Nasal irrigation with salt water is recommended by 87% of family doctors as an adjunctive treatment to relieve the symptoms of nasal congestion and sinusitis. The simplest method is to hold salt water in your cupped hand, block one nostril while you inhale the water into the other nostril, then blow your nose. The high-tech version is to use a Neti pot, a little jug with a spout. You pour the salt solution from the Neti pot into one nostril and it drains out the other nostril. The technique is described here.  Neti pot

The Neti pot originated in India in Ayurvedic medicine. Neti is Sanskrit for “nasal cleansing.” Other related ancient techniques that have not been adopted by scientific medicine include using a string instead of water and a yoga technique where you close one nostril, pour the solution into the other nostril and allow it to run out of the mouth. 

Nasal irrigation provides short-term symptomatic relief and may improve nasal mucociliary clearance. It removes mucus not only from the nose but also from the maxillary and ethmoid sinuses.  

A randomized controlled trial in 2002 found that daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis.  Its effectiveness is supported by a Cochrane review.  

A recent review article in American Family Physician  gave nasal irrigation an “A” strength of evidence rating as an effective adjunctive therapy for symptoms of chronic rhinosinusitis, and  a “B” rating for irritant and allergic rhinitis and viral upper respiratory infections. 

Just don’t overdo it. A new study presented at the annual meeting of the American College of Allergy, Asthma and Immunology in November 2009 found that while short-term nasal irrigation is therapeutic, long-term use of nasal irrigation is harmful. Regular users of irrigation who continued using it had an average of 8 episodes of recurrent rhinosinusitis per year, while those who discontinued it only averaged 3 episodes per year.  The investigators hypothesized that the nasal mucosa serves as the first line of defense, and irrigation depletes the nose of its immune blanket of mucus, thereby increasing the risk of recurrent infection.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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