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Nasal Irrigation Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.
Jala Neti is a method of nasal cleansing originating in the yoga tradition. Practiced for thousands of years, it is believed to clear the sinus cavity and the mind. Physicians in the 19th century promoted nasal irrigation for routine cleansing. In modern times, nasal irrigation is becoming more widely accepted as a home remedy for treating allergies, colds and sinus infections. There is growing scientific evidence supporting the use of nasal irrigation for these conditions. Supporters of this therapy assert that it is more soothing and less expensive than many over-the-counter drugs, and it lacks side effects such as drowsiness or upset stomach that may be associated with other therapies. Forms of nasal irrigation used in clinical trials include the following: - Saline lavage — Application of warm liquid saline solution (for example, one teaspoon of salt mixed in one cup of water) to the nasal and sinus passages
- Humidified warm air lavage, also known as hyperthermia — Delivery of heated mist, steam or humidified air to the nasal mucosa
- Large-particle nebulized aerosol therapy — Use of an aerosolized saline solution
Occasionally, antibiotics or other drugs are added to the solution. In practice, there is variability in nasal irrigation techniques, with differences in the method of saline delivery, the strength of the saline solution and the use of other additives. Delivery methods include the traditional neti (irrigation) pot, nasal sprayer, bulb syringe, cupped hand and commercially available devices. The strength of the saline solution depends on the amount of salt added to the water. Additives have included antibiotics, vasoconstrictors (which narrow the blood vessels) and buffers (which reduce acidity). Some practitioners recommend buffered hypersaline solution, although this may irritate the mucous membranes. Gravity-fed normal saline is often used in Jali Neti. The International Consensus Report on the Diagnosis and Treatment of Rhinitis recommends nasal irrigation for the treatment of rhinitis. Nasal saline irrigation is sometimes used as a treatment for acute rhinitis in infants, because excessive use of vasoconstrictor nose drops is not recommended in early childhood.
The precise mechanism by which saline nasal irrigation may work is not known. Theories include the following: - Mechanically clearing mucus
- Improving the function of cilia (the tiny hairs that move mucus through the nasal passages)
- Reducing adhesion formation in the nasal passages
- Decreasing mucosal swelling
- Decreasing levels of chemicals that cause inflammation
It has also been suggested that heat from nasal irrigation may directly interfere with allergens and that vapor may stabilize the mucosal surface and reduce secretions. In traditional systems of healing, nasal irrigation is believed to be an effective tool in preventing disease and in improving symptoms of a variety of nasal and sinus conditions.
Scientists have studied nasal irrigation for the following health problems: Allergic rhinitis | Several studies suggest that nasal irrigation with normal or hypertonic saline may be effective for treating allergic rhinitis in adults and children, and the International Consensus Report on the Diagnosis and Treatment of Rhinitis has recommended nasal irrigation as a treatment for rhinitis. Overall, the available scientific research is not high quality, and better studies are needed before a strong recommendation can be made. Techniques and equipment have varied in studies, and some studies have added drugs or lubricants to the saline. It has been suggested that "nasal douching" may be more effective for distributing irrigation solutions. | Chronic sinusitis | Chronic sinusitis is an inflammatory condition that may be associated with polyp formation. Patients with chronic sinusitis with or without polyps may be fungi carriers, and use of nasal irrigation with normal or hypertonic saline (with or without antifungal drugs) has been tested as a treatment. Initial research suggests that nasal irrigation may be useful in the treatment of chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms and decreases in medication use. Further study is needed before a strong recommendation can be made. | Occupational exposure to irritants | Promising early evidence supports the use of nasal irrigation for respiratory symptoms or diseases caused by occupational exposure to dust or air pollutants. In addition, there is scientific support from several studies that nasal irrigation can be used to examine the inhalation effects of acute occupational exposure, especially to pollutants. | Common cold | A small number of trials in humans have examined the use of nasal steam inhalation for common cold symptoms. However, these studies lack statistically significant results, and a well-conducted trial is needed to make a more compelling case. | Sinus or nasal surgery | Studies have examined whether the amount of bacteria in the nasal passages before and after nasal surgery can be reduced by nasal washing (with or without added antibiotics or corticosteroids). Although some research reports that bacteria are reduced, it is not clear if there is a reduced risk of postoperative infections. | Mucus clearance in cystic fibrosis | There is some evidence that saline nasal irrigation or inhaled steam may improve mucus clearance in people with cystic fibrosis. Some studies have added antibiotics or drugs that affect cellular sodium channels. Limited research suggests that lung infections after surgery may be reduced by nasal irrigation. Further study is needed. | Rhinosinusitis | There is evidence that saline nasal irrigation may improve the inflammatory process of chronic rhinosinusitis. Well-conducted studies are needed before clear recommendations can be made. | Chronic obstructive pulmonary disease | Results from one pilot trial suggest that the use of hypertonic saline aerosol enhanced the clearance of lung secretions. Well-designed clinical trials are required before recommendations can be made in this field. |
