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Neti pot, by Flickr user Mookies.

It's been a miserable year for allergy sufferers: everyone I know who has problems with ragweed, including me, felt sickly for months.

Now that it's almost December, it's just about time for everyone to come down with colds and flus. Many happen at this time of year, due to germs passed around during social gatherings and holiday shopping, nasal passage dryness caused by artificial indoor heating, and the indoor allergies that proliferate in colder areas during the winter.

Constant congestion can lead to sinus infections, which require a visit to the doctor, and antibiotics, to clear up (even if the initial illness was viral). But there's some simple maintenance you can do that will nip a potential sinus infection in the bud: rinsing out your sinuses, also known as nasal or sinus irrigation or lavage.

This may seem gross, but most people who try it find it extremely helpful. It clears out stagnant mucous and helps to moisturize your nasal passages. It's my number-one "Don't get sick!" tip. Find supplies, recipes, and instructions after the break.


Sinus irrigation is not the same thing as using a saline nasal spray like Ocean. Those sprays can be useful, because they will help moisturize your nasal tissue and dry up congestion. But they don't do anything to clear mucous, wet or dry, out of your nose or sinuses.

If you had a skin contact allergy to a substance, and that substance was all over your hands, you'd definitely wash your hands to get it off of you, right? Sinus irrigation follows the same concept: get the allergens and the excess mucous out before enough illness-causing bacteria can grow in the mucous to make you sick.

Ear infections may be minimized; some are just sinus infections in an adjacent location. Sinus irrigation can also be helpful for sufferers of sleep apnea and other respiratory problems.

Since following this regime, I have gone from having chronic severe sinus and ear infections to not needing antibiotics at any time in the past year. A study done at the University of Wisconsin's School of Medicine and Public Health shows that my results are standard among people who try nasal irrigation.

And in spite of a general fear of putting water up your nose, it's not painful. Once they get used to it, most people prefer the feeling of the irrigation to the feeling of congestion. If you follow the instructions, you are unlikely to inhale any water.

The tools of the trade

There's a popular recent article on Instructables about sinus rinses, but the author recommends using a gravity-method neti pot, which can be uncomfortable for some people: you must pour the water into your nose at an upwards angle.

Neti pots are widely sold in health food stores that market alternative medical products. They're also sold in most American drugstores under the name SinuCleanse. It's suggested that if you purchase a neti pot, you should look for one with a conical tip: it will seal to your nostril better than the kind that looks more like a watering can with a long, slender spout.

Neti pot usage is a popular YouTube subject. (Who can resist watching a guy pour water through his nose?)

Other systems use "positive pressure," which is the same thing as squeezing water up your nose. I prefer these systems; people who don't like one may like the other.

I like the NeilMed Sinus Rinse bottle, which is used by bending at the waist over a sink, placing the nozzle at your nostril, and squeezing. It has a small tube that runs from its top to the bottom of the bottle, keeping air from getting into your nose as you rinse. The bottle is available in several sizes: special use (very small), pediatric, regular (8 ounces) for most adults, and extra-large (16 ounces).

Doctors also recommend using the nasal aspirators that are made for babies, similar ear bulb syringes, and the "spout bottles" that are made for travel (the kind with a "pull-up, push-down" cap that also acts as a squirting nozzle). There are higher-end systems that attach to a Teledyne Water-Pik, and similar stand-alone products.

Here are several types of bottles and pots that you can try. Please note that I have never purchased from these retailers: I am neither endorsing nor condemning them, but they may have what you need.

Mixing a solution

You can purchase rinsing solution, or you can buy pre-mixed solutions from some of the aforementioned companies in your local drugstore. Or, you can make your own.

Water used to make a solution should be either recently boiled and allowed to cool to at least a lukewarm temperature, or distilled water that has been heated to a comfortable temperature. (The boiled water can be reheated, too.)

For the most basic solutions, some people recommend using just salt and warm water. There are several such recipes out there, but most recipes, and most commercial preparations, use a combination of non-iodized salt and baking soda. The baking soda is added to buffer the salt solution, so that it won't sting while you're using it. It can also neutralize some of the nasal odors caused by infections.

Salt used for sinus irrigation should be non-iodized: the iodine makes rinsing with iodized salt unpleasant for some people. Coarse sea salt is ideal, but kosher salt will also work. (Ultimately, all salt is sodium chloride. There is no need to use super-gourmet stuff when you're going to be dissolving it in water and running it through your nose, so don't bother hunting down anything in an interesting color or texture; the pink or blue salt from Whole Foods is not going to make this any more effective than it already is.)

Recipes differ, however, in the other ingredients and in the exact proportions of the salt and baking soda. The aim is for a solution that has the approximate salt concentration of the human body: about 0.9% (that's one-tenth of one percent). [UPDATE: please see note below -- ed.]

