about the identity of another Wikipedia editor. See WP:OUTING. I trust that this combative approach to discussing the article stops now so that I don't have to draw the attention of an administrator to this page. Thank you. --Hans Adler (talk) 10:41, 26 February 2009 (UTC)

Yes I fully agree, I have worked with Orange Mike in the past and make every effort to respect the rules and principles of posting in Wikipedia. The comments posted and speculation of the poster simply got the best of me and apologize if my comments were out of line.--[[--Grockl 7:27, 26 February 2009 (UTC)

67.170.1.167 is a troller that continues to remove posts for no reason needs to be brought to the attention of an administrator.--[[--Grockl 8:30, 5 March 2009 (UTC)

Grockl, the speculation about your identity was not OK. However, it is painfully obvious that you have a conflict of interest here. Read WP:COI to learn about the restraint that you are supposed to exercise when editing Wikipedia in such a situation. You are trying to push a section into this article which discusses a product that is being advertised by an astroturfing campaign, as can be observed here, for example.

While you are showing no willingness to restrain yourself in the way required by this situation and do not even try to keep up the appearance that you are editing to build an encyclopedia (as opposed to editing in order to get a specific passage placed into an encyclopedia), I am not sure that it is in your interest to ask for administrator intervention. --Hans Adler (talk) 23:36, 5 March 2009 (UTC)

If the purpose of Wikipedia is to inform and educate that is what I am trying to do. Pulsating irrigation has been well documented for the past 30 years as a proven and effective method of nasal irrigation. With a growing awareness of nasal irrigation and unfortunately a growing presence of low cost mildy efective products people should be aware of all methods available. As I have indicated, I am not a doctor but I am knowledgeable in this area and have cited proper references. My contributions have every right to be displayed as anybody else. —Preceding unsigned comment added by 71.156.53.160 (talk) 20:25, 6 March 2009 (UTC)

If pulsatile irrigation is in fact so much more effective, then I trust that you can find the studies which prove this. The study you used says that positive pressure (i.e. pulsatile irrigation or a standard squeeze container or a neti pot) is somewhat more effective than negative pressure (snorting from cupped hands), which is much more effective than spraying the water into the nose. In the context in which you used it, the reader could easily misled to think it said pulsatile is more effective, but it's not clear from the abstract whether they even tried this.

Oh, and please don't remove other editors' comments without a very good reason. --Hans Adler (talk) 13:18, 8 March 2009 (UTC)

There are over 40 published medical reports on the efficacy of pulsating irrigation. Some of which have been posted. Is it your goal to deny the knowledge of pulsatile irrigation and its effectiveness? It appears you are trying to own this article rather than build consensus. Neti pots are just one form of nasal washing and are actually not even considered irrigators by many within the medical community but rather nasal wash or lavage products. The Wikipedia topic is Nasal Irrigation NOT specifically Neti Pots. As such, pulsating irrigation deserves discussion every bit as much as any other form of nasal irrigation. Pulsatile irrigators have been a mainstay in North America since their introduction in 1967. Unfortunately for various reasons, the UK has had very limited distribution of these types of products subsequently consumers as not as aware of these products as those in North America. Perhaps this is the reason for your ignorance in this area. Pulsatile devices are eligible for reimbursement by most major insurance companies as a proven and effective device and registered by the FDA. I do not believe your credentials simply as a math teacher elevate you to some authority figure in this area. Efforts have been made repeatedly to substatiate the claims for pulsating irrigation as much or more than those referenced for the neti form of irrigation (wash). All the claims cited have references to published medical reports to support the efficacy of pulsating irrigation.

Additional published medical references:

Pulsatile irrigator Irrigation with [Nasal] Adaptor is used for CF, Cystic Fibrosis Currents Volume 11, No 4 Clinical Study and Literature Review of Nasal Irrigation, Davidson, T., Laryngoscope 110: July 00 Management of Sinusitis: Current Clinical Strategies, Michael Kaliner MD and David W Kenned, MD, in Sinusits Disease Management Guide. PDR 2000 Therapeutic Agents In The Medical Management Of Sinusitis, Mabry, R.L. In: Inflammatory diseases of the sinuses. Otolaryngologic Clinics Of North America, Volume 26, Number 4, pp 561, 1993. Sinusitis: Acute, Chronic and Mangegeable, Rachelevsky G S, Slavin R G et all. Patient Care. Feb 28, 1997 Vol 131:4. Sinusitis: Bench to Bedside, Kaliner MA et al. Otolaryngology June 97 116:6 Part 2 Study of Sinusits. Pulsation Irrigation: a Simple, Safe Effective Treatment of Many Nasal Complaints, Pope, A., O.R.L. Digest August 1974 15:8 pp 3638. 71.156.53.160 10:45, 11 March 2009 UTC)

I have removed your section over a sequence of about 10 edits, each of which had an edit comment explaining why I considered it necessary. Now you have simply reinstated the section completely unchanged, and without any edit summary. [1] [2] This incredibly rude behaviour is technically known as edit warring and is bound to get you into trouble. Especially in the context that it comes from a single-purpose account with an obsession about a single commercial product and access to advertising-style photographs of it, who stopped logging in the very moment the issue of astroturfing came up.

Your section has become a single sentence at the end of Nasal irrigation#Benefits and uses. By reinstating it unchanged, you have effectively duplicated it. I will revert you now. If you want to put a section like that into the article again, you will need to put any supporting references into the article itself, not on the talk page, and you will need to address my edit comments.

Concerning your point about the UK, I wouldn't know it as I haven't been living there for long. But if these machines were common in Germany I am sure I would know about it. That seems to be consistent with them being a specifically North American phenomenon, and if that is the case they need to be treated accordingly. This is a global project.

I can assure you that it is not my "goal to deny" anything. (You realise that that's a loaded question, right?) It is my goal to make sure that this article remains free of advertising and free of questionable efficacy claims. You have done a very bad job of convincing me that your goals are equally consistent with the policies of this project, and therefore I am not going to trust your word that pulsatile irrigation is more effective than the standard method. You have offered obviously inappropriate sources for this claim, such as publications about the cleaning of skin wounds or metal implants. That makes me very suspicious about anything else you are going to offer, and I am certainly not going to trust that a paper really supports one of your claims unless I can verify this by reading the abstract or my university has a subscription for the journal. I am still open to being convinced that pulsatile irrigation is really known to be so much more effective, it's just that when people try to support a position with faulty arguments one tends to get a bit suspicious. --Hans Adler (talk) 23:43, 11 March 2009 (UTC)

I am not going to debate a math teacher on the efficacy of a proven medical device. The claims are well documented. Your behavior and condescension is everything that is wrong with today’s academia. I am not going to spend more time convincing you of something you simply choose to ignore. You would rather spend time allocating time and energy on the anecdotal benefit of pouring saline in the nose from cheap plastic pots or overpriced ceramic pots as you try to convince readers that this is the only form of nasal irrigation. This is absurdity at the highest level. If our forefathers were equally suspicious of advancements we would still be praying to the sun gods. Your efforts to own this article should not be allowed. —Preceding unsigned comment added by 71.156.53.160 (talk) 08:38, 12 March 2009 (UTC)

Your ad hominem is inappropriate. I already asked WikiProject Medicine for help. So far we had one reaction from a project member, see below under #Formatting issue. Note that the second paragraph of her comment evidently refers to the absurd references in your paragraph, which you have just inserted again without any corrections at all. Reverted. --Hans Adler (talk) 08:51, 12 March 2009 (UTC)

I have added yet two more published medical references one from the University of California, San Diego [13] which demonstrates the efficacy of pulsatile nasal irrigation. I am sure you heard of this higher learning facility. The other from Spain [14], for the global viewpoint you said my references lacked, citing the efficacy of pulsatile nasal irrigation as an effective nasal irrigator but also demonstrates measured reduction of the IgE level that triggers the allegic response mechanism. You really need to look at the medical references I have cited as well as the others cited throughout this article which I am more than familiar with. Many of the medical references cited throughout this article actually used pulse lavage devices (Water Pik type devices) in their studies. You really must read more than the abstracts if you want to fully understand the clinicals and determine the methods of irrigation used.

While a few medical references demonstrate the efficacy of pulse lavage on bacterial removal and the ability to break down biofilm regardless of the particular application. Several other references support the specific use of pulse lavage for nasal irrigation. The combination of the references supplied provides more than the anecdotal references filing this article.

As far as the comment from the reader below with regards to formatting unlike you I do not pretend to be a wiki master or whatever you call yourselves. It is just another example of acedemia doing what they do best lecturing. There is truth to the old line "those that can do, and those that cant.. teach". It is clear from Wikipedia’s own recently announced position that they recognize the need to make editing these articles more user friendly and open it up to more contributors and not simply folks that have their heads buried in wiki articles and are experts in formatting. I will leave the formatting to the experts to clean things up. I welcome medical experts unless there is a MD behind your name I suggest you are in no position to adequately dispute these claims. If accuracy is something you strive for while accomplishing your desired goal of censoring pulsating irrigation form this article I suggest you change the name of this article to Neti Pot and not Nasal Irrigation otherwise you have no basis to exclude pulsatile nasal irrigation from this article.--71.156.53.160 (talk) 09:35, 12 March 2009 (UTC)

^ Davidson, TM; Tomooka LT, Murphy C School of Medicine, University of California San Diego, USA. (2000 Jul). "Clinical study and literature review of nasal irrigation". Laryngoscope 110 ((7)): 1189-93. PMID: 10892694. http://www.ncbi.nlm.nih.gov/pubmed/10892694?

Additional Published Medical References Supporting Pulsating Nasal Irrigation;

Therapeutic Agents In The Medical Management Of Sinusitis, Mabry, R.L. In: Inflammatory diseases of the sinuses. Otolaryngologic Clinics Of North America, Volume 26, Number 4, pp 561, 1993. Not only is the pulsating sinus Irrigator beneficial for patients with bothersome thick postnasal secretions, but is especially helpful for postoperative cleansing following nasal surgery.

Sinusitis: Acute, Chronic and Mangegeable, Rachelevsky G S, Slavin R G et all. Patient Care. Feb 28, 1997 Vol 131:4. "A particularly helpful stratergy is salilne washing using a a pulsating sinus irrigator is so effective in clearing the blocked passages that , if it is done regularly, some patients with persisitent or chronic sinusitis need no drug treatment at all.

Sinusitis: Bench to Bedside, Kaliner MA et al. Otolaryngology June 97 116:6 Part 2 Study of Sinusits. Pulsatile sinus irrigation is recommended as a treatment for sinusitis, and as a supplement to other treatment modalities.

Treatment of Sinusitis in the Next Millennium, Kaliner, M. Allergy and Asthma Proceedings, 19:181-4, 1998 Saline irrigation with (pulsating irrigator) is an effective non-drug treatment for sinusitis.

Nasal Hyperthermia and Simple Saline Irrigation for Perennial Rhinitis, Changes in Inflammatory Mediators, Georgitis JW. Chest 106:1487 - 82, 1994 Pulsating saline irrigation reduces significantly the presence of mediatiores of inflammation in the nasal exudate six hours after treatment.

Sinus Survival, Ivker R., Putman Publication 1995. Pulsating irrigation is shown to remove pus and allow for natural, holistic healing.

Pulsation Irrigation: a Simple, Safe Effective Treatment of Many Nasal Complaints, Pope, A., O.R.L. Digest August 1974 15:8 pp 3638. Pulsatile nasal irrigation is reccommended as a simple safe treatment for many sinus, ear and allergy complaints. High patient acceptance and enthusiasm is reported.--71.156.53.160 (talk) 11:02, 12 March 2009 (UTC)

Would you please start concentrating and reply to what I say rather than to straw men:

• I referred to the second paragraph of WhatamIdoing's post below: "some of the papers linked here were remarkable for their irrelevance. If you want to talk about the efficacy of pulsed irrigation in this article, then the paper must actually be talking about its use for nasal irrigation, not in some other situation." This clearly refers to your references with titles "Evaluation of wound irrigation by pulsatile jet and conventional methods" and "The efficacy of various irrigation solutions and methods in removing slime-producing staphylococcus", which you still haven't removed. I removed them for you and explained why in the edit summary. You simply ignored this. Now you pretend that I referred to the first paragraph of WhatamIdoing's post. That's hardly constructive behaviour.
• My daughter is ill today, so I am currently editing from home. I will look at those of your references which seem to make sense once I get access to them. But the fact you are insisting on completely irrelevant references (not just in my opinion but also in WhatamIdoing's) doesn't inspire me with great confidence in the others. As a general rule on Wikipedia, statements that are followed by a long string of references are usually wrong or at least contentious. If there are clearly irrelevant ones among them, you shouldn't be surprised that it raises red flags.
• I am exposing my identity for all to see. That doesn't give you the right to dismiss my input for lack of a medical degree. Especially as you have been 1) hiding first behind the pseudonym Grockl, now behind an IP address and 2) obscuring your own background. Anyway, what counts on Wikipedia is not formal qualifications but the quality of our edits. The quality of your edits speaks for itself. And I am not referring to technical wiki things but to your obsession with a single aspect of the topic treated in this article, your uncooperative behaviour, the incoherence of what you are adding (a single paragraph "The presence of Biofilm has been widely reported and implicated in chronic sinusitis." – WTF?), and the utter irrelevance of some of your sources. --Hans Adler (talk) 11:19, 12 March 2009 (UTC)

