The Ins and Outs of Nasal Irrigation

By Sarabeth Lowe, MPH

Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center.

As the United States (US) inches closer toward the peak of its flu season, which is expected to be especially brutal this year, it’s worth doing an audit of your medicine cabinet.^1–3 In addition to cough drops and pain medicine, you might want to consider adding another treatment to your cold and flu regimen: a neti pot. This tea pot–shaped tool shot into the US mainstream nearly 20 years ago when Dr. Mehmet Oz demonstrated its use on the Oprah Winfrey Show, but the practice of nasal irrigation, or rinsing, dates back to Ayurvedic medical traditions of India in the 15th century.^4–6 Thousands of years later, this alternative medicine tool has stood the test of time. Here is what you need to know.

What is Nasal Irrigation?

Nasal irrigation is a process of gently rinsing the nasal cavity with a saline solution (a mix of water and sodium chloride) to treat conditions such as sinus inflammation, congestion, and allergies.^5,7–9 This saltwater liquid flows in one nostril and out the other to help clear your sinuses, which are the hollow, air-filled cavities behind the bones in your face that produce and circulate mucus. Normally, your sinuses remain open and uninflamed, which allows you to breathe easily. However, these small, delicate cavities can cause significant discomfort when they are disturbed. 

When you inhale, the mucus in your nose traps all kinds of foreign particles from the air, including viruses, fungi, bacteria, and allergens. This can lead to inflammation, congestion, excess mucus, pain, postnasal drip, and swelling around your eyes, cheeks, nose, or forehead.^5,8,10 Nasal irrigation helps wash away this blockage, along with any other allergens or environmental contaminants.

The liquid itself also plays a role. Because salt water is slightly lower than freshwater on the pH scale, it is slightly more acidic, which creates an environment that is inhospitable for viruses and makes it harder for them to replicate.^8,11 Nasal saline also helps restore one of the body’s natural defense systems. There are microscopic, hair-like projections inside your nose called cilia that serve as a natural filtering system, moving viruses and other foreign particles out of your nose.^8,12,13 Nasal saline irrigation helps keep this system up and running.

What the Research Says

A growing body of research supports the effectiveness of nasal irrigation. In 2021, an international team of experts issued a statement on the best ways to manage common sinus issues, including the chronic inflammation of the nasal and sinus passages. They concluded that regular rinsing with saltwater was among the most effective treatments.^5,14,15 A 2012 meta-analysis of ten randomized controlled trials found that nasal saline irrigation produced a 27-percent improvement in nasal symptoms and a 62-percent reduction in the use of allergy medications.¹⁶

This approach can also help mitigate the length and spread of acute illness. For example, a recent randomized controlled study of more than 11,000 people showed that nasal saline irrigation, initiated at the first sign of symptoms and performed up to six times each day, reduced the duration of symptomatic illness by two days.^8,17 Another study showed that saline irrigation performed every four hours over a 16-hour period decreased COVID-19 viral load by 8.9 percent in hospitalized patients. Notably, the viral load in the control group continued to increase during that time.¹⁸

Even with all of these benefits, there are other approaches that can more quickly or effectively reduce the symptoms of acute and chronic sinusitis, including topical nasal steroids and corticosteroids (more commonly known as nasal sprays) or surgical interventions.^{14,17,19–22} However, some of these options are expensive, require a prescription, or require access to specialized care via an otolaryngologist (an ear, nose, and throat doctor). 

Additionally, antibiotics aren’t always an option. Even though these drugs are not designed to treat viruses, and it is well established that they do not shorten the duration or reduce the severity of respiratory tract infections, millions of these prescriptions are given each year to treat these illnesses.²⁴ In fact, a study of more than 49,000 of these patient encounters showed that 42 percent of them were unnecessarily prescribed antibiotics.^8,25,26 Antibiotics might make patients feel better in the short term, thanks to their off-target, anti-inflammatory properties, but this effect can also be achieved with other over-the-counter anti-inflammatory drugs, like ibuprofen or naproxen, that can be taken in conjunction with nasal saline irrigation.^8,27,28 The overprescription of these drugs is also a major contributor to antibiotic resistance, a pressing and growing public health issue.^29–31

Instructions and Safety

One of the greatest benefits of nasal irrigation is its convenience; you can do it in your own home! You don’t even need a neti pot. Many pharmacies sell ready-to-go kits with all of the tools you need. Here is how to do it safely.

1. Choose your tools. First, choose your rinsing apparatus. If you don’t have a neti pot, you can also use a syringe or spray bottle. Powered irrigation devices are available, but there is limited data comparing the efficacy of different irrigation tools, and there is no specific recommendation on which one to use.^32–34

2. Select your solution. Prepare your saltwater solution. The US Centers for Disease Control and Prevention recommends always using distilled or sterile water, which can be purchased at a pharmacy, or tap water that’s been boiled for at least one minute and cooled.^35,36 Mix ½ to ¼ teaspoon of noniodized salt with one to two cups of water.^5,7,8 Some experts recommend against using table salt because it has too many additives.³⁷ Note that saltier solutions are not more effective.⁸

3. Lean and tilt. Next, lean over a sink and tilt your head so that your nose is perpendicular to the surface below. One ear should be facing the ceiling and the other the bottom of the sink. Imagine listening for a sound coming from the drain.

4. Rinse and repeat. Place the tip of the irrigation device into the nostril that is farthest away from the sink, and gently squirt the solution toward the back of your head with your mouth open. The solution should flow out of the other nostril, but some might come out the back of your mouth. Try to avoid swallowing large quantities of water; aim to spit it out instead.^38,39 This technique can take some getting used to, so don’t be discouraged. Some sneezing, gagging, and burning are normal at first, but any discomfort should subside with time. Aim to breathe evenly through your mouth. Repeat on the other side, continuing until the solution is gone.⁷

5. Blow your nose. Once you’ve completed the process on both sides, return to a standing position. Breathe air forcefully through your nose to remove any residual solution or mucus.⁷

6. Clean your kit. This might be the most important step. Keeping your tools clean and dry is essential for preventing mold or residual bacteria. Throw away the prefilled container or thoroughly wash your rinsing apparatus. If it is not dishwasher safe, let it air dry on a clean towel.

Final Thoughts

There is no official recommendation for when and how frequently you should repeat this process. Some experts suggest using nasal irrigation after any potential exposure to an infectious illness, starting at the first sign of sickness for best results.⁸ You can repeat rinses throughout the day as often as needed for the duration of the illness, but, at minimum, you should complete this process in the morning and evenings. However, nasal irrigation is not for everyone. While it is appropriate for both children and adults, you should not try this process if you have:⁷

An ear infection;

Pressure in one or both ears;

One nostril that is completely blocked; or

Had recent surgery on your ears or sinuses.

Contact your healthcare provider to see whether nasal irrigation is safe for you.

Sources

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