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Sinus congestion

gotgame

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Hmm i dont think i have ever started a thread before. I get this question a lot from friends and family so i figured id make a quick post that may help some people.

There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.

Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.

1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.

Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.

Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.

Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.

Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.

Oral prednisone: Systemic effects...dont take too often.

INFECTIOUS:

Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.

Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.


Other tools:

Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.

Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.

Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.

Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help


Im not going to discuss surgical options.
 

thethinker48

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I think fall under the category of partially clogged sinuses half the year (prob should pay more attention as to why), but no breathing issues so not noticeable

Worst was when I used carditone for a brief period for BP; you basically become a mouthbreather on that
 

gotgame

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I think fall under the category of partially clogged sinuses half the year (prob should pay more attention as to why), but no breathing issues so not noticeable

Worst was when I used carditone for a brief period for BP; you basically become a mouthbreather on that

Being congested at night and being an obligate mouthbreather is just poor for your health and heart. if you are most congested when laying down its most likely your turbinates becoming swollen.

Ive also noticed that some guys report increased congestion when on GH. Im not sure if its from some fluid retention or due other reasons but some guys swear that when on GH there congestion gets bad and resolved a few days after stopping.
 

muscle96ss

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Hmm i dont think i have ever started a thread before. I get this question a lot from friends and family so i figured id make a quick post that may help some people.

There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.

Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.

1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.

Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.

Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.

Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.

Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.

Oral prednisone: Systemic effects...dont take too often.

INFECTIOUS:

Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.

Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.


Other tools:

Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.

Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.

Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.

Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help


Im not going to discuss surgical options.

As far as daily nasal lavage, I use the Grossan Sinus irrigator. It is like a water-pik for the nose. I have been using it for years religiously every day in the morning and the evening and love it.
 

Gravyv

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Thanks for this write. What are your thoughts on allergy testing? I've been dealing with sinus issues for awhile now. A few years ago I got a turbinate reduction surgery which helped for a few months then my congestion came back. The ENT told me allergy testing would be the next step if I keep having problems but it can take a few months to figure out.

I think with me my sinusitis is caused by an allergy to dust and withdrawal from medications. I breathe much better after cleaning out my room and changing bedding. Then with meds, I've been taking tramadol and gabapentin regularly for my back issues. However, I don't necessarily always take the same amount every day which probably ends up giving me some withdrawal effects. I've been using a neilmed rinse bottle with salt and baking powder. Now i'm going to give adding some baby shampoo a try.
 

jcc80

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Agree on nasal irrigation, I just started doing that and it's borderline miraculous. Another thing to consider is that I think a lot of guys like to use daily Cialis or the like for blood pressure (and for obvious reasons). That shit will make you a mouth breather too.
 

Bobik

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Hmm i dont think i have ever started a thread before. I get this question a lot from friends and family so i figured id make a quick post that may help some people.

There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.

Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.

1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.

Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.

Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.

Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.

Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.

Oral prednisone: Systemic effects...dont take too often.

INFECTIOUS:

Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.

Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.


Other tools:

Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.

Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.

Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.

Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help


Im not going to discuss surgical options.
I have to agree. I sometimes have increased basophils on the cycle, but I don't have an allergy .... I have basophils okay on TRT .... I'm still struggling with the rapid increase in HCT and HGB on the cycle, can it be related? ... OSA tested and all right.
 

IronLion2

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good timing. I'm on my first hard "bulking" stage in a while, kind of forgot how much stress eating a highly inflammatory diet plus wet gear puts on the body.
 

TheOtherOne55

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Im dealing with this RIGHT now.
About 1/2 the year I deal with bad sinus congestion....and its a mix of a bad deviated septum as well as allergies.
It's terrible. PLUS right now I'm in my offseason, so I'm huge...eating all the time...and can only breathe from my mouth. I just sound gross and I'm always trying to get more air lol

Its weird though. I went the flonase route for awhile and it just stopped working after awhile. Bronkaid DOES work and go back and forth between using that. And even though its terrible, i do have Afrin on hand when it gets real bad.

Honestly, its debilitating. I also have sleep apnea and its makes my life miserable from that perspective. It doesn't allow me to use a nasal mask because I'm a mouth breather.
I know several people who have gone in for surgical sinus cleaning and some have said its a great fix, others have told me horror stories.
 

gotgame

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As far as daily nasal lavage, I use the Grossan Sinus irrigator. It is like a water-pik for the nose. I have been using it for years religiously every day in the morning and the evening and love it.

People seriously underestimate how useful irrigating your sinuses is. I do it every day. I mean they catch so much dust, debris and allergans and then create an environment for bacteria.

I did make the mistake a while ago of just adding salt and then i get pseudomonas growing on my nasal culture when i was congested lol. add baby shampoo and prevent that.

As for the flossing water-pik.... i use that for my teeth and its great. So much junk comes out makes you think you were just a dirty mouthed guy before lol. I use a water-pik to get the food out, floss and then brush. I add a lil bit of mouth wash to the water-pik container.
 

gotgame

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Thanks for this write. What are your thoughts on allergy testing? I've been dealing with sinus issues for awhile now. A few years ago I got a turbinate reduction surgery which helped for a few months then my congestion came back. The ENT told me allergy testing would be the next step if I keep having problems but it can take a few months to figure out.

I think with me my sinusitis is caused by an allergy to dust and withdrawal from medications. I breathe much better after cleaning out my room and changing bedding. Then with meds, I've been taking tramadol and gabapentin regularly for my back issues. However, I don't necessarily always take the same amount every day which probably ends up giving me some withdrawal effects. I've been using a neilmed rinse bottle with salt and baking powder. Now i'm going to give adding some baby shampoo a try.

