According to the device for propelling the irrigation liquid, there are three irrigation procedures:
Negative pressure irrigation (for example, sniffing), Gravity irrigation (as with the traditional Neti pot) and Positive pressure irrigation (manually or motor-driven devices). The form of carrying out the irrigation and the position of the head change depending on the utilized procedure and device.
Gravity-based devices require placing the head in an inclined position for the irrigation to take place. In gravity-based procedures, the water pressure gradually goes down as the container has less water.
The positive pressure devices are able to maintain the propelling pressure more or less constant. Some devices (like syringes or rubber bulbs) may require the user to tilt the head back, while others allow irrigation with the head straight and slightly forward (Sinusalt, Grossan-HydroPulse). These devices are more convenient because, in addition to providing ease of use, they maintain the Eustachius canal in an upper position, preventing the access of liquid into the middle ear and minimizing the risk of otitis.