The American Academy of Allergy, Asthma, & Immunology has a recipe on their site, which is also available as a PDF download. This recipe uses 3 parts "pickling or canning" salt to 1 part baking soda:

  • Use a clean container.
  • Mix three heaping teaspoons of iodine-free salt with one rounded teaspoon of baking soda.
  • Store in a small, airtight container.
  • Add 1 teaspoon of mixture to 8 ounces of lukewarm water.
  • If stinging occurs, use less of the mixture in the water.
  • Use 4 ounces of water and 1/2 teaspoon of mixture for children.

On the other hand, the Allergies subject at About.com suggests:

  • 8 ounces of warm water
  • 1/2 to 1 teaspoon non-iodized salt
  • A pinch of baking soda, or more, as needed.

Dr. Terrence Davidson, of the University of California at San Diego's School of Medicine, recommends the following in his Handbook of Nasal Disease:

  • 1 to 2 level teaspoons of salt
  • 1 pint of tap water between 72o Fahrenheit and 102o Fahrenheit
  • 1/4 to 1/2 teaspoon of baking soda, but only if you experience a burning sensation without it.

The Apnea Support Forum (which has a great writeup of sinus irrigation resources) published this formula, from the Division of Allergy and Immunology at Scripps Clinics in La Jolla, CA. The corn syrup is intended to mimic your body's sugar concentration. I have not found it necessary, but others may wish to try it.

  • 1/2 teaspoon salt
  • 1/2 teaspoon baking soda
  • 1 teaspoon white Karo syrup
  • 1 pint warm water
  • The prepared solution will keep in the refrigerator for up to two weeks.

Ultimately, it doesn't seem to matter much which solution you use: all are effective to some degree. Most seem to use either equal amounts of salt and baking soda, or half as much baking soda as salt, and most use between 1/4 and 1 teaspoon of salt per 8 ounces of water.

If you choose to buy premixed solution, you don't need to purchase the same brand of solution as your bottle: I often buy SinuCleanse rather than NeilMed to use with my NeilMed bottle. Both brands come out to around ten cents per rinse, but SinuCleanse comes in a box of 50 and NeilMed comes in a box of 100. Do I really want to spend ten dollars at a time on packets of salt and baking soda, particularly when my cabinet space is limited? (No.)

There are also hypertonic solution recipes out there, which are essentially a greater percentage of salt in the salt-to-water ratio. They are saltier than your own physiological chemistry, and are used in an attempt to dry up swollen nasal tissues. There is some mild controversy over whether or not they dry tissue out too much, which can leave the nose's owner more vulnerable to infection.

(The cilia in your nose are tiny, moving hairs that help eliminate undesirable material. Studies seem to show that, despite its other benefits, a hypertonic solution can interfere with their function.)

Irrigation time

To do the rinse, you'll need to mix the solution you choose. Lukewarm water (98.6° F) is best: water that's too hot or cold can be uncomfortable.

Follow the usage instructions for the bottle or pot that you're using. If you choose to use a travel "spout" bottle, or a bulb syringe, you'll need directions.

  1. Wash your hands and make sure your bottle is clean.
  2. Fill the bottle with your rinse solution and go to the sink. If using a nasal aspirator or ear bulb syringe, squeeze the bulb to push as much air out as possible, hold the nozzle in the prepared rinse solution, and release the bulb to fill it with liquid. (You may have to repeat this after each squeeze.)
  3. Bend over above the sink as much as possible, but don't hold your breath or close your mouth: once you're used to the procedure, it's completely possible to breathe through your mouth while you do it, without choking.
  4. Hold the bottle up to one nostril, so that its nozzle is almost up your nose, and squeeze. (If it's a bulb syringe or nasal aspirator, it will need to be inserted in your nostril as far as "the width of a fingertip," according to the Mayo Clinic, in their instructional video.) The water in it should jet up that nostril, through your sinus cavity, and out the other nostril, into the sink. You'll probably also see some mucous. Some water may also drain out of your mouth.
  5. Repeat for each nostril. The order doesn't matter. With the spout bottle, there's some danger of air going up with your rinse solution, which will sting. Feel free to refill the bottle once if you need to, after you've used about half its contents, so that you'll have more solution than air in the bottle.
  6. Clean your bottle. (For me, this usually means at least a thorough rinse under very hot running water both before and after I use the bottle. Once in a while, I wipe off the piece that touches my nose with a disposable antibacterial towelette a few times, then rinse it again. The rest of the time, I put a bit of dish soap into the palm of my hand and wash it that way. I've done sinus irrigation a few times a week for the past two years, from the same bottle, and have never been infected by a dirty bottle.)

If you can tolerate it, it's also helpful to sniff in whatever water remains in your nose, then spit it out (it will most likely go to your mouth when you sniff). Tilting your head to the side should produce more from one nostril than the other, and more than sniffing with your head held erect. If water goes down the back of your throat, try to spit it out instead of swallowing it.

