Do neti pots work? A guide to nasal irrigation for allergies.

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With the onset of spring and increased pollen counts, many seasonal allergy sufferers seek relief from bothersome and even debilitating symptoms. Nasal irrigation using a variety of methods – neti pots, squeeze bottles, bulb syringes and battery-powered devices – is one of the most effective ways to clear stuffy noses – although, experts say, you’ll probably have to still treat the underlying cause of your allergies.

Neti pots, which look like small teapots with long spouts, only gained popularity in the United States relatively recently. But their use and the practice of rinsing the nasal cavities with fluid are thought to date back thousands of years to Ayurvedic medicine, which has its roots in India. Since then, nasal irrigation has become one of the “best-studied non-pharmaceutical interventions” that can help improve common sinus symptoms, said Benjamin Bleier, rhinologist at Mass Eye and Ear and associate professor at Harvard. Medical School.

Besides being inexpensive, rinsing your nasal passages with a salt water solution “is the safest and actually one of the most effective treatments, overall, for the nose,” Bleier said. But he and other experts, including allergists, said the approach may have limitations and must be done hygienically to reduce the potential risk of contamination.

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What is nasal irrigation and why might it be useful?

Nasal irrigation or rinsing generally refers to a variety of different ways of introducing fluid – usually buffered saline (salt water) – into the nose to help clear the nasal passages.

Ideally, the saline solution is poured or squirted into one nostril and out the other, experts say, flushing out the nasal cavities. Bleier noted, however, that a similar cleansing effect can occur even if fluid comes out of the same nostril.

Regularly rinsing the nasal passages can be beneficial because the nose acts as a “filtration system for our body”, trapping bacteria, viruses, pollutants and other airborne particles, such as pollen, that we breathe in, said Ryan Steele, a board certified. allergist-immunologist and internist, and assistant professor of clinical medicine at Yale. “Just like you clean the air filter in your car or your air conditioner or your air filter around the house, you want to make sure that [the nose] is able to do his job effectively.

Bleier added that even a small amount of thickened mucus can make a person feel “completely clogged because there’s not a lot of space in the nose.”

Nasal irrigation also has the benefit of keeping the inside of the nose moist, which can help reduce irritation, said Andrew Lane, professor of otolaryngology and director of the division of rhinology and sinus surgery at Johns Hopkins.

What kind of evidence shows that nasal irrigation works?

Multiple nasal rinse studies and scientific journals published over the years have reported benefits in improving nasal symptoms related to a variety of causes, such as allergies and upper respiratory tract infections, Lane said.

A 2021 consensus statement on how to manage common nasal conditions released by an international team of experts noted that saline irrigation, when performed as directed, was one of the most common non-pharmaceutical therapies. effective in relieving symptoms. Right now, this article is “the best compendium of all this kind of evidence-based research,” said Bleier, who worked on the article.

But while pouring or squirting water into your nostrils can provide immediate relief from symptoms such as a runny or stuffy nose as well as sinus pain and headaches, it’s important to remember that the effects are temporary, Purvi Parikh, allergist and immunologist with the Allergy and Asthma Network, wrote in an email.

And, according to experts, rinsing is unlikely to address the cause of the allergies. Unlike medication, the rinse “doesn’t provide the same anti-inflammatory action or block the allergenic chemicals that cause allergies,” Steele said.

Although many allergy sufferers still need to take medications, such as antihistamines, or use a steroid nasal spray, nasal irrigation is “a great addition to these medications because it’s so safe when used correctly,” Bleier said.

Which method and which rinse should I use?

Neti pots, which rely on gravity to pour liquid into the nose, and squeeze bottles that deliver gentle squirts are popular options. Although deciding which method to use is largely down to individual preference, some experts recommend a squeeze bottle.

The flow from a neti pot may not “cover the inside of the nose as securely as the squeezing action does,” Bleier said. A squeeze bottle “allows you to get a large amount of this saline solution into the nose, but under relatively low pressure.”

Additionally, simple squeeze bottles may be easier to clean than neti pots, which have narrow spouts, or more complicated battery-powered devices that use gentle pressure or suction to move saline solution through the nose. said the experts.

The saline solution you flush with is also important. You can buy pre-made packets that already contain the right amount of salt and baking soda, or you can mix them up yourself using a reliable recipe, like the one provided by the American Academy of Allergy Asthma and Immunology.

When preparing the solution, you should use distilled or sterile water. If using tap water, the FDA recommends boiling it for three to five minutes and allowing it to cool to the appropriate temperature. “Some tap waters contain low levels of organisms — such as bacteria and protozoa, including amoebas — that can be safely swallowed because stomach acid kills them,” the FDA says. “But in your nose, these organisms can stay alive in the nasal passages and cause potentially serious infections.”

Although there have been a few reports of nasal flushing leading to fatal infections caused by a brain-eating amoeba that can be found in fresh water, Bleier and other experts have pointed out that these cases are “extremely rare”. .

Along with making sure your water is clean, it should be room temperature or slightly warm, experts said. Avoid too hot or too cold water.

Stand over a sink or some type of basin. Tilt your head forward and down slightly to minimize the risk of swallowing the solution, place the spout of the neti pot or squeeze the bottle into one nostril and begin rinsing. Squeeze gently if using a bottle. Repeat the process for the other nostril. Steele recommended beginners start with a smaller volume of solution as a test. Be prepared for water to come out of your nostrils or mouth.

“Make sure you do it where it’s comfortable and you have a towel or something, or you don’t mind getting wet because it takes a bit of time to master the technique,” Steele said. For more detailed advice on how to rinse, it may be helpful to watch a video tutorial from an ear, nose and throat specialist or allergist.

After rinsing, you can gently blow your nose, Bleier said. But avoid closing your nostrils completely and using too much force. “Now that you have some of that fluid inside, if you forcefully blow your nose, you can still squeeze some of that fluid into the ear space,” he said.

Along with using distilled, sterile or boiled water for the solution, you should wash your device well with soap and water between uses and keep it dry, experts said. Check to see if your product comes with cleaning instructions.

Regular cleaning is important because there will inevitably be a backwash in your rinser after use, which may contain virus particles, bacteria, allergens or other irritants that were rinsed through your nose, Lane said. . “Unless you clean the device, you’re probably reintroducing germs the next time you rinse.”

Bacteria can also grow easily in many flushing tools, Bleier said. “If you took an irrigation bottle and put a drop of water in it and left it on your counter for an hour, you would be able to grow bacteria from that because there are bacteria which float in the air and they settle in the bottle.

If you notice any visible wear or fading on your device, it’s probably time to replace it, Steele said.

Some users report feeling like the solution “backs up in their ears or clogs their ears afterwards,” Lane said. You might also notice a burning sensation or irritation inside your nose. These side effects are often mild and go away after you stop rinsing.

If you experience nasal irritation, check the water temperature and the salt level of your solution, Lane said.

And if nasal irrigation doesn’t help, consider seeing a professional.

“You’re not going to hurt trying saline solution for yourself,” Lane said. “But if your symptoms persist or worsen, you should see a doctor and not just rinse yourself more.”

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