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 i 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 units ml or gentamicin mg ml some use tobramycin to the saline solution irrigations delivered at ml once or twice daily one down two to go