Neti Pots

Anyone who has ever played in rough surf at the shore can probably tell you there’s nothing quite so bracing as having cold seawater forced through your nasal passages. While initially unpleasant, this forced irrigation sometimes results in unexpected—but not unwelcome—relief from clogged sinuses. Perhaps it was just such an experience that inspired someone in India, long, long ago, to try voluntary nasal irrigation to relieve the annoying symptoms of allergies.

Among the worst symptoms of nasal allergies (allergic rhinitis) are excess mucus production, stuffy nose, runny nose, and irritated nasal passages and sinuses. Some people with allergies develop a condition called chronic rhinosinusitis—a continually inflamed condition characterized by irritated or even infected sinus cavities.

Ancient Practice

Centuries ago, practitioners of Ayurveda, the Indian traditional medicine system, pioneered the use of warm saltwater to flush nasal cavities and remove excess mucus, pollen, and other debris.

Also known as “nasal douche” or “nasal lavage,” nasal irrigation uses two simple ingredients: salt water and a specially designed vessel, called a neti pot, which delivers a stream of salt water into the nasal cavities through one nostril and allows it to drain out through the other nostril. Practitioners usually do this one to four times per day—no dip in the sea required.

Supporters of the technique claim that it offers significant relief from nasal congestion and irritation. They also claim that it can reduce headaches associated with sinus congestion and allow patients to reduce their reliance on antibiotics to combat sinus infections. It can decrease the use of nasal corticosteroid sprays for the control of allergy-related nasal inflammation. Users report feeling “empowered” to take control of their allergies, and claim that it delivers significant improvements in quality of life. 

Numerous clinical trials have been conducted, and most agree that nasal irrigation is safe and well-tolerated. At worst, they note that the procedure can be cumbersome, requiring more effort than other options, such as taking medications.

At best, nasal irrigation provides significant improvements in a wide range of allergy symptoms. For example, researchers at the University of California, San Diego studied more than 200 patients who used the procedure. Subjects experienced “statistically significant improvements” in 23 of 30 symptoms, plus improvements in subjective quality-of-life ratings.

Warning

There are a few caveats, however. Irrigation shouldn’t be used on infants. According to a conference abstract presented to medical professionals in 2009, constant use of nasal irrigation may actually increase the risk of sinus infection. Occasional use hasn’t been linked to this risk, but routine use should be discouraged, the presenter said, as it may remove some protective elements of the mucus membranes lining the nasal passages and sinuses. The study informing this warning hasn’t yet been published in a peer-reviewed journal.

One final warning: it’s crucial to use sterile water to prepare irrigation solution. Boiling before use should be sufficient. A parasitic amoeba, called naegleria fowleri, has been linked to several deaths among neti pot users who failed to use sterile water. Once introduced into the sinuses, the parasite makes its way to the brain, causing an infection that is invariably fatal.

How It’s Done

A neti pot is a simple device somewhat resembling a smaller version of Aladdin’s legendary lamp. Warm, sterile water is mixed with pure salt in the pot. Tilting the head slightly to one side, the spout is placed in the nostril on the elevated side of the head and saline solution is allowed to drain through the nasal cavities and out the other nostril.

As noted above, it’s crucial to use sterile water, purchased directly or obtained by boiling and cooling. Saline solution, either isotonic (0.9% salt; 9 g sodium chloride dissolved in one liter of water, for example) or hypertonic (0.7% to 0.3% salt solution) is made by adding the correct amount of pure, non-iodized sodium chloride.

Kosher salt is a suitable source of pure sodium chloride with no added minerals. Nasal irrigation should not be attempted with tap water or distilled water. Sterility is essential for safety, and salt prevents the uncomfortable burning sensation associated with the use of a non-isotonic solutions.

Isotonic solutions contain enough dissolved solids to match the concentration of solutes dissolved in the blood. Not surprisingly, seawater is essentially an isotonic solution of salt and water. However, it should never be used deliberately, due to risk of introducing unwanted contaminants.