Do neti pots work? A guide to nasal irrigation for allergies.

Publish date: 2024-07-14

With the arrival of spring and soaring pollen counts, many seasonal allergy sufferers are seeking relief from bothersome, or even debilitating, symptoms. Nasal irrigation using a variety of methods — neti pots, squeeze bottles, bulb syringes and battery-powered devices — is one of the most effective ways to clear clogged noses — although, experts say, you’ll probably still have to treat the underlying cause of your allergies.

Neti pots, which resemble small tea pots with long spouts, have gained popularity in the United States only relatively recently. But their use and the practice of flushing nasal cavities with fluid is believed to go back thousands of years to Ayurvedic medicine, which has roots in India. Since then, nasal irrigation has become one of the “best-studied non-pharmaceutical interventions” that can help improve common sinus-related symptoms, said Benjamin Bleier, a rhinologist at Massachusetts Eye and Ear and associate professor at Harvard Medical School.

In addition to being low cost, rinsing your nasal passages with a saltwater solution “is the safest and actually one of the most effective treatments, in general, for the nose,” Bleier said. But he and other experts, including allergists, said the approach can have limitations and needs to be done hygienically to reduce the risk of contamination.

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What is nasal irrigation, and why might it be helpful?

Nasal irrigation or rinsing broadly refers to a variety of ways to introduce fluid — commonly a buffered saline (saltwater) solution — into the nose to help clear the nasal passages.

Ideally, the saline solution is poured or squirted into one nostril and comes out the other, experts said, which flushes out the nasal cavities. Bleier noted, however, that a similar cleaning effect can occur even if the liquid comes out the same nostril.

Regularly rinsing the nasal cavities can be beneficial, because the nose acts as a “filtration system for our body,” trapping bacteria, viruses, pollutants and other airborne particles, such as pollen, that we breathe in, said Ryan Steele, a board-certified allergist-immunologist and internist, as well as an assistant professor of clinical medicine at Yale. “Just like you would clean the air filter on your car or air conditioner or your air filter in the house, you want to make sure that [the nose] is able to do its job effectively.”

Bleier added that even a small amount of thickened mucus can make a person feel “completely obstructed, because there’s not a lot of space in the nose.”

Nasal irrigation also has the benefit of keeping the inside of the nose moist, which can help reduce irritation, said Andrew Lane, a professor of otolaryngology and director of the division of rhinology and sinus surgery at Johns Hopkins.

What kind of evidence shows nasal irrigation works?

Multiple studies of nasal rinsing and scientific reviews published over the years have reported benefits in terms of improving nasal symptoms related to various causes, such as allergies and upper respiratory infections, Lane said.

A 2021 consensus statement on how to manage common nasal conditions published by an international team of experts noted that saline irrigation, when done as directed, was one of the most effective non-pharmaceutical therapies for symptom relief. As of now, that article is “the single-best compendium of all that type of evidence-based research,” said Bleier, who worked on the paper.

But although pouring or squirting water into your nostrils can provide immediate relief from symptoms such as a runny or congested nose as well as sinus pain and headaches, it’s important to remember that the effects are temporary, Purvi Parikh, an allergist and immunologist with the Allergy and Asthma Network, wrote in an email.

And, the experts said, rinsing probably will not address the cause of allergies. Unlike medication, rinsing “doesn’t offer the same anti-inflammatory action and block the allergy chemicals that are responsible for allergies,” Steele said.

Although many people with allergies will still need to take medicine, such as antihistamines, or use a nasal steroid spray, nasal irrigation is “a very nice adjunct to those medications because it’s just so safe when used properly,” Bleier said.

What method and rinse should I use?

Neti pots, which rely on gravity to pour liquid into the nose, and squeeze bottles that deliver gentle gushes are popular options. Deciding which method to use can largