Several products on the market utilize hypertonic saline to spray or irrigate the nose and others isotonic. What exactly is hypertonic and isotonic?  Which is better for me?

Isotonic saline solution - "Iso" refers to something equal and in this case it means that the concentration of salt or saline  is equal to or similar to salt concentration of body fluids.

Hypertonic saline solution - "Hyper" refers to something "greater" or "higher" and in this case it means that the solution has a greater salt content than body fluids. A hypertonic solution is thought to be better at reducing swelling of the mucous membranes because of this greater salt concentration.

Locke-Ringer, Gleichenberger, and Ems salt solutions - Well known solutions with varying concentrations of different salts. 

There has been some research on the best solution to use. but it is mostly conflicting. Although some research shows that hypertonic solutions are more effective than isotonic solutions, other studies show that hypertonic solutions decrease sinus drainage and movement of the cilia, which are cells that "sweep" the sinuses and push particles out. From the few research studies conducted on Locke-Ringer, Gleichenberger, and Ems salt solutions , these do not appear to decrease ciliary movement, making them preferable to hypertonic saline solutions.

Our SinuAir® powdered saline mix is a modified Ringer’s solution.  Several medical articles have demonstrated this solution best for restoring nasal ciliary function. SinuAir® preservative free and contains no Benzalkonium, known to impair cilia function, cause burning or stinging sensation, and cause rebound and congestion.

There are several economical advantages with our concentrated formulated saline. It is much less expensive than the leading hypertonic solutions. When mixed yourself SinuAir® used as a spray, from our standard 200 gm bottle will make over 40 pints or 640 ounces of an Isotonic solution. 20 pints or 320 ounces of a 2x hypertonic solution. Compare this to the size and price of the other leading hypertonic solutions.

The advantage of SinuAir™ powdered saline is the ability to customize your saline concentration (Isotonic or Hypertonic) to your individual comfort. The ability to change concentration and not purchase a new product provides flexibility and economy. If your nose is dry and irritated, a hypertonic solution can make the nose drier by taking liquid out. In this particular instance an isotonic solution is better. However, if your nose is swollen, a hypertonic solution may be best. It is recommended to start with isotonic and move slowly to hypertonic. Over time a hypertonic solution may be too strong for some and should be reduced to an isotonic concentration. There  really is no universal answer.  

• For a 2X hypertonic solution, just add the 1 teaspoon to 8 ounces of water or 2 teaspoons to 16 ounces for use with the SinuPulse Elite®.
  

• For a 3X hypertonic, just add 1 1/2 teaspoons to 8 ounces of water or 3 teaspoons to 16 oz of water for use with the SinuPulse Elite®.

What about plain water?

Salt follows water, and water follows salt. Anyone who has ever seen the effect of salt on a snail knows what happens to the snail. Hypertonic saline will tend to draw a small amount of water from the tissues it contacts; this is desirable if the tissues are swollen. Plain water, on the other hand, will tend to enter the tissues, thereby increasing swelling.  When you sit for a long time in a bath, your fingertips wrinkle because the water content of the skin is increasing, so the skin must "buckle" to accommodate the extra water. In addition irrigating with plain water can irritate or be uncomfortable.

Each SinuAir® package contains:  
200gm of formulated saline powder for nasal solution  
Refillable nasal spray bottle  
Double sided measuring spoon

• 1/4 tsp. for adding to 4 ounces of water for nasal spray bottle.

• 1 tsp. to add to a pint (16 oz) of water for irrigation with the SinuPulse Elite® Advanced Nasal / Sinus Irrigation System.

For more information on obtaining SinuAir®,  click here.

References:

Physiologic and hypertonic saline solutions impair ciliary activity in vitro. Boek WM. Laryngoscope, 109(3):396-9 1999 Mar
Physiological salt solution (0.9%) was found to slow cilia movement. Locke-Ringers solution with soda bicarbonate, potassium and calcium chloride, and salt was found best for cilia. "This solution is more appropriate than saline for nasal irrigator and nebulazation or sinus lavage." He reported complete ciliastasis with some hypertonic solutions, often within 5 minutes of exposure.

Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers. Clin Exp Allergy.1995; 25:957-965
Benzalkonium chloride induces mucosal swelling, which explains why the presence of this preservative in a decongestant spray aggravates nasal/sinus symptoms

Effects of topical nasal steroids on human respiratory mucosa and human granulocytes in vitro. Steinsv¡ag S. Acta Otolaryngol (Stockh), 116(6):868-75 1996
"It is concluded that benzalkonium chloride has toxic effects on human respiratory mucosa and human neutrophils in vitro."

Effect of topical corticosteroids and topical antihistaminics on ciliary epithelium of human nasal mucosa in vitro. Hofmann T. HNO, 46(2):146-51 1998 Feb
"An irreversible cessation of ciliary movement was observed in all cells exposed to nasal sprays containing benzalconium chloride....." "we recommend that this preservative should not be used anymore in topical nasal medications."

The effects of topical nasal steroids on rat respiratory mucosa in vivo, with special reference to benzalkonium chloride. Berg OH. Allergy, 52(6):627-32 1997 Jun
"In conclusion, benzalkonium chloride appears to be potentially toxic to the nasal mucosa."

A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Adam P. Arch Fam Med, 7(1):39-43 1998 Jan-Feb
Hypertonic saline does not improve nasal symptoms or illness duration in patients with the common cold or rhinosinusitis. Thirty two percent of users noted burning and wouldn't use the product again.

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