What is the best modality to minimize bacterial contamination of nasal saline irrigation bottles?

BACKGROUND Nasal saline irrigation is a common component of chronic rhinosinusitis (CRS) management. The benefits of irrigation have been noted in primary and postoperative management of CRS. The irrigation consists of physiologic saline solution applied into a nostril via a squeeze-bottle, a bulb syringe, or a neti pot. As the saline flows through the nasal cavity from anterior to posterior, then into the nasopharynx and contralateral nasal cavity, it washes out mucus and potential irritants. The efficacy of nasal saline irrigation has been demonstrated, with improvement shown in the endoscopic appearance as well as symptom scores in CRS patients. However, it has recently been shown that a large proportion of irrigation bottles have evidence of bacterial contamination. A link between irrigation bottle contamination and clinical infection has not been established; however, there is significant concern for infectious transmission, especially in the postoperative setting. Given the potential for the contaminated fluid to contribute to sinonasal infections, several approaches have been evaluated in an attempt decrease the bacterial presence within the irrigation bottles, and subsequently the irrigation fluid.