Nifty Neti: Why & How I Rinse My Nose

[jesse_the_k]

Nasal rinsing (also called nasal or sinus irrigation) is a long-standing practice in Ayurvedic medicine. In this tradition, the "neti pot" is the tool to have.

According to a 2006 study in the Annals of Family Medicine:

a closely monitored 6-month randomized controlled trial […] found that daily hypertonic saline nasal rinse using 2% saline is associated with high patient satisfaction, improved quality of life, decreased antibiotic and nasal spray use, and improved sinus symptoms in adult participants with a history of frequent rhinosinusitis and chronic sinus complaints.

I’ve struggled with allergic rhinitis, reactive airways (coughing fits generated by particulates and fragrances), migraine and frequent sinus infections. I knew nasal rinsing was a good idea, but I physically can’t juggle a neti pot.

obstacles

• teapot in nose
• awkward body mechanics
• nasty saline taste
• waterfall afterwards

I’d been told the next best thing to neti was saline nasal sprays. Unlike sprayed medication that can create rebound nasal congestion, salty water on its own can relieve chapped nostrils and help break up congested sinuses. It also tastes foul. On a pharmacist’s advice, I tried Xlear nasal spray which adds xylitol to saline. It didn’t taste at all. Hmmm.

The miracle of plastic has come to my rescue: positive pressure nasal rinse bottles are available at your local pharmacy for less than US$10.

Don’t use tap water! It’s crucial to only use sterilized water, or I’d introduce more germs into the nasal cavities.

my tools

• clean water

  • no tap water!
  • distilled is fine, but you have to buy it
  • I boil in my kettle & let it cool

• upright squeeze bottle

  • soft cone top fits snugly against nostril
  • gentle squeeze pushes saline solution upwards

• bulk saline mix I assemble at home

  • my formula by weight
    90g salt : 20g sodium bicarbonate (baking soda) : 20g xylitol
    Fits into a 1c/240ml bottle that formerly held 200 capsules.
  • started with Xlear packets
    worked fine but expensive; required scissors to open
  • xylitol cancels out salt and baking soda flavors
  • research shows xylitol’s benefits
  • xylitol available in bulk on the baking aisle

my daily routine, step by step

• Prep the bottle immediately after my morning tea
  • 1 tsp/5 ml neti mix in plastic bottle
  • pour 8 oz/240 ml water from kettle into bottle to fill
  • must be body temp or cooler (therefore final step in kitchen)
• test water temp: squeeze drop on wrist. If it feels warm, wait 10 more
• pull paper towel from roll
• bend head over sink, chin tucked as much as possible
• press cone tip of bottle gently against nose to make seal
• four sets of squeezes, in pairs for each nostril, left and right.
  1. point cone towards front of nostril and squeeze. Water goes in one nostril and pours out the other (then reverse and repeat)
  2. point cone straight up, hold one nostril closed and squirt into other. Water goes up into sinus cavity and pours back out (then reverse and repeat)
  3. same as 2 but this time saying ahhh, so water comes out back of mouth (then reverse and repeat)
  4. repeat 1
     - Pictures illustrating 1–4
• set bottle aside, head still over sink
• tilt head 45° right, gently pressing left nostril, breathe out through right nostril
• repeat on left side
• sit down and lean over
• put paper towel under nose, repeat the tilt and breathe for each side
• blow nose gently three times

benefits

• no sinus infections since I started daily neti use
• no more bloody noses and cracked skin in winter
• reduced asthma inhaler use
• fewer headaches

I'm glad that I've found something that can actively improve my health. I'm ready to smell the flowers that are bravely point their heads out.

Have you tried using a neti pot?

Comments

[sonia]

I do use a netipot occasionally, when I feel a cold coming on or when one has already arrived, or when I feel annoyingly congested and have a singing group meeting coming up. I dislike it pretty intensely, but it does seem to reduce frequency/intensity of colds and definitely clears out my sinuses.

I've found that it's best when I get the water temperature right and measure the right amount of salt. My sinuses like things to be just right. I do use tap water though.

Interesting that it reduces reactions to fragrances for you. My reactions are more neurological than respiratory, but I wonder if it would help when I know I've been exposed. I was just thinking of posting to ask for post-exposure suggestions.

[jesse_the_k]

This particular bottle & xylitol made a daily-neti-snorter out of me. It's very squishy, so not much force creates a non-painful stream of water.

My neti setup is at home, and (happily) I'm never exposed to fragrances there. So I don't have any post-exposure data for you.

My theory is that rinsing knocks back the level of allergens and other contaminants. I can handle a little bit of fragrance on a good day; I'm choosing to believe the neti makes for more "good days."

I'm delighted that 3M redesigned their 9210 N95 respirator so that it uses covered elastic instead of a bare rubber band. It's much more comfortable. But on super-sensitive days, MyGuy modified one to use 1mm elastic cord--pry open the staples, thread cord thru with knots on both ends, smash staple back. These fit even better with glasses & hat.

[sonia]

Thanks for the neti pot tips and the respirator link!

[sovay]

Have you tried using a neti pot?

Not an actual pot for various reasons, but I have been doing warm saline rinses through my nose since 2004 and it is extremely useful to me; it is part of my regular maintenance.

[jesse_the_k]

I like the notion of "regular maintenance." We're like Amphicars: tuneups, waterproofing, dehydrating, new batteries, etc.

[mdlbear]

I started nose-watering (literal translation of "nasal irrigation") about the same time I got my first CPAP. I use kosher salt (no iodine) and tap water (recently tested) at somewhat higher than body temperature -- around bath temperature. I recently got a new neti pot from Health and Yoga; it's noticeably bigger than the older one I got from that company. The instructions say that it holds 450ml.

I love my neti pot.

[jesse_the_k]

That's a beauty!

[tim]

I used a neti pot for years, on the recommendation of an ENT. (Allergic rhinitis, generally swollen/inflamed stuff in the head and face area that's always made it hard for me to breathe through my nose, and the occasional reactive airway situation, usually as a lingering post-viral thing that can last for months.) Seemed to work pretty well. I saw a different ENT who said that neti pots were bad because they wash out helpful bacteria from your sinuses. (I wasn't aware that sinuses had helpful bacteria -- I know vaginas and colons do -- and I haven't verified this for myself.) She recommended that I switch to the saline nasal spray instead. I don't notice any taste from it other than slight ocean-water taste, which I like just fine. I'm not sure it actually works better than the neti pot did, but it's not appreciably worse.

I dropped and broke a couple of neti pots, but I tried the plastic bottles too and found it unpleasant somehow (maybe due to the tendency of the bottles for having air bubbles in them which went up my nose; not an issue with the pots, which I could pour gently and slowly.)

I continue not to be sure whether anything is true, with respect to ENT issues. (Perhaps also in general.)

[jesse_the_k]

I wasn't aware that sinuses had helpful bacteria -- I know vaginas and colons do -- and I haven't verified this for myself.

That's a new one--but I've heard (reference lost) that the vast majority of our body's cells are actually not us but visitors. Which is reassuring and creepy.

(There are no medical truths, IME. It's a rapidly moving target.)

[vass]

Creepier (maybe. I find it comforting myself) thought for you: what if they're not visitors, they are us, but "we" are not all the one single entity, and what we are changes over time? And we might experience existence as a single, coherent narrative belonging to a single individual (not all humans do, but it's the most common experience) but that's not reality or even our unfiltered perception, it's our brains course-correcting/editing for clarity, like they do with our eyesight so we can't see saccades and can adjust to being upside-down?

[tim]

that the vast majority of our body's cells are actually not us but visitors. Which is reassuring and creepy.

Yep, I can confirm this at least based on my microbiology class this semester!

https://aeon.co/ideas/i-holobiont-are-you-and-your-microbes-a-community-or-a-single-entity

Also, what I found just as peculiar to learn is that up to half of human DNA comes from horizontal gene transfer from other species, brought to us by viruses. ( https://www.sciencemag.org/news/2015/03/humans-may-harbor-more-100-genes-other-organisms , https://www.nytimes.com/2017/10/04/science/ancient-viruses-dna-genome.html ). Turns out the tree of evolution isn't actually hierarchal.

(There are no medical truths, IME. It's a rapidly moving target.)

So true.

[vass]

research shows xylitol’s benefits

*follows link* "Sino-Nasal Outcome Test 22 (SNOT-22)" I love it when scientists have fun with their work.

Have you tried using a neti pot?

I've tried it, and found it to be useful once I got my head around the fact that it really does need to be saline not plain water, and warm not cold.

Then I went to a convention at which one of the panel discussions was on brain-eating amoebas. Some PhD candidates did a presentation in which they just enthusiastically infodumped about all the grossest things in their field. It was great. But the tl;dr(tmi) version is that I decided not to use a neti pot any more.

How do you sterilise your squeeze bottle?

[jesse_the_k]

SNOT-22 made me guffaw and then--appropriately--snort.

I'd heard about the brain-eating amoebas, and it somehow doesn't phase me. You ask an excellent question which I had never considered before, and which makes me want to get a new bottle STAT.

Drop of bleach plus more boiling water?

[vass]

I love your userpic!

Drop of bleach plus boiling water sounds like a reasonable measure.

[monanotlisa]

I have!

The normal ones feel good, but since they don't relieve sinus pain, I gave up on them. I got the Sinupulse Elite, one of those monster machines with strong pressure, and those totally get to the festering crud! Downside, though -- because they dislodge said festering crud, it drops into my lungs, and causes upper respiratory tract symptoms there (I think it's the sheer amount of residue in the case of the forceful water stream).

Given that I find pain worse than URT issues, I'd still do it if faced with severe sinus issues, honestly.

[jesse_the_k]

I admire your enjoyment of strong pressure! It matches your icon!

[monanotlisa]

:P

Sent from my iPhone

[siegeofangels]

I use a similar setup, the NeilMed Sinus Rinse kit, which comes with these nice premixed packets. It calls for washing the bottle after use, then sticking it in the microwave for a minute, which steam-sterilizes it. And I use either bottled distilled water or tap that I've boiled for 5 minutes.

I use it at night to rinse out any pollen/pollutants I've picked up during the day, and it definitely helps me breathe better. I also have way fewer air-pressure-triggered headaches, too.

The only thing is that since water goes ALL up in there, sometimes not all of it drains out, and then later I'll tilt my head a certain way and it'll come out then. But I usually do the rinse before I shower, so if something drains I can just . . . get rid of it.

[jesse_the_k]

Steam sterilization is a great trick, thanks!

[cadenzamuse]

I use the NeilMed kit that seigeofangels mentioned. I am not very faithful to it when I'm well, because I find either letting boiled water cool or microwaving our filtered water (reverse osmosis so hopefully no brain-eating amoebae) to the right warmth to be for some reason an enormous barrier to entry. I do manage it at least once or twice a day when I'm sick. I should probably make myself do it now, as it's allergy season and I've had a really ferocious sinus headache today.

Sorry about the headache

[jesse_the_k]

One of the many virtues of retirement is I can wander back into the kitchen 60 minutes after I've prepped my kit and it's just the right temp. On the other hand, in a hurry I have put my complete hot squeeze bottle in a go-cup, and filled the cup with tap-water-cold and it's cool enough in 10 minutes. When I've forgotten the bottle on the counter for three hours, the reverse also works--pour in tap-water-hot in the go cup.