I am sorry to hear your daughter is ill, however, the frustration I feel being asked repeatedly to substantiate the efficacy of pulsatile nasal irrigation beyond the medical references already cited by me as well as others in the article, many which actually used pulsating irrigation in their study, is becoming absurd. I posted 7 more major medical references above in this discussion rather than put them in the article itself leaving a long string of references, more than necessary, and somewhat redundant. I posted the references along with the abstracts (not just title) for a quick review. However, I encourage you to read the full reports if you want to educate yourself in this area.

Your assertion that the three medical references that study the physical actions of pulsatile irrigation and its benefit for bacterial or biofilm removal in applications other than nasal irrigation has no place in this article is the area where I have tried to understand your reservation and have repeatedly tried to address it. When discussing the physical properties of bacterial removal or breaking down biofilm through the process of pulsating irrigation it is relevant to cite studies performed even if not directly applied to nasal irrigation. While the study may not directly discuss nasal irrigation it is nevertheless relevant to the physical benefit. As a math teacher, I would compare it somewhat to the associative property in math. The presence of biofilm or bacteria in a wound is no different than in the nose or anywhere else in the body. The only difference is the ability to effectively irrigate the area with a pulsatile lavage. Fortunately the nose is highly accessible for pulsatile irrigation including the ethmoid and maxillary sinuses.

Regardless of my frustration, I have tried to respond in earnest and provide additional references, more than sufficient to support the benefits of pulsating nasal irrigation. If you are suggesting these additional medical references included in this discussion appear in the article itself to further support the benefits of pulsatile nasal irrigation I would challenge it only serves to extend the string of references which you seem to think is a red herring anyway and I believe is simply redundant.--71.156.53.160 (talk) 16:21, 12 March 2009 (UTC)

Since you keep repeating it: Could you please stop your conjectures about me being a "maths teacher". It's trivial to find out that I am a postdoc researcher at Leeds University, so you are being as rude as if you called a physician a biology teacher. And stop claiming relevance of obviously irrelevant studies. We are talking about mucous here, not about skin wounds or metal surfaces. If you can't tell the difference you shouldn't even try to edit this article. Such studies can serve as inspiration to try the same in the nose, nothing more. Inspiring people to do their own research is well outside the scope of an encyclopedia.

What I suggest is that you remove all irrelevant references and if necessary add a few relevant and reliable sources for potentially questionable statements. I also wish you would start addressing the other concerns that I expressed in my edit summaries. In case you haven't seen it, at the top of the article there are links saying "article – discussion – edit this page – history – move – watch". If you click "history" you will see all recent edits with their edit comments. (You will also see that you are the only editor of this article who is consistently not writing edit summaries.) --Hans Adler (talk) 18:02, 12 March 2009 (UTC)

Your ignorance is simply mind bending. There is more to sinunasal disease and its treatment than mucous. I see no purpose in continuing dialogue with someone that is so ignorant in this area and blind to the facts. I strongly suggest you read the medical references and educate yourself in this area. Repeating yourself with baseless assertions when I am supported by the facts only demonstrates what is wrong with our educational system. I suggest it is your position as a post doc researcher that is a contributing factor. Your comparison of a doctor and a biology teacher only further demonstrates the box you live in. A good physician is anything but an academic. By the way, I am not hiding behind an IP as you suggest I am simply too tired to log in or is this another requirement you have unilaterally decided upon.--71.156.53.160 (talk) 18:16, 12 March 2009 (UTC)

It would really help your case if you were able to respond to and perhaps act upon my concrete suggestions. Merely retorting to my responses to the straw men that you have set up isn't going to help much. Talk pages are not for shouting matches; we are supposed to work constructively towards improving the article. --Hans Adler (talk) 18:35, 12 March 2009 (UTC)

I have been reading this discussion with great interest and even entertainment. It has been a very good exchange but have to agree with grockl that the article is about nasal irrigation and all forms of nasal irrigation should be discussed. There is so much unsupported stuff on wikipedia the complaints about appropriate references are blown way out of proportion. There appears to be substantial references provided to support the claims. Who doesn’t know about a water pik where does Hans live??

Anyway regarding the formatting you almost need a PHD to understand wikipedia’s requirement so I am not impressed with comments about poor formatting. We need more folks like the poster that live in the real world. By the way I have used a neti pot and they are ridiculous. Just go to Youtube and watch all the parodies. They are messy and not very effective if there is something better I want to know and appreciate the info and don’t want this information kept hidden for any reason. I think Hans is simply trying to be a fly in the ointment and would not waste time trying to convince him. It like arguing with a wall or my 11th grade teacher.--99.150.237.2 (talk) 19:14, 12 March 2009 (UTC)

I just wanted to say how glad I am that I got the ball rolling on removing this material. By the way, anyone notice something funny about the IP addresses of the person who keeps adding the advertisements for pulsatile irrigation back?? I'm SURE whoever this guy is, he is COMPLETELY unbiased when it comes to pulsatile irrigation :-)

Thanks for doing this Hans!!

 —Preceding unsigned comment added by 67.170.1.167 (talk) 19:55, 15 March 2009 (UTC) 

I've been out for awhile so didn't have time to clean up Grockl's product placement. By the way, I took a look at the study. Please note that it is over 10 years old and to say you are taking things out of context would be an incredible understatement. Keep it up, doc!67.170.1.167 (talk) 00:30, 5 April 2009 (UTC)

Grockl, I admire your persistence. I finally had a chance to read your articles! Very inspiring, if not completely out-dated (the best you could find is 9 years old?) and unsubstantiated by empirical data. Hardly enough evidence to say that pulsatile irrigation is "more effective" than other types of nasal irrigation.

