Medical Consumer’s Advocate nasal saline solutions, leeches, and other odd forms of torture

Q: Back in ’77, I was diagnosed with sinusitis (oh, and a deviated septum, too.) There was one part of the exam that still makes me shudder and shall haunt me forever. I heard the doctor tell the nurse to give me ‘the treatment’. (He might have said ‘water treatment’; it was a long time ago).

My chair was then positioned so that my head was lower than the rest of me. The nurse then proceeded to squirt water up my nose and vacuum it out again. Many times. I thought I was drowning/dying. It was horrific. (I don’t swim, by the way, so maybe I’m overly sensitive to have water in my nose.) The nurse ended up telling the doctor that she couldn’t finish ‘the treatment’ because I was being ‘a baby.’ (Good bedside manner.)

Anyway, my question is, is this particular form of treatment still used? I *think* they were ‘irrigating’ my nose to get a better look inside, but I’m not sure. Is that the purpose of a CT scan these days then, to prevent this medieval water torture?

Thanks for taking the time to read this. And thanks for an entertaining and informative site.

A: Thanks for the kind feedback.

In Mexican prisons, they allegedly torture prisoners by opening a bottle of Coca Cola (you know, the old style curvy bottle), adding a teaspoon or so of cayenne, shaking it up, and unleashing it on the nostrils of the unfortunate victim.

Count your blessings, you only got the Saline Treatment.

Nowadays, we still recommend nasal saline spray and even saline irrigation using a variety of devices (there are even Water Pik attachments that are modified to produce a less powerful stream.) Key difference: you, the patient, does it– not a nurse (was she wearing black leather and spiked heels?) That way, you can control the forcefulness of the treatment. If you blow the back of your head off, you only have yourself to blame.

Trendier still (and one step closer to the Mexican prison) is hypertonic saline, which is salt water that is a bit more concentrated than regular saline (AKA normal saline, which matches the salt concentration of your blood.) Hypertonic saline is a bit of an irritant, producing a lot of mucus, which tends to flush the nose of unwanted bacteria, dust, pollen, etc.

By the way, in some cultures, nasal douching is as much a part of the daily routine as toothbrushing is in ours.

The purpose of this douching is to improve the environment within the nose, decrease inflammation and thereby improve your sinuses’ ability to drain. There are caveats to this procedure, however. Aside from the discomfort of douching, there are some organisms which thrive on wet environments. Thus, by douching, you could get rid of some bad bugs but make your nose a homey place for different bad bugs.

Nevertheless, on the whole, I like nasal saline irrigation, particularly in patients who have had sinus or septal surgery.

Q: Thanks for your reply. I was hoping nasal irrigation had gone the way of leeching, but no such luck, I guess. 🙂

A: Sorry to disappoint you, but leeching has NOT gone the way of leeching. Leeches are alive and well. I should know, I was the leech keeper during my residency at USC.

Leeches are used for a very specific purpose: relief of venous obstruction in a reattached bit of tissue. Typical example: man slices finger off in a band saw, and the hand surgeon reattaches the finger. Two hours later, the digit is blue. The problem is usually not with the arterial supply, but with obstructed venous outflow. Solution: attach a leech. Leeches ‘inject’ an anticoagulant. Not only do they suck out a bit of venous blood, they create a wound which continues to ooze for an hour or more.

We use only medicinal leeches, which are leeches that are raised under very clean conditions. Thus, you don’t need to worry about acquiring some bizarre parasitic disease from a wild-caught leech; the leeches are quite clean, and in fact, make rather attractive aquarium pets. But they will be quite deadly to the fish in your tank.