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July 2020 (Vol. 5 Issue 5)

Neti pots: sinus-soothers or just plain potty?

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Neti pots: sinus-soothers or just plain potty? image

Thanks to an appearance on The Oprah Winfrey Show, the neti pot-a device used to flush out the nasal passages-has become a hugely popular alternative remedy for treating sinus problems

Thanks to an appearance on The Oprah Winfrey Show, the neti pot-a device used to flush out the nasal passages-has become a hugely popular alternative remedy for treating sinus problems. Proponents claim that this simple method of nasal irrigation can combat con-gestion, alleviate allergies and reduce respiratory tract infections. But what does the science say about this odd-looking contraption?

What's a neti pot?

A neti pot is a teapot-looking container designed to rinse out the nasal cavity. It's usually filled with a simple saltwater solution (saline) that is poured into the nostrils, one at a time, to help flush mucus and foreign irritants out of the nasal passages. Supposedly, this has been used for thousands of years as an Ayurvedic practice for maintaining a healthy nasal lining and clearing the sinuses.

Scientific evidence

Unlike many much-hyped natural treatments, the neti pot actually has solid scientific evidence to support its use. Saline nasal irrigation (SNI), as the technique is known, has been shown to be beneficial for a number of common upper respiratory conditions, especially those affecting the nose, mouth, sinuses and throat.
u Chronic sinusitis. Studies have demonstrated that SNI is an effective adjunctive therapy for persistent sinus symptoms such as congestion and facial pain. In one randomized controlled trial (RCT), patients with chronic sinus symptoms who used SNI daily for six months in addition to routine care saw a 64-per-cent improvement in overall symptom severity compared with patients who used routine care alone. The SNI group also reported a significant improvement in sinus-related quality of life along with reduced medication use (J Fam Pract, 2002; 51: 1049-55).
Another RCT concluded that nasal irrigations performed with large saline volumes and delivered with low positive pressure (as is the case with the neti pot) are more effective than saline sprays for the treatment of chronic nasal and sinus symptoms (Arch Otolaryngol Head Neck Surg, 2007; 133: 1115-20).
u Allergic rhinitis. SNI may be useful for people who are allergic to pollen, dust mites, pet dander or other allergens, according to some evidence. A small RCT of children suffering from hay fever found that SNI combined with antihistamine medication significantly reduced the severity of their symptoms compared with antihistamines alone. The SNI users were also able to cut down on their antihistamine use (Pediatr Allergy Immunol, 2003; 14: 140-3). Similar results were reported in a study of pregnant women with hay fever (Int Arch Allergy Immunol, 2010; 151: 137-41).
In yet another study, patients with a history of allergic rhinitis reported improvement of allergy symptoms when using SNI (Am Fam Physician, 2009; 80: 1117-9).
u Colds and flu. A study of 401 children suggests that SNI can be used to treat and even prevent uncomplicated colds and flu. The children (all of whom had a cold or flu) were randomized into two groups, one of which took standard medication and another that carried out daily SNI (with a saltwater solution) in addition to taking standard medication. The trial consisted of a three-week treatment phase followed by a nine-week prevention phase. In both phases, the SNI group reported significantly better outcomes for nasal secretion, obstruction and medication-use assess-ments. The SNI users also reported significantly fewer illness days (31 per cent vs 75 per cent), school absences (17 per cent vs 35 per cent) and complications (8 per cent vs 32 per cent) compared with the medication-only group (Arch Otolaryngol Head Neck Surg, 2008; 134: 67-74).
u Other uses. Other evidence suggests that SNI might be helpful for acute sinusitis, asthma and nasal polyps, and for patients who have undergone sinus surgery (WMJ, 2008; 107: 69-75; Am Fam Physician, 2009; 80: 1117-9). In a small RCT of patients who had undergone endoscopic sinus surgery, SNI three times a day for six weeks significantly reduced nasal discharge and improved swelling slightly during the healing phase (Clin Otolaryngol, 2008; 33: 462-5).

How does it work?

Exactly how SNI works is not known, but it's thought that by flushing out the nasal cavity, it facili-tates the removal of potentially bacteria-, allergen- and irritant-containing mucus. A more complicated explanation is that it improves the function of the cilia-tiny hair-like struc-tures inside the nasal passages that move back and forth to push mucus either to the back of the throat, where it can be swallowed, or to the nose to be blown out. Indeed, studies show that SNI can significantly improve mucociliary clearance time in patients with allergic rhinitis, and acute and chronic sinusitis (J Laryngol Otol, 2009; 123: 517-21).

Is it safe?

SNI appears to be safe, with no studies reporting serious adverse events (Am Fam Physician, 2009; 80: 1117-9). However, minor side-effects can occur, such as nasal irritation and stinging. Reducing the amount of salt in the solution, adjusting the frequency of neti pot use and changing the temperature of the water appear to reduce side-effects. In general, lukewarm water with a salinity of 0.9 to 3 per cent is recommended.
According to a study presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting, long-term use of SNI may be counterproductive by actually increasing the frequency of respiratory infections. The researchers said this may be because SNI washes away "good mucus", which acts as the first line of defence against infections (see 712146). Although the study remains unpublished, it may be worth sticking to short-term use until more is known about the long-term effects of using neti pots and other SNI methods.

Joanna Evans

Factfile: How to use a neti pot

Neti pots (also known as 'nasal cups') and nasal saline salt packs are available online or from healthfood stores and pharmacies. For effective saline nasal irrigation, the American Academy of Family Physicians recommends the following three steps:
1. Mix the solution. Follow the directions on the salt package to make saltwater using lukewarm water. Pour 4 fl oz (100 mL) of the solution into the nasal cup.
2. Position the nasal cup. Lean over the sink so that you are looking down into the basin. Turn your head slightly to one side, and gently place the spout of the nasal cup into your upper nostril so that it forms a comfortable seal. Be sure to not press the spout against the middle part (septum) of your nose.
3. Pour the solution. Tip the nasal cup so that the solution pours into your upper nostril. Make sure to breathe through your mouth. The solution will soon drain out of your other nostril. When the cup is empty, breathe out through both nostrils to clear away any extra saltwater and mucus. Gently blow your nose into a tissue. Repeat the process for the other nostril.
A variety of squirt and spray bottles are also available for nasal irrigation. See for more information.

Factfile: A simple sinus-rinse recipe

A home-made saline solution can be just as effective as a commercial pre-made product. Try the following recipe, which was developed by the American Academy of Allergy, Asthma and Immunology Rhinosinusitis Committee.
u In a clean container, mix three heaped teaspoons of pickling salt (or any salt that's free of iodine, anticaking agents and preservatives) with one rounded teaspoon of baking soda, and store in a small airtight container.
u Add one teaspoon of the above recipe to eight ounces (one cup) of lukewarm distilled or boiled water. Use half of this solution for the right nostril and the other half for the left.
u Use less of the dry ingredients to make a weaker solution if burning or stinging is experienced. For children, use a half-teaspoon with four ounces of water.


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