Since pulsatile irrigation is so great, where are the articles praising it? Where is the statistical evidence that demonstrates it's greatness (relative to normal irrigation)? Is there anything aside from the postings of you and Dr. Grossan (notice I made a distinction where none exists; I hope you're flattered) that can substantiate your claims? —Preceding unsigned comment added by 71.227.174.7 (talk) 05:22, 17 April 2009 (UTC)

Your comments posted on the talk page is both insulting and bigoted and only demomstrates your level of ignorance. To make homosexual references in this day and age is ugly. I guess you are one of those kids that was stuffed in a locker in high school probably by someone like me and I apologize for that, Get some therapy.--Grockl (talk) 06:56, 19 April 2009 (UTC)

Hey Dr. Grossan! Good to see you again. I sure have enjoyed papering your talk page with obscenity, but its time to pick you apart in the realm of science, which is easier but admittedly less entertaining.

I've removed your first citation referencing RHINOSINUSITIS: Current Concepts in Evaluation and Management for obvious reasons: the article does not endorse pulsatile irrigation as an improved method of irrigation. Below is the only text which makes reference to pulsatile irrigation, but note that it does not promote it whatsoever:

"Aside from antimicrobial therapy, there is little in the way of placebocontrolled studies on other drugs commonly prescribed for the rhinosinusitis patient.I5 It is generally agreed that maintenance of a moist intranasal environment and the mobilization of inspissated mucus, particularly with impaired mucociliary transport from infection (viral or bacterial), is beneficial in patients with all forms of rhinosinusitis, and ample oral fluid intake should be encouraged. Saline nasal sprays are inexpensive and provide moisture to the nasal cavity, reduce dryness, and help to clear secretions. Nasal irrigations, via a pump (e.g., Water Pik, Teledyne, Fort Collins, CO) and an appropriate diffusion spray tip, may be performed twice a day when the patient is symptomatic; many use such a nasal and sinus cleansing regimen for months after sinus surgery until the nasal lining reepithelializes. In those with bacterial carrier states difficult to eradicate with oral or intravenous antibiotics alone, such as the Klebsiella of ozena or the Staphylococcus or Pseudomonas of cystic fibrosis, antibiotics can be delivered directly to the mucosa and infected secretions by adding bacitracin (250,000 units/1000 mL) or gentamicin (160 mg/1000 mL; some use tobramycin) to the saline solution irrigations, delivered at 200 mL once or twice daily."

One down; two to go!! —Preceding unsigned comment added by 98.201.139.55 (talk) 01:09, 7 May 2009 (UTC)

It should also be noted that this study was authored so long ago that the neilmed and other nasal lavage alternatives were not available for comparison. I don't believe that neti pots had really garnered much attention in the ENT community either. The pulsatile irrigation method was an attempt to "reinvent the wheel" but was quickly rebuffed in later years. Thanks! —Preceding unsigned comment added by 98.201.139.55 (talk) 01:12, 7 May 2009 (UTC)

Discrediting the second source Oh my god Grockl this is too funny. You California boys sure are intent on promoting nasal irrigation! I had no idea the depth of your stupidity (and apparently that of UCSD. After alll, "Nasal irrigation was originally used at the University of California, San Diego Nasal Dysfunction Clinic after endoscopic sinus surgery"). Grockl you must have been on this team!

So here is the hilarious and somewhat tricky part. I bet Grockl really patted himself on the back for this one. Grockl cited "Clinical Study and Literature Review of Nasal Irrigation" which, guess what, was authored by UCSD physicians. In this study, there is NO OBJECTIVE EVIDENCE that says pulsatile irrigation is more effective than other irrigation methods EXCEPT in the following reference: "It has also been shown that pulsatile saline delivery is more effective in removing bacteria than delivery via bulb syringe." They then reference a particular study. Guess which one??? :-)

"The efficacy of various irrigation solutions in removing slime-producing Staphylococcus." written in the Journal of Orthopaedic Trauma. That's right folks: THE STUDY ABOUT REMOVING BACTERIA FROM IMPLANT SURFACES. Grockl, you tried so hard.

Seeing as how this is obviously irrelevant to nasal irrigation since the nose is not an implant surface, I've removed this source. I'll remove the final one shortly. —Preceding unsigned comment added by 98.201.139.55 (talk) 01:46, 7 May 2009 (UTC)

Your continued attacks and accusations are neither constructive or accurate. Your continued effort to identify me as Dr. Grossan are just another breach of Wikipedia policy. Your efforts to malign Dr. Grossan and other leading ENT experts like Dr. Davidson, Dr. Josephson, Dr. Tichenor all of whom support and promote pulsatile irrigation demonstrates your lack of neutrality in this area. You are clearly not a physician or an expert in this area. I have invited a medical review of the citations by contributing ENT's or allergists. The article is on nasal irrigation not specifically neti pots. To omit pulsatile irrigation as a viable modality from the category is absurd much like many of your hateful comments. Your attempt to pick apart medical transcripts and interpret to your POV only demonstrates a lack of expertise and neutrality. Your repeated use of anti gay and obscene comments further demonstrates you should not be taken seriously. On a side note I think it is worth pointing out that while you malign Dr. Grossan it was the American Medical Association that awarded him with the Certificate of Merit nearly 30 years ago for his work on nasal muciliary function and the importance of restoring ciliary function through the use of pulsatile nasal irrigation. I think you need to educate yourself further and refrain from personal attacks if you are to be taken seriously and be constructive. --Grockl (talk) 07:11, 7 May 2009 (UTC)

Alright, Grockl. You win. If you really want me to, I'll gladly disprove your sources calmly and quitely.

My statements above were a tad malicious, but they are correct. All studies that support the use of pulsatile irrigation are biased (as in the UCSD study) and have never once shown improved efficacy relative to the other irrigation methods. Your statements are 100% false and unsupported.

