Nasal irrigation for nasal irritation: evidence for the effectiveness of neti pots

by Ali Schumacher on October 31, 2012

You want me to do what?!

Imagine: you feel awwwful.  Your nose is stuffed.  Your head hurts.  Your sinuses ache.  The ibuprofen you took does not seem to be doing anything, and try as you may, each kleenex you blow into comes away disappointingly empty.  All you want is relief.  Although streaming water up your nose may not be the first cure that comes to mind, it may be just the remedy you’ve been looking for. I must admit, at first the idea of shooting warm, salty water up one nostril only to have to have it stream out the other like a a real-life, human fountain was not so appealing to me.  (After all, there’s a reason why we plug our noses before we go underwater, right?)  My siblings have always raved about the joys of neti-potting (seriously… “joys”) and every time they put the bottle to their noses, I would look on in apprehension and disgust.  However, a few weeks ago, as my desperation grew and my need for relief outweighed any fear of discomfort, I gave the ol’ neti pot a try.  However, might the faith in my siblings have been misplaced?  Despite the rave surrounding nasal irrigation, the research is still somewhat unclear as to whether it is an effective remedy for symptom relief.

Believe it or not, the practice of nasal irrigation has been around for millennia.  It is believed to have originated in the ancient Hindu practice of Ayurveda, a medical system founded in beliefs of interconnectedness and balance.  The practice of “neti” or “jala neti” aims to clear the air passages in the head, and does so by using gravity to draw the flow of salt water through the nasal passages.  But, despite its legacy, there is some skepticism of how effective the practice really is.

A recent review of the nasal irrigation literature called “Is nasal saline irrigation all its cracked up to be?” written by Khianey and Oppenheimer, and published in the Annals of Allergy, Asthma and Immunology compiled and compared multiple studies on the efficacy of nasal irrigation treatments.  Results from the review are somewhat mixed, but do point to a mild benefit in use of nasal irrigation strategies to relieve sinus irritation.

A few of the studies reviewed looked at the effects of nasal saline irrigation (NSI) on upper respiratory tract infections. In the first study, 390 children aged 6 to 10 with upper respiratory tract infections were randomized to receive either standard medication alone, or standard medications with NSIs (such as neti pots or fine mist nasal sprays). Participants were followed for a total of 12 weeks, and tasked with taking their respective medication regimen 6x per day for the first 3 weeks, and 3x per day for the remaining 9 weeks.

What did they find?

  • participants taking NSIs in addition to the regular medication showed a statistically significant improvement in the amount of nasal secretions and obstructions compared to the control group
  • participants taking NSIs showed statistically significant improvement in symptoms of sore throat and cough

“Helps alleviate: nasal and allergy dryness, nasal irritation, post nasal drip and congestion”

However, another study in the review reported somewhat different results. 143 adults with upper respiratory tract infections were randomized to receive either a nasal spray, standard nasal irrigation using gravity, or no treatment. Their symptom scores (taking into account severity, duration, etc) were taken for three consecutive days.

What did they find?

  • there were no significant differences in the mean symptom scores between groups. (I.e. the NSI was not more effective in treating the sinus related symptoms)

The reviewers do point to a few limitations in their study comparisons: they note that 1. attrition was often significant 2. blinding of treatments was often not addressed, and 3. the study designs were pretty heterogeneous in their outcome measures and duration of treatment. Despite these limitations, the review does point to a at least a minimal benefit in the use of nasal irrigation to treat upper respiratory infections and other more chronic sinus conditions.  Online experts agree that nasal irrigation is an inexpensive and reasonably effective way to relieve symptoms associated with sinus irritation.  Popular medical websites like WebMD and MayoClinic recommend the use of neti pots to relieve those pesky and often persistent problems with sinus and nasal blockages.

The glamorous world of neti pots

So how did my experience fair?  Once the shock of purposefully pouring water into my nose wore off, I have to say I felt some relief.  Just as Khianey and Oppenheimer point the need for further research, I too will continue my experiments with “jala neti.”  It’s not the most glamorous method of treatment (see photo), but there does seem to be merit in its efforts.  Afterall, a practice that’s survived a couple millennia must work in some way, shape, or form… even if that form is a viscous, mucus-y, ball.