After you've done the rinse, hold a couple of tissues to your nose. Do the following things slowly:

  1. Bend at the waist, getting your head as low as you can. Somewhere around your knees is good. (It's totally OK to bend your knees if you need to: you're not doing stretches.)
  2. Blow your nose, and tilt your head to each side, letting water drain.
  3. Stand up straight.
  4. Get a new tissue, handkerchief, or folded paper towel, and repeat steps 1-3 at least once.

A rush of water should come out of your nose during steps two and three. It's better to be prepared for this event, rather than bending over to pick something up and having your nose drip all over the floor, or going to bed and having the water drip out of your nose while you sleep. I have learned all this through unfortunate experience.

When to rinse your sinuses

You can do the rinses as often as several times each day to help clear out and dry up congestion, or you can wait until you're starting to feel under the weather. The University of Wisconsin study shows that most people who develop a nasal irrigation habit will do it around three times each week.

However, if you're already sick -- i.e., so thickly congested that the rinse can't get through your sinuses and come out the opposite nostril, and that congestion is green or brown -- you're out of luck. Time to call your doctor.

Note on January 31, 2008: A reader wrote in (thanks, Mark!) to point out my error in referring to 0.9 percent as "one tenth of one percent" with regard to the salt content of the human body. He is absolutely right in stating that the figure represents nine tenths of one percent, or almost one percent.

Not only was the wording incorrect: the figure itself may also be incorrect. Unfortunately, this post was written several months ago, and I no longer recall the source of that figure: it will be in one of the linked articles, if the source has not itself been corrected in the interim.

Human
blood is about 0.9% salt (or almost one percent), and salt makes up about 0.25% of human body weight. The sodium content of the human body -- not the same as salt, but a component -- is supposedly 0.15%, which suggests that something is unreliable somewhere in these figures (the 0.15% figure is said to also be by weight; another source says that the sodium content is 0.2% by mass; another says 0.1% by mass and 0.2% chlorine).

With this in mind, and the differences between weight, mass, and volume, I can't accurately quote any exact figure. Hence the new strike-through.

I am not a doctor -- you should
always consult your own doctor if you have any serious medical concerns -- but I know that the recipes quoted in this article are commonly used without trouble. Prepared solutions of the correct salt concentration are also widely available for purchase. -- M.E. Williams



Source

  • diane.rixon

    This is so great. Thanks! A year ago I saw an allergist (long overdue visit) and he recommended the NeilMed kit. Tried it. OMG. I was horrified - so gross!! But over the months I've seen more buzz about nasal rinses in the media and I've kinda gotten over the shock of my first innocent experiment. So now I'm trying it again. Hoping it will give me some relief with the cold I have. It's definitely not grossing me out so much this time around. And if you bend right over and squeeze gently and slowly, you can avoid the awful mouth drainage experience. Shudder.

    Reply
  • M.E. Williams

    It is definitely an... acquired tolerance.

    I started having problems with it around the time I wrote this article... it was burning, it was bothering me, etc etc etc.

    It turned out that I was no longer heating the rinse enough. I was letting it cool to room temp, then heating for around 7 seconds on high in the microwave. It was still cool enough to irritate, so I was thinking it was the salt/soda packet and started using half as much, which didn't help.

    So, now I heat it for about 20-25 seconds. (I would definitely test it on my arm before using it at that temp, though.) It's much more comfortable again now.

    (Glad you liked the article! Thanks! :)


  • JohnRainville

    Informative, educational and resourceful, M.E. Williams provides a valuable article on sinus irrigation and its value to healthy living. As a person who has suffered from chronic sinusitis and allergies for over two decades, I found the article to have excellent links for further research and it provided a personal step by step guide for the interested reader. Great job!

    Reply
  • Susan O'

    If you've ever gargled with warm water and salt...use the same consistancy. (If you can taste the salt, perfect). I just dip a paper towel in the solution then squeeze a couple of drops up the ole nostril with head tilted back and sniff it in. Usually just takes a couple of tries to clear out the most clogged nostrils. However, you will get the drip down the throat, but can breath easier.

    Reply
  • M.E. Williams

    I think the salt water gargle can actually go a little saltier than this. If your nasal rinse solution gets too salty, it supposedly interferes with the action of the cilia (nose hairs) that work to move out allergens and other things that get into your nose even though they shouldn't. :)

    Still, I think your plan is a pretty good one for people who can handle it and who don't want to mess with bottles!

    Reply
  • M.E. Williams

    Thanks, John! I worked pretty hard on this on and off for a while. I'm glad you liked it, and I hope people find it useful. Sinus irrigation has definitely helped me a lot.

    Even people with chronic sinus problems are often not told about it by doctors, which doesn't make much sense to me, given that the kits are in almost every drugstore.

    Reply
  • jitesh

    Useful information i think i will be regular reader of this blog.
    http://talkhealthonline.com

    Reply
  • 7 Comments / 1 Pages
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