If you'd like, we can start with a disclaimer that says "while pulsatile irrigation is superior on implant surfaces and open wounds to bulb syringe, it has not been proven more effective for nasal irrigation". When you can show a single study (not by Dr. Grossan please) that illustrates this effectiveness, you can keep your statement. Groskl (talk) 16:43, 7 May 2009 (UTC)

Hans I think you did a good job cleaning up the nasal irrigation article and did so with an emphasis on balance and neutrality. As I do not want to further complicate matters by posting edits, and will refrain from doing so, I would suggest you use the broader non specific term pulsatile irrigator over the more specific and somewhat limiting term dental water jet as not all dental water jets actually pulsate. In addition, the suggested benefit of the pulsatile action which has been reported and its efficacy whether described as a dental jet or pulsatile irrigator is based on the intermittant pulsating flow of the saline solution not pulsating pressure which is more or less consistent. --Grockl (talk) 10:09, 8 May 2009 (UTC)

Thank you for starting the constructive dialogue that I was hoping to involve you in from the beginning. Regarding the change from "dental water jet" to "pulsatile irrigator", there was a time when I would have done this without thinking twice. But now that I know your present and past affiliations, I tend to be a bit more cautious. The problem has to do with the kind of research that I can do and can't do. What I can do:

• Read and evaluate the relevant medical publications.
• Use Google to search for "nasal irrigation" "pulsatile irrigator" and "nasal irrigation" "water jet". The results suggest that certain companies use "pulsatile irrigation" as a unique selling proposition for their products, which are much more expensive than those of the competition.

What I can't do:

• Decide the efficacy question. As you write, suggested benefits have been reported. I can understand why they are suggested, but I can't understand why some authors make misleading claims that are clearly not supported by the references they are citing. I believe you are aware of the following opinion of David Rabago, responding to comments on his 2006 paper "Qualitative Aspects...": "Re neti pots vs pulsatile devices, I think the main thing is getting the saline into the nasal cavity, though I am not aware of a head to head trial. Different patients would likely prefer different vessels, again the best at this time might be to offer the choice. I am unaware of different rates of harm in either case. "
• Determine relative market share of pulsatile versus non-pulsatile water jets for nasal irrigation.
• Find out why some sources examine pulsatile irrigation exclusively or push it in a questionable way, while many other sources that begin with an overview over nasal irrigation don't mention it at all. This is particularly striking for the much cited paper by Brown & Graham, "Nasal irrigations: good or bad?"

Regarding the more technical point of pulsating flow or pressure, do I understand you correctly that the signal coming from the device is a square wave caused by switching the flow on and off? I will try to rephrase accordingly and also take the similar, non-pulsating devices into account, as well as the fact that the water jets in question are not necessarily "dental". --Hans Adler (talk) 11:56, 8 May 2009 (UTC)

Hans, thank you for including me in the discussion. I believe it is best that I simply be a contributor on the discussion page going forward. I think I can best be constructive in that manner while avoiding future conflict. I don’t believe a single POV is necessarily a bad thing when coming from an informed source but understand the need for neutrality. As you know I am not very experienced with wikipedia, although I have learned a lot under fire recently. I don’t see where a SPA is prohibited from posting but neutrality must prevail I understand this better now.

To answer some of your points: from my experience in irrigation for the past 30 years nasal irrigation in the US is still very new and until recently was limited to saline moisturizers. The use of neti pots and other forms of irrigation like sniffing saline from cupped hands has been much more popular in Europe and the UK for many years. I think they refer to it as snorfing or snurfing, only recently within the past few years have the methods of manual irrigation become more popular.

Pulsating nasal irrigation has been relatively popular in the US for many years due to physician referral primarily ENT’s and allergists because of the availability of the Water Pik type irrigators that have been used for many years with a nasal adapter. Water Pik type irrigators are primarily used in the US where they have been extremely popular for about 40 years. Their use overseas has always been quite limited due to voltage requirements and the cycle rate. For example in the UK shaver sockets were notorious for not working well for this type of product. That has since changed with upgrades and newer construction.

As far as the published medical reports on nasal irrigation Nasal Irrigation has largely been considered adjunctive therapy and not given a lot attention. Getting controlled studies on a treatment protocol that does not generate large protected revenue streams like a prescription drug or other revenue enhancing treatment is difficult at best.

To your point, there is a lot of anecdotal use of references and physician support accross the category. However pulsatile irrigation is well supported by leading ENTs and allergists as an effective method of irrigation especially for removal of slime producing bacteria and biofilm. It is true that many reports draw conclusions from the use of pulsatile irrigation or lavage on bacteria in applications other than nasal irrigation as we have certainly discussed before and are therefore anecdotal but still meaningful. Another example of this would be the recommendation of Xylitol which is quite popular and one I personally support. Virtually all the medical references that support Xylitol as a natural antibiotic are in the area of oral care (toothpastes, chewing gun etc.) where studies have been published demonstrating the effectiveness in preventing dental caries (ie: cavities). Making the jump to the sinuses with limited references and medical support is anecdotal as well but is well supported by physicians just as pulsatile irrigation is with bacterial and biofilm removal from the sinuses bases on the effectiveness of this type of irrigation in other applications like wounds and surgery. We find a similar situation with claims about dead sea salt vs regular salt. The high mineral content associated with dead sea salt can equally be argued against and has. We also see anecdotal references to the support of a Ringers solution over a regular saline solution. This does not mean there is an attempt to misinterpret but simply that the references and direct clinicals have not yet been performed. This is not limited to nasal irrigation. Anecdotal references are all around us and can prove to be useful and generally in time lead to better more detailed studies that can further differentiate and validate or possibly invalidate. As the nasal irrigation category grows in awareness there will be no doubt better reports and studies to clarify and distinguish methods of irrigation as there should be. Neti pots and Nasal wash bottles will most likely be defined more appropriately as nasal washes or rinses as opposed to irrigators and the mechanical devices will better defined as irrigators.

In summary I think it is important to point out to readers that various forms of irrigation exist and each have the advantages and disadvantages aside from clinical support. An example of this would be that neti pots use negative pressure irrigation and require the user to carefully position their head by tilting to one side for gravity to work but are very inexpensive. A nasal wash bottle is equally inexpensive but a little easier to use since it can be squeezed in an upright manner and relies on positive pressure irrigation. A powered irrigator while being the most costly can be offset with insurance reimbursement and may be easier to use since you just turn it on and the machine does the rest while maintaining a consistent flow and pressure.

Regarding your comment as a square wave I am very impressed actually it is a pulse wave or alternating current which is clearly similar to a square wave but not as symmetrical.--Grockl (talk) 14:45, 8 May 2009 (UTC)

Good job Hans I can see it was a lot of work cleaning up the irrigation article. Some comments you may wish to include in the article. Under methods, I propose "nostril adapter" should be changed to "nasal adapter" which is the term generally used. In addition it may be helpful to provide some information on the difference between normal saline and a ringers solution. A "Ringers" solution for nasal irrigation generally consists of potassium chloride, calcium chloride, and sodium chloride with the buffering agent sodium bicarbonate. Normal saline is just sodium chloride with usually a small amount of sodium bicarbonate. A Ringers solution can be purchased but may be expensive. It is easy to mix, at home, a solution that approximates a Ringer's solution, or you can get some of the other salts (KCl and CaCl2 )found in Ringer's by using sea salt, but generally not in the same proportions as in Ringer's. Some studies (can be provided if needed) claim a "Ringers" type solutions are better than normal saline for nasal irrigation (muco cilliary clearance), however, the added expense or time preparing at home is a negative. Just trying to be helpful and add content. I will leave to you and the other editors the decision to include or not.--Grockl (talk) 16:42, 9 May 2009 (UTC)

It wasn't all that much work, actually. Thanks for suggesting the wording "nasal adapter", I have changed that. As to Ringer's solution, I am not sure what to do. I really want to avoid excessive detail as per WP:NOTMANUAL. I am aware that people use Wikipedia articles as manuals and I try to accommodate them as much as possible, but it needs to stay within reasonable bounds for an encyclopedia. We already have a link to lactated Ringer's solution, and information about approximating that seems to go a bit too far. But I have made some small changes that I hope make the section a bit clearer. --Hans Adler (talk) 18:14, 9 May 2009 (UTC)

I agree Hans, I like that your revisions have made the article much more concise. From my experience with nasal irrigation the most frequent questions have to do with saline ingredients and recipes which is why I suggested the information but after I submitted it I too thought it might be too much detail for this particular article. I agree, if folks want to look up greater detail on the various saline solutions its easy enough to find on line or follow the links. Thanks for the update--Grockl (talk) 06:55, 10 May 2009 (UTC)

Hans looks like some commercial brand advetising was recently posted on neti pots. I suggest removing to maintain neutrality and remove any commercial preference.--Grockl (talk) 09:40, 14 May 2009 (UTC)

Thanks, for some reason I didn't see it on my watchlist when it happened. In principle one can discuss such things, but to do it right one would have to find neutral information, which isn't easy at all. And then we would have all sorts of weight problems. --Hans Adler (talk) 10:57, 14 May 2009 (UTC)

Happy to help. After all we have been through, and some of us have learned, I think its important to keep the sandbox clean otherwise you end up having to give shout outs to every brand in every method of nasal irrigation not only with devices but next saline preparations and other irrigants, where will it end. If I learned anything it’s the importance of neutrality and to avoid any sign of commercialism and brand preference. It is defintely a slippery slope.--Grockl (talk) 18:30, 14 May 2009 (UTC)

Anatomical

The claim that the liquid goes in one nostril and out the other is anatomically incorrect. The sinuses are not connected. It could be possible to exit the Nasopharynx into the Oropharynx and then reenter the other side of the Nasopharynx, but other than that or a congenital abnormality the left and right sinuses are isolated from one another. Phalen1 (talk) 22:32, 17 January 2009 (UTC)

• The liquid certainly goes in one nostril and out the other. The anatomy of the nasal passages is quite complex but it seems that the nostrils communicate within the nasal cavity and so this is the junction. I have updated the article accordingly. Colonel Warden (talk) 08:54, 27 February 2009 (UTC)
• I don't know about the details of anatomy, but the water definitely goes into one nostril and comes out of the other. Just look at the top right photo. I am using something similar, and the almost spherical bit that goes into the nostril came in 3 sizes, so that everybody can choose one that fully blocks the nostril through which the water enters. It's a while since I last used it (I am currently living in clean air and in a badly isolated flat, so it's not necessary), but I seem to remember that a fraction of the water also runs down the throat. --Hans Adler (talk) 01:40, 1 March 2009 (UTC)

Formatting issue

If you're using {{cite journal}}, please don't add a PubMed URL to the |url= field. The |pmid= field provides that link automatically, without the ugly and unnecessary cruft that tells the reader (for example) what position this article was in the search you just performed, which is wholly unimportant.

That said, some of the papers linked here were remarkable for their irrelevance. If you want to talk about the efficacy of pulsed irrigation in this article, then the paper must actually be talking about its use for nasal irrigation, not in some other situation. WhatamIdoing (talk) 05:45, 12 March 2009 (UTC)

Regarding the second paragraph, see above under #Pulsatile irrigation. User:Grockl, now editing logged out as User:71.156.53.160, has been edit warring to include the section with the irrelevant references. I would appreciate some input as to whether electrical irrigation devices are really as effective and as common in the US as the editor claims. The editor appears to have a conflict of interest and I am not impressed by the overall quality of their contributions. --Hans Adler (talk) 11:27, 12 March 2009 (UTC)

Hans, I know the UK is not exactly the world leader anymore but come on you never heard of a Water Pik? Folks have been using these types of products to irrigate for the last 40 years both the mouth and nose including me. They are really effective and easy to use. When used for nasal irrigation, they clean out the mucous much better with greater leverage than the manual methods like neti's and squeeze bottles, but they are pricy.

My two cents you have to get out from the books a little. The poster replied to your request for more references with several quality ones, did you even read them? You keep picking on the same area. The only straw man I see is you. Move on already your being ridiculous. --71.133.137.50 (talk) 21:03, 12 March 2009 (UTC)

Hans, I think pulsatile irrigation should be included in this article, but without the irrelevancies. Are they common devices for nasal irrigation? No -- definitely not in regular home use. (I exclude clinical settings: many dentists and surgeons use them daily.) Are they exceedingly rare? No, I wouldn't say that, either.

But the biggest problem with the sourcing is the usual one for medicine-related articles, especially with new editors that have a special interest: sources that don't reflect the real-world experience in the specific setting under consideration. The stuff about biofilm belongs in Biofilm, not in Nasal irrigation (although the concept of biofilm might be mentioned in passing, in a general section on how nasal irrigation works). The stuff about wound debridement belongs in Debridement. What a Water Pik does to your teeth isn't useful information about what happens if you shove it up a nostril. Again; they're not all bad sources; they're just not on the relatively narrow topic here.

