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.

Ashley P October 31, 2012 at 4:58 pm

Perfect timing on this post, as I’ve been dealing with major allergy-related sinus irritation for the past few days. I’ve tried the neti/nasal irrigation, but (and of course this is anecdotal evidence, so YMMV) the relief has mostly been temporary, lasting for an hour or so.

This post is for the most part a really well-written one, with clear argument and clear evidence that supports it. I especially appreciate the captions on your photos – sometimes the little things are what catch the readers’ attention the most! I am a bit surprised, though, that you don’t mention the studies that indicate potential problems with unsanitary neti pots (however briefly). Those problems are rare, but pretty significant, and they were in the news fairly recently. In addition, you may need to explain the limitations of the study in plainer language.

Ali Schumacher October 31, 2012 at 7:31 pm

Thanks for your comments Ashley. I wanted to jump into all of the sanitary issues, especially the idea of “brain eating bacteria”, but didn’t feel I had enough space to cover it sufficiently. A possible topic for next week’s post?
I have to say I agree with you on the temporary relief aspect as well. It worked for me, but it didn’t last. The literature I found on nasal irrigation is somewhat sparse and inconclusive, but I’m sure more is out there and I’m tempted to keep looking for it :)
Also, thank you for the advice on my language use- I will definitely keep that in mind on my future posts.

Ashley P November 1, 2012 at 9:07 am

Yes! Definitely tackle it for a follow-up. You did a lovely job with this, and I’m looking forward to seeing what you do with the “other side.”

Also, thought I would share my follow-up experience. I went to the doctor almost immediately after I posted the comment. She put me on three different meds to counter the allergic reactions I’ve had this week! I’m on a nasal steroid, standard antihistimine/decongestant, and another drug (but I can’t quite remember the name of it). That nasal irrigation was never going to help the severe case I’ve been having :(

Ali Schumacher November 1, 2012 at 9:17 am

I’m so sorry to hear that! Yes, definitely not something a neti pot could handle. I hope you feel better soon!

Bo October 31, 2012 at 8:25 pm

There is a systematic review of this issue in the Cochrane database:
Saline nasal irrigation for acute upper respiratory tract infections
Jessica C Kassel , David King and Geoffrey KP Spurling
October 2010
These authors conclude: “Included studies showed limited benefit for symptoms relief with nasal saline irrigation in adults. Nasal saline is safe and may reduce time off work but may cause minor adverse effects such as dry nose or irritation in less than half of users.
Future studies are needed to establish the use of nasal saline irrigation as a way of reducing acute URTI symptoms safely while keeping people at work and reducing antibiotic use”
My question to you is,”Who will do these studies?” There is no giant pharmaceutical company pouring money into neti -pot research and I doubt that the neti pot people are “together” enough to do a proper study. If no one does the study what should the consumer do?

Ali Schumacher October 31, 2012 at 10:19 pm

Great question Bo, and I think it illuminates why the literature may be so sparse to begin with. It’s a tough one to answer too. The only thought I have is maybe some sort of medical association or organization with investment in more chronic sinus conditions… I don’t think that nasal irrigation would ever receive funding to explore its effect on URTIs but maybe there could be some enthusiasm from a more chronic and perhaps serious side of sinus irritation. Just a thought.

Emmett October 31, 2012 at 9:46 pm

I think you’re right when you question the validity of the neti-pot, and I certainly agree with Bo’s comment about how neti-pot research is an unlikely grant-winner. I also agree that NSIs may be an effective way to help treat some symptoms, as it says on the box in the picture. The history of use provides some sway in a positive direction as to whether or not it’s effective too, though. Do consumers recommend using this product to cure, or treat? Sounds like it doesn’t really matter because even you said you’d continue using the product because it provided at least a little relief. Can’t really be proven to do everything we think it’s supposed to, but can’t be totally unproven, right?

Ali Schumacher October 31, 2012 at 10:24 pm

I agree with you Emmett. The proof is in the pudding. If using a neti pot makes me, personally, feel some sort of relief why not continue to do it? I was hoping to find articles saying YES! They’re great! but as I discovered, and as Bo seemed to explain, the literature is lacking. Maybe someday we’ll have more proof, until then there’s no reason to refrain from (or fail to encourage for that matter) using nasal irrigation methods.

Mark October 31, 2012 at 10:21 pm

I have been performing an unfunded, uncontrolled, non-randomized, phaseless clinical trial on myself and the results are conclusive – the neti-pot is absolutely a priceless tool in relieving symptoms typically associated with drinking far too much alcohol.

Ali Schumacher October 31, 2012 at 10:31 pm

Hmm. I may have to try to replicate those findings in my own unfunded, uncontrolled, non-randomized, phaseless clinical trial…

Kurt November 1, 2012 at 10:15 am

You neti-pot for hangovers? Seriously? How does that possibly help?

Annie November 1, 2012 at 3:57 pm

Interesting post, I’ve always wondered about any trials on NSI. I use the same product you show above and thought that it is meant as a preventative tool, something you do daily to prevent getting stuffed up, etc., not something you use after you get sick. The product also lists citations but I haven’t looked them up.
I’ve only used it when I had nasal congestion and my anecdotal evidence is that it shortens the time I’m sick and lets me breathe, similar to steam inhalation (temporary relief) . . . and just seeing all that gunk and mucus come out makes me feel like I’m getting better, but I have no idea if that’s scientifically true.

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