Nasal Irrigation - Efficacy and Safety

Efficacy and Safety

Nasal irrigation is used to treat a wide range of chronic sinus and nasal symptoms; for chronic rhinosinusitis it is an effective adjunctive therapy. It is also an effective measure against chronic sinus symptoms induced by work-place exposure to sawdust. Further evidence suggests that nasal irrigation causes relief for both hay-fever and the common cold. The neti pot used with a saline solution has been shown to be an effective treatment for hay fever, sinusitis, and other nasal conditions. SNI could also be an effective treatment for allergic rhinitis and chronic sinusitis.

Daily nasal irrigation with salt water solution (a mixture of 0.9% non-iodized sodium chloride and either purified or filtered water warmed to around 98 degrees F/ 37 degrees C, with or without inclusion of a buffering agent such as sodium bicarbonate) is recommended as both an adjunctive and primary treatment in such cases and is preferable to the use of corticosteroids except in the most serious cases of acute bacterial sinusitis which should be immediately referred to an otolaryngologist. Irrigation should be used with caution in infants, as nasal drops are not widely tolerated.

Flushing the nasal cavity with salt water has been claimed to promote mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material, although there is no clear evidence to support this. In proper proportion, nasal salt water solution with slight acidic pH functions as an anti-bacterial irrigant. The flow of salt water through the nasal passage flushes the dirt, airborne allergens (dust and pollen), pollutants and bacteria-filled mucus.

Salt water flushing also loosens and thins the mucus, making it easier to expel. Without this build up of mucus, the tiny cilia, or hairs in the nasal passage are able to function more efficiently, pushing excess mucus either to the back of the throat or to the nose to be expelled.

Potential allergens (such as iodine) or contaminants (algae, etc.) are to be avoided in the sodium chloride, water, or buffering ingredients. Premanufactured dosages of salt water flushing solutions can be purchased, or the user can mix non-iodized 'kosher' salt, with or without a buffering agent such as sodium bicarbonate or baking soda (table salt frequently is iodized, while sea salt may contain algae or other contaminants). Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity.

A conference abstract presented in 2009 indicated that long-term nasal irrigation led to higher rates of sinus infections, which the principal researcher theorized was due to alterations in nasal immunological chemistry brought on by flushing out the protective elements of the mucous membrane of the nose. Note that this study has not been published in any peer-reviewed journal, and that the results may have been affected by the method of selection of test subjects and by the neti pot methods followed by the subjects. No such results were observed for short term use. However, it is of note that efficacy studies in general have not been conducted on groups utilizing this specific treatment, and that claims regarding the efficacy of the technique rely largely on anecdotal evidence.