Additionally, we're supposed to avoid representing "This worked once under totally artificial lab conditions" as "This really works for real people in the real world" -- an approach that any responsible healthcare provider or patient advocate will appreciate for 99% of the articles in Category:Alternative medicine, and consequently should be able to respect in other articles. WhatamIdoing (talk) 21:08, 12 March 2009 (UTC)

• The material about pulsatile irrigation seems essentially sound - it's just a matter of cleanup and sourcing. I like this source which is written by a practising professor of otolaryngology and discusses the merits of particular devices and nasal irrigation in general. I thought about adding to the article previously but working upon this article seemed a thankless task and this does not seem to have changed, alas. Colonel Warden (talk) 21:35, 12 March 2009 (UTC)

I have no problem whatsoever with discussing pulsatile irrigation in this article. Please ignore the straw men that Grockl is setting up. What I don't want is an isolated mini-article complete with its own lede and duplicate discussion and framing of aspects that are already covered outside. ("Some people use bulb syringes, squirt bottles, and neti pots. Others use pulsating irrigation devices that deliver an intermittant pulsing saline rinse to remove bacteria, purulent material, and help restore ciliary function.")

What I also don't want is that an astroturfing campaign for a product successfully compromises the content of this encyclopedia. See Wikipedia:Sockpuppet investigations/Grockl for supporting evidence. In my web research for this article I have come across several blogs / discussion forums with suspicious activity, i.e. enthusiastic support for Dr Grossan devices that just doesn't look authentic. I am completely open to the possibility that these devices are more effective than the standard method; note that it's me who introduced the last sentence into the "Benefits and uses" section: "Medical reports indicate pulsatile lavage is more effective than non-pulsating nasal wash products like bulb syringes, neti pots and squeeze bottles which rely simply on gravity and conventional flow at breaking down biofilm, general cleansing and removing bacteria." (The reference still needs checking, I believe.) But I am not going to take the word of someone (Grockl) who seems to be a sales rep or producer of these devices and who claims that the standard method, which is clearly dramatically more effective than doing nothing, is ineffective. And who is throwing around obviously irrelevant references and appealing to his own authority and my lack of a medical degree. Unfortunately I am still not in a position to check the references, or I would do it now. --Hans Adler (talk) 09:09, 13 March 2009 (UTC)

Adults

The sniping on this page is really inappropriate. I'm going to proceed under the assumption that we're all adults. So: act like it. I don't really want to see anyone waste any more time on "his job makes him biased" or "he's too stupid to understand" or anything like that. New editors may want to read WP:TALK for some advice about how these things are supposed to be discussed, because this page is a pretty poor example for you.

A few ground rules:

• We have a dispute about article content. We want to resolve it. It can probably be resolved by polite conversation on this page. If not, other options are available.
• Because there's a dispute, anything that you wanted added should be posted on this page first. Include the references, because that burden of proof is always on the person who wants to add information. Wait at least one day to get a reaction from other people. I recommend posting something that you think is short, simple, non-controversial, and specifically about nasal irrigation first. We can expand it later. I also recommend starting a new section for the proposal.
• Please comment on the content, not on the contributor.

There's no need for this dispute to get any worse, and I think this basic approach will help get it resolved. Thanks, in advance, for your cooperation. WhatamIdoing (talk) 21:17, 12 March 2009 (UTC)

Hans, I agree with the poster your efforts to ban pulsating nasal irrigator in an article ABOUT nasal irrigation have been ridiculous and without any basis. You are NOT an authority on the subject at all. Maybe you should concentrate on a discussion of Algebra for all I know you are not an expert in that either. I prefer to trust the medical references that have been published that support this thing. There is plenty of research material all over the web supporting these products. Some of your statements and condescension make me ask have you ever held down a real job or do you just suck at the teet of tax dollars at the university you work at? Pulsating irrigation is useful and effective for nasal irrigation even more so than the ridiculous neti pots you are so proud of pushing. I am beginning to wonder where exactly you put the neti pot?

[removed]. I would gladly offer my help to the original poster to keep this in the article where it belongs and stop [removed] from hijacking an article where you have no expertise. [removed]. --71.130.129.37 (talk) 21:20, 18 March 2009 (UTC)

Please do not make comments like this. We need to talk about content, not about contributors. We don't need any more nastiness about "you university types" or who is a real-world expert in which field. These comments violate Wikipedia's basic behavioral rules and may result in you losing the ability to edit anything on Wikipedia. WhatamIdoing (talk) 06:17, 23 March 2009 (UTC)

[removed]

Hans, thank you again for following up on this obvious astroturfing campaign. [removed] —Preceding unsigned comment added by 67.170.1.167 (talk) 03:57, 19 March 2009 (UTC)

Please stop making accusations on this page. Your comments are not helpful. If you think that a user is using multiple accounts inappropriately, please read WP:SOCK and then file a report at WP:RFCU so that it can be dealt with through the proper channels. Please do not continue making these claims here. WhatamIdoing (talk) 06:10, 23 March 2009 (UTC)

That's not good advice at this point, because I have done it already. The result was that sockpuppeting could not be proved but the two IPs who supported Grockl on this page (from the same city and internet provider as Grockl) were meatpuppeting. MBisanz blocked the IPs temporarily. See Wikipedia:Sockpuppet investigations/Grockl. A check user request only makes sense if and when there is another incidence. But I agree that the concrete accusations must stop, especially on this page. Unfortunately there has been no third party response to WP:COIN#Nasal irrigation. --Hans Adler (talk) 08:15, 23 March 2009 (UTC)

I guess if someone does not agree with you we are all related. Hans,I am tired of this. Why not simply have an MD or some medical authority figure rule on this form of irrigation and whther it si relevant in this article once and for all. I will abide by whatever decision is made if you agree to do the same. It was a matter of principle but quite frankly its not worth it. —Preceding unsigned comment added by Grockl (talk • contribs) 06:46, 19 March 2009 (UTC)

I added a heading for pulsating irrigation above your abbreviated edit. Is this acceptable to you? BTW please stop referring to me as a physician - I am not.--Grockl (talk) 07:10, 19 March 2009 (UTC)

• I removed part of the coments of the IP per WP:RPA, as violating WP:NPA. Although talk pages might go off-topic once in a while, they are mainly for discussing changes to the articles, not for expressing your thoughts on other editors. Go to his talk page or send him an email. --Enric Naval (talk) 16:37, 7 May 2009 (UTC)

Biofilm

I have removed this statement:

The presence of Biofilm has been widely reported and implicated in chronic sinusitis.

from the section on pulsating nasal irrigation because it's off topic. It is not specific to pulsating nasal irrigation. It is possible that -- if we have with a (non-speculative) paper that says nasal irrigation effectively treats chronic sinusitis -- it could be moved to the section #Benefits and uses, but it's obviously not about the section that it has been placed in.

