“I routinely recommend the use of nasal saline irrigation with distilled or boiled water for my patients,” says Angela Donaldson, MD, an otolaryngologist at the Mayo Clinic in Jacksonville, Florida. But experts like Dr. Donaldson insist there are ways to make this practice more effective — and, most importantly, safe.
What Is Sinusitis, and How Does It Happen?
Sinusitis, or sinus inflammation, tends to happen when too much mucus builds up in the cavities behind your face. This causes one or more of these cavities to become swollen or inflamed, and when severe, it can lead to bacterial infections. (1,2) In some people, especially those with allergies or asthma, this recurs regularly, leading to constant pressure around the nose, a bad-tasting post-nasal drip, headache, exhaustion, or other symptoms. (1) Sinusitis from allergies can be treated or prevented with medication, including allergy pills or mucus-thinning drugs. Some people prone to recurrent sinusitis may need surgery with an ear nose throat specialist to fix the architecture of their nose to allow for drainage of their sinuses. (1) Whether or not you use medicines or have this surgery, sinus irrigation can be beneficial.
What Is Sinus Irrigation, and Is It the Same as a Nasal Wash or Rinse?
Nasal irrigation is a type of personal hygiene, basically an attempt to use salt-water solutions to force out bacteria and other germs residing in the sinus passages behind the face. Other terms for this are nasal wash, nasal douche, or lavage; some people refer to it by one of the popular devices used to do this, a “neti pot.” This ancient practice likely got its start in the Indian medical tradition of Ayurveda, according to a review published in 2017. (3)
Small Studies Show Nasal Irrigation or Rinsing Helps Sinus Health
Unfortunately, as with most alternative treatments, there are not many large, well-done studies of nasal irrigation. Still, those that do exist generally show a benefit. Researchers examining the available studies, for example, found just one randomized controlled saline-solution trial meeting their strict criteria. (4) Although this one study had weaknesses, it did find that after six months, the irrigation group had slightly better results than a control group. A study from 2016 also found the method to be effective. (5) More than 800 patients in several physician practices were randomized to use either irrigation, simple steam inhalation treatments, a combination of the two, or neither. Participants did their method daily at home for up to six months. The researchers found patients had more symptoms improve after using the nasal irrigation than the other methods. (Steam inhalation was found mostly to reduce headaches.) People who used the irrigation were also able to reduce their use of over-the-counter medicines and didn’t need to see their doctor as frequently.
How Nasal Irrigation Works to Help Stop Sinus Symptoms and Sinus Infections
Experts aren’t sure of the exact way nasal irrigation works. Some have wondered whether it is something about the composition of the solution used that makes a difference. That may play a role, but most likely it is the mechanical action of the liquid pouring into the sinuses that are responsible, experts say. The pressurized liquid in the sinuses helps soften and ultimately dislodge some of the mucus lining. Plus, pollen and other foreign substances in these passageways responsible for allergic reactions can be flushed away. (3)
Why It’s Crucial to Rinse or Irrigate the Sinuses Safely
For the most part, irrigating your sinuses produces minimal side effects. Some people experience irritation or discomfort in their nose, and possibly an occasional, short-lasting earache. (3) But the U.S. Food and Drug Administration (FDA) has warned that improper use of nasal-rinsing devices (such as bulb syringes, squeeze bottles, and battery-operated pulsed water devices) can increase the risk of infection. According to the agency, any bacteria or other organisms in a contaminated device or in the liquid can enter your sinuses, causing harm. (6)
Keep Your Nasal Irrigation Devices Clean
In rare cases, this is very serious. The Centers for Disease Control and Prevention (CDC) warns that very rarely, people using nasal irrigation with tap water have become infected with the dangerous parasite Naegleria fowleri. (7) While these organisms may not cause harm if swallowed because stomach acid wipes them out, they can live and thrive in the warren of passageways of your sinuses. (7)
Safety Guidelines: Use Only These Types of Water for Nasal Irrigation
To prevent this potentially dangerous problem, the FDA suggests using only carefully selected water:
Buy special bottles of water bought in the store labeled “distilled” or “sterile.”Sterilize water yourself, by boiling tap water for three to five minutes, then cooling it until it is lukewarm. You can store this boiled water in a clean, closed container for use the following day (but no longer).
Water coming directly from the tap or shower is not safe to use, the FDA says, because this does not remove potential contaminants. (6) It’s also important to properly clean the device you use to insert the water (more on that below). The FDA advises washing it according to the manufacturer’s directions, and drying it thoroughly either with a paper towel or by air-drying between uses. (6) Once you’ve mastered the sanitation basics, you can focus on your personal hygiene practice and rinse out your sinuses on a regular basis.
6 Practical Nasal Irrigation Tips for Comfort and Effectiveness
1. Consider Adding Some Salt to Your Nasal Rinse
Because your nasal passages are naturally salty, using a saline solution rather than straight water can feel better. The American Academy of Allergy, Asthma, and Immunology (AAAAI) suggests a recipe: Mix 3 teaspoons (tsp) of non-iodized salt (iodide may irritate your nasal lining) with 1 tsp of baking soda, and store the mixture in a small, airtight container. Then add 1 tsp of the mixture to 1 cup of lukewarm distilled or boiled water. (8)
2. Get the Right Tools to Get Saline Into Your Nose for Nasal Irrigation
There are several ways to get the water into the passages behind your nose. You can use a squirt bottle, a pump designed for this purpose, or a vessel with a long spout called a neti pot. (4)
3. Find the Nasal-Rinsing Technique That Works for You
You simply fill the device with the solution, then lean over your sink (or, even easier, do it standing in the shower). Tilt your head sideways with your forehead and chin roughly level. Breathing through your mouth, place the container into your upper nostril and allow the water to drain out naturally. (6)
4. Try Rinsing Nasal Passages Again if Necessary
Repeat until your passages feel clearer, then turn your head the other way and work the other side. (6)
5. Keep Turning Your Head to Reach Deep Sinus Passageways
Some experts think it’s best to turn your head further so it is almost upside down. As one physician wrote, since the openings of the deep sinus passageways are at the very top of the nasal cavity, this is the best way to ensure the water gets into these back tubes. (9)
6. Talk to Your Physician About Sinus Washing
If you have questions or concerns about using a saline nasal rinse, be sure to speak with your doctor. You should also do so if you experience pain or any problems after using this treatment.
