Neti Pot, Nasal Irrigation Pros and Cons

Find out when it's OK to use a neti pot or other forms of nasal irrigation, and when you may need more help.

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Chronic sinus or allergy problems can leave you feeling as though your nose is perpetually stuffed. To breathe freely again, many sinus sufferers rely on nasal irrigation, a technique that flushes out clogged nasal passages using a saltwater solution.

"I find it to be the first line of defense in dealing with complicated sinus problems and allergy problems," says Evangeline Lausier, MD, assistant clinical professor of medicine and director of clinical services at Duke University's department of integrative medicine. "Particularly if you are developing congestion or have a sinus infection, it's very helpful."

Several different types of products can be used for nasal irrigation. The most basic are a bulb syringe, squeeze bottle, or neti pot. With these devices, the user manually pours or sprays a mixture of salt and water into the nostril. The fluid flows through the nasal cavity and into the other nostril. More high-tech nasal irrigation systems propel the solution into the nose, allowing the user to control the spray and pressure.

The basic technique with all the devices is the same, so choosing a system is largely a matter of personal preference. "I think the most important thing is finding a technique that the patient can do and is willing to do," says Melissa Pynnonen, MD, associate professor of otolaryngology at the University of Michigan.

Pros of Nasal Irrigation

The idea behind nasal irrigation is that it helps the body get rid of irritating and infectious agents that make their way into the nose. The nasal passages come equipped with tiny, hair-like structures called cilia, which beat back and forth to catch dirt, bacteria, viruses, and other unwelcome substances.

"It is a defense mechanism that your body has," Lausier says. "The cilia beat and the mucus acts kind of like flypaper, catching spores and particles you inhale." Those particles get pushed down to the back of the throat, where they are swallowed and destroyed by stomach acid.

"What happens with sinus problems or allergies is the consistency of the mucus changes, so that it's harder to beat, or harder to move, or thicker," Lausier says. Nasal irrigation helps thin out the mucus and improve the coordination of the cilia to help them more effectively remove bacteria and other irritants from the sinus passages.

Nasal irrigation can be an effective way to relieve sinus symptoms, and a complement to traditional sinus treatments such as antibiotics and nasal steroids. "Nasal irrigation is one attempt to help patients manage their symptoms, whether that's in addition to antibiotics or instead of antibiotics," Pynnonen says. "It works best to relieve symptoms of dry mucus, thick mucus, and crusty mucus."

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Cons of Nasal Irrigation

Using nasal irrigation to clear stuffed sinuses can be helpful from time to time for relieving symptoms, but a study presented at the American College of Allergy, Asthma, and Immunology in 2009 shows that it may actually be counterproductive when used regularly over the long term. The study showed that patients who used nasal saline irrigation for a year and then stopped using it for a year had a 62% lower incidence of sinusitis during the year in which they stopped.

The idea behind this finding is that nasal mucus serves a beneficial function, helping to protect the body against infection. "The nasal mucus we have in the nose contains very important immune elements that are the first line of respiratory defense against infections," explains Talal Nsouli, MD, who headed the study.

As it helps remove the bad mucus, saline may also dilute or wash away these beneficial antibacterial, antifungal, and antiviral agents, says Nsouli, who is a clinical professor of pediatrics and immunology at Georgetown University's medical school and the director of the Watergate & Burke Allergy and Asthma Centers in Washington, D.C.

Nsouli doesn't advise stopping nasal irrigation altogether. He only suggests using it in moderation.

"I don't have anything against nasal saline. But I have something against nasal saline being used long-term on a daily basis," he says. "People who are using nasal saline on a regular basis, it makes them feel like it is helping them, but they are only patching the problem."

Nsouli advises using nasal irrigation for no more than one to three weeks. If your symptoms don't improve during that time, see your doctor, who can diagnose the underlying problem and get you the appropriate treatment.

Keep it Safe and Clean

Nasal irrigation is generally considered to be safe, but a small percentage of regular users experience mild side effects such as minor nasal irritation. People whose immune system isn't fully functioning should ask their doctor before trying nasal irrigation because they are at greater risk for infections.

Also, anyone who is prone to frequent nosebleeds or who doesn't have a good swallowing mechanism might want to avoid nasal irrigation.

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Do not use tap water for nasal irrigation. "If you are irrigating, flushing, or rinsing your sinuses (for example, by using a neti pot), use distilled, sterile, or previously boiled water to make up the irrigation solution. It’s also important to rinse the irrigation device after each use and leave open to air dry," the CDC's web site states.

It's very important to keep your nasal irrigation device clean because it can harbor bacteria that can cause an infection. Either wash it by hand, or put it in the dishwasher if it's dishwasher-safe.

No matter how well you clean your nasal irrigation device, you don't want to keep it forever. Just as you toss out your toothbrush every few months, throw out your neti pot or syringe and buy a new one, Pynnonen says.

WebMD Feature Reviewed by Laura J. Martin, MD on December 20, 2011

Sources

SOURCES:

Evangeline Lausier, MD, assistant clinical professor of medicine and director of clinical services, department of integrative medicine, Duke University.

David Rabago, MD, department of family medicine, University of Wisconsin School of Medicine and Public Health.

Rabago D., Annals of Family Medicine, 2006; vol 4: pp 295-301.

Harvey, R. The Cochrane Library; 2007: 3.

Melissa Pynnonen, MD, associate professor of otolaryngology, University of Michigan.

American College of Allergy, Asthma and Immunology (ACAAI) Annual Meeting, Miami Beach, Fla., Nov. 5-10, 2009.

Talal Nsouli, MD, clinical professor of pediatrics and immunology, Georgetown University School of Medicine; director, Watergate & Burke Allergy and Asthma Centers, Washington, D.C.

CDC: "Naegleria FAQs."

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