If we can't find a paper that says nasal irrigation effectively treats chronic sinusitis, then it might be wanted at the article Biofilm. WhatamIdoing (talk) 21:27, 12 March 2009 (UTC)

I may revert as the significance of biofilms to nasal irrigation seems obvious and so does not require exceptional sourcing. I observe that User:WhatamIdoing is making sundry bold edits and shall wait until she is done. I am generally not content with recent changes to the article which have undone work which I did previously. We need more talk here before we waste more time. Colonel Warden (talk) 21:37, 12 March 2009 (UTC)

But you think it is relevant specifically to pulsatile nasal irrigation, and not any other form of nasal irrigation? Because that's the only possible justification for insisting that it be in that specific section instead of being moved to #Benefits and uses. WhatamIdoing (talk) 22:26, 12 March 2009 (UTC)

My general understanding is that the various methods of irrigation vary in the effectiveness with which they wash out the nasal passages. The source I referenced above states clearly, "The pulsatile irrigation is the key to success. Non pulsatile systems are not recommended and are considered less effective.". It seems obvious that such effectiveness matters most in the case of stubborn encrustations and sticky films. I am not too bothered exactly how we say this but I am not understanding the objection to saying something of this sort. Colonel Warden (talk) 23:02, 12 March 2009 (UTC)

As a further point, Dr Davidson says "One of the yet unsolved problems in chronic sinusitis is the development of biofilms. Bacteria produce a honeycomb like film, which is impermeable to antibiotics. The bacteria reside in the biofilm, and are immune to local nasal immunity, antibiotics, and everything else we have used in trying to treat sinusitis. Johnson’s Baby Shampoo, while not destructive to biofilms, is one of the nasal irrigant additives that helps reduce bacterial growth in the biofilm." This indicates that pulsation is not enough and that additives such as detergents are required to address such stubborn cases which may still be intractable. Colonel Warden (talk) 23:09, 12 March 2009 (UTC)

Reading through some of these comments I appreciate the work you folks do to edit these articles, however, it seems to me it would be helpful to have editors with a medical background that can fully understand and put into context the medical references. Biofilm certainly does have a primary role in nasal irrigation as its presence can limit the effectiveness of the cleansing effect especially with non pulsating irrigation which tends to flow over the surface of the biofilm. As noted, biofilm is a sticky plaque like material that can contribute to the formation of bacterial colonies and has been shown in several medical reports to be present in 90% of all sinus infections. Pulsating irrigation is helpful to break down the biofilm and remove bacteria because of the added leverage associated with intermittent pulsing action of saline delivery, rather like a jackhammer or more appropriately water hammer effect. It is this unique benefit from the pulsating action which makes this type of irrigation so effective for chronic sinusitis. I simply do not understand why some fail to understand the relevancy of reports that demonstrate HOW pulsatile irigation works to remove bacteria and biofilm regardless of the application the efect is the same. Perhaps it needs to be under a different heading to make it more relevant but it should be included and not excluded.--Grockl (talk) 23:57, 12 March 2009 (UTC)

• The bald fact that biofilms are linked to a disease tells us absolutely nothing about pulsatile nasal irrigation.
• If nasal irrigation is ineffective (see Col. Warden's second comment), then the bald statement that biofilm is associated with sinusitis should be moved entirely to Biofilm.
• If any kind of nasal irrigation works for biofilms (see Grockl's comment), then this information belongs with all the other information about what nasal irrigation works for. If our sources say that pulsatile nasal irrigation works better for this, then we can say that, but we should not separate it from all the other uses and bury it in the middle of a section that is about "what it is" instead of "why you use it". Readers reasonably expect the "Why you use this" section to contain all of the "Why you use this" information. WhatamIdoing (talk) 00:02, 13 March 2009 (UTC)

• The section Benefits and uses needs more work to expand upon the variety of conditions for which nasal irrigation is indicated. I did this previously but another editor has reworked this on stylistic grounds, objecting to it as a "laundry list". I shall have another go at better presenting this material and shall perhaps add something general about biofilms which, as stated above, are present in many cases. I have no special expertise in this matter but it seems common sense that there are obvious similarities to hygiene practises for the mouth cavity. Rinsing your mouth is not sufficient in most cases because the stubborn biofilm of dental plaque will resist this. Mechanical action is commonly used such as toothbrushing, flossing, dental picks, tongue scraping and ultrasonic cleaning. In the case of the nasal cavity, this is more difficult - picking the nose seems to be the only common action. We might perhaps say something about the advanced Indian practise of using string to floss the nasal passages. We perhaps can't say too much here as that wouldn't be irrigation. I shall look at starting a separate article for that to which we can refer. Colonel Warden (talk) 08:00, 13 March 2009 (UTC)

Neti pot photo

Is there some reason why the photo of a man using a neti pot needed to be removed? I can understand nasal irrigation better with that photo than without it. Peter Chastain (talk) 10:28, 21 May 2010 (UTC)

Thanks for the alert. I have no idea why it was removed, and have restored it. Hans Adler 11:29, 21 May 2010 (UTC)

Health benefits

Added the following

• The saline solution irrigation promotes good nasal health, and patients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge) and nasal congestion often find nasal irrigation to be provide effective relief. In published studies, “daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis,”[3], and irrigation is recommended as an “effective adjunctive treatment of chronic sinonasal symptoms.”[4][5]

Any problems? I'll make the citations formal if there's no disagreement with the content.Yris (talk) 16:16, 4 June 2010 (UTC)

Fixed a bad source.Yris (talk) 16:34, 4 June 2010 (UTC)

Saltwater available in a pressurized can

Trade name Sterimar [6] You can easily do nasal irrigation at a bathrom sink using just your hands. Fresh water does work well compared to salted water.

Depends on your nasal disease. Most doctors advise tap water because tap water is osmatically absorbed into nasal tissue causing increased tissue swelling. So generally tap water would be most suitable for case of strict dehydration of sinus tissues (overall body dehydration or dry air or high altitude) rather than cases where irritable swelling and congestion already exist. Additionally level of chlorination in some tap water may be an additional irritant. You can find citations for this rather easily but I don't have the time. 65.26.139.168 (talk) 20:06, 22 January 2010 (UTC)

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