My thoughts are allergy testing is useful if you are going to change something or if you are going to go the allergy shot /densitization route. If you arent gonna do those things then just use a good air purifier and prevent your turbinates reaction to all allergans by keeping up with the flonase, azelastine and irrigation and that should help a lot.

With enlarged turbs u have to keep them from getting irritated and inflammed. Even if you are feeling ok you have to keep up with the regimine. If its not working then go back and have them reduced again or even partially resected but dont over do it ofcourse.
 

gotgame

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Agree cleaning your house and getting air purifiers work very well!!

Soo much dust gets caught in a good air purifier and you can only imagine how much you are breathing in before. So many guys are lazy and dont clean out the prefilters or change the hepa filters regularly. I clean all the air filters in my house each weekend when im cleaning up and i change the hepa filters every 2-3 months.

If you are trying to save money and cant really filter all the air in your house then just get a good air filter for your bedroom, leave it on low all the time and keep door closed. You will be spending quite a few hours in there so you want clean air at night.
 

gotgame

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Agree on nasal irrigation, I just started doing that and it's borderline miraculous. Another thing to consider is that I think a lot of guys like to use daily Cialis or the like for blood pressure (and for obvious reasons). That shit will make you a mouth breather too.

The daily cialis absolutely will cause many guys to have swollen turbinates while taking it. Ive seen studies on some guys who are less affected by it over time at low dose but still many guys will experience some congesting. If you are having congesting from the cialis try dropping it down to 2.5mg daily instead of 5. I dunno why guys would be on more then 5mg daily unless they are treating like pulmonary hypertension. There are better options then high dose cialis if guys are self medicating for systemic BP
 

gotgame

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I have to agree. I sometimes have increased basophils on the cycle, but I don't have an allergy .... I have basophils okay on TRT .... I'm still struggling with the rapid increase in HCT and HGB on the cycle, can it be related? ... OSA tested and all right.


All part of hematopoesis so its likely all related. Some guys will notice itchy skin post shower like a classic polycythemia situation but thats also related to histamine release. I have seen a few decent studies directly looking at estrogen the bodies reaction to allergens. I can also imagine BP can play a role.


Having higher HCT levels for short periods of time probably isnt too bad for ones health but dont let it stay there too long. Donate regularly or drop doses.

I have had a few friends tell me that when there HCT creeps up there nasal breathing ability decreases significantly and they are congested and a bit red in the face.
 

gotgame

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Im dealing with this RIGHT now.
About 1/2 the year I deal with bad sinus congestion....and its a mix of a bad deviated septum as well as allergies.
It's terrible. PLUS right now I'm in my offseason, so I'm huge...eating all the time...and can only breathe from my mouth. I just sound gross and I'm always trying to get more air lol

Its weird though. I went the flonase route for awhile and it just stopped working after awhile. Bronkaid DOES work and go back and forth between using that. And even though its terrible, i do have Afrin on hand when it gets real bad.

Honestly, its debilitating. I also have sleep apnea and its makes my life miserable from that perspective. It doesn't allow me to use a nasal mask because I'm a mouth breather.
I know several people who have gone in for surgical sinus cleaning and some have said its a great fix, others have told me horror stories.

Sometimes surgery is needed but if you are responding to afrin its most likely your turbinates and not your deviated septum. Lets say you were to use 3 sprays of afrin in each nostril...are you breathing VERY good after? If so then its your turbinates as the primary issue and not your septum. If you had a turbinate reduction you can mostly likey expect the results to be as if you just took a few sprays of afrin.

If you do respond to the afrin i suggest using an 2x a day nasal irrigation protocol with salt and baby shampoo. Also pickup some azelastine spray and use that 2 sprays each nostril 2x a day...its a script so you may need your dr to pick it up for you or acquire via other means like overseas. Along with that keep up with the flonase. If in about 2 weeks ur significantly better you can try taking a short blast of oral predinose just to knock out that last bit of inflammation and then maintain in with the protocol.

If that doesnt work then look into a turb reduction. After you have the reduction though id still do that protocol but less aggressively that way you dont have to have surgery again.
 

gotgame

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People would be suprised to know all the irritants in their household.
Keep your air conditioner/furnace filters changed every 90 days or if you
have problems do it every 30 days.

the household airconditioning/furnace filters are quick swap and should definitely be done more often for people with allergies. I have dogs so i change those out every 60 days or so and i should maybe make the interval shorter.

some people never change them or dont even know where they are...but then again these same people probably dont change the cabin filters in there car either lol
 

micro2000

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Hmm i dont think i have ever started a thread before. I get this question a lot from friends and family so i figured id make a quick post that may help some people.

There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.

Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.

1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.

Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.

Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.

Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.

Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.

Oral prednisone: Systemic effects...dont take too often.

INFECTIOUS:

Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.

Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.


Other tools:

Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.

Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.

Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.

Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help


Im not going to discuss surgical options.
I'm lucky to not have any real nasal issues but my wife has them pretty bad. She uses Xyzal, Flonase, Olopatadine and Singular daily and will get a raging sinus infection about once every 3 months that can require 2-3 rounds of antibiotics.

I am not against using additives in nasal irrigation, but I would hesitate to use shampoo. Surfactants and thin mucosa seem problematic. Have you ever tried Alkanol for irrigation? My wife uses it when hers gets bad and its preserved so any residual left in the sinuses has low chance for microbial growth. Also, NAC has biofilm disrupting properties. If you're flushing with shampoo a little NAC doesn't seem too crazy.
 

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