Nasal irrigation has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using nasal irrigation for any use. Asthma
Chronic bronchitis
Nasal polyps
Nasal septal deviation
Reduction in antibiotic resistance
Swollen mucous membranes
Vertigo |
Nasal irrigation is generally reported as being well tolerated. There are some reports of nasal irritation, nasal discomfort, itchiness, earache, sneezing, nosebleed, increased allergy symptoms, dizziness and pooling of saline in the paranasal sinuses. Some preparations have added drugs that may cause side effects. Studies using saline with 1 percent ephedrine added have noted brief episodes of heart palpitations, lightheadedness and nasal burning in a small number of people. In one study, cystic fibrosis patients experienced increased cough, throat irritation and chest tightness and coughed up blood. Nasal irrigation should be used cautiously in people with frequent nosebleeds. After nasal surgery, nasal irrigation should be discussed with the surgeon. People with an impaired gag reflex (such as after surgery, after anesthesia or with chronic illness) may be at risk of fluid entering the windpipe or lungs (aspiration); a health care provider should be consulted before starting therapy. Irritation or burning of the nasal passage may occur if the irrigation solution is too hot. Bacterial infection from dirty equipment is possible. In children, nasal irrigation is sometimes performed by health care providers. Limited research suggests that nasal irrigation is safe in children older than 7 years. However, the safety in children is unclear when nasal irrigation is performed outside of a health care provider's office.
Nasal irrigation with saline has been used historically for a number of conditions. Initial research suggests that nasal irrigation may play a role in the treatment of allergic rhinitis and chronic sinusitis. Nasal irrigation has not been proven effective for any other condition. The method of delivering saline to the nasal passages is variable in studies and in clinical practice and may include steam inhalation (rather than liquid saline), different concentrations of salt in the saline, and the addition of drugs or chemicals that may have independent effects and adverse reactions. Nasal irrigation may not be safe in people with nosebleeds, after surgery, or with an impaired gag reflex.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Nasal Irrigation Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created. Some of the more recent English-language studies are listed below: - Bachmann G, Hommel G, Michel O. Effect of irrigation of the nose with isotonic salt solution on adult patients with chronic paranasal sinus disease. Eur Arch Otorhinolaryngol 2000;257(10):537-541.
- Berger ME, Jones OW, Ricks RC, Garrett S. Decontaminating the nasal passages. Health Phys 2003;May, 84(5 Suppl):S80-S82.
- Cordray S, Harjo JB, Miner L. Comparison of intranasal hypertonic dead sea saline spray and intranasal aqueous triamcinolone spray in seasonal allergic rhinitis. Ear Nose Throat J 2005;Jul, 84(7):426-430.
- Friedman M, Vidyasagar R, Joseph N. A randomized, prospective, double-blind study on the efficacy of dead sea salt nasal irrigations. Laryngoscope 2006;Jun, 116(6):878-882.
- Garavello W, Romagnoli M, Sordo L, et al. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol 2003;Apr, 14(2):140-143.
- Greiff L, Anderson M, Wollmer P, Persson CG. Hypertonic saline increases secretory and exudative responsiveness of human nasal airway in vivo. Eur Respir J 2003;Feb, 21:308-312.
- Heatley DG, McConnell KE, Kille TL, et al. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg 2001;125(1):44-48.
- Hull D, Rennie P, Noronha A, et al. Effects of creating a non-specific, virus-hostile environment in the nasopharynx on symptoms and duration of common cold. Acta Otorhinolaryngol Ital 2007;Apr, 27(2):73-77.
- Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference. Evidence-Based Clinical Reviews, USA. Elsevier/Mosby, 2005.
- Papsin B, McTavish A. Saline nasal irrigation: its role as an adjunct treatment. Can Fam Physician 2003;Feb, 49:168-173.
- Rabago D, Zgierska A, Mundt M, et al. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract 2002;Dec, 51(12):1049-1055.
- Ricchetti A, Landis BN, Maffioli A, et al. Effect of anti-fungal nasal lavage with amphotericin B on nasal polyposis. J Laryngol Otol 2002;116(4):261-263.
- Shin SH, Ye MK. Effects of topical amphotericin B on expression of cytokines in nasal polyps. Acta Otolaryngol 2004;124(10):1174-1177.
- Tomooka L, Murphy C, Davidson T. Clinical study and literature review of nasal irrigation. Laryngoscope 2000;110(7):1189-1193.
- Wormald PJ, Cain T, Oates L, et al. A comparative study of three methods of nasal irrigation. Laryngoscope 2004; 114(12):2224-2227.
Last updated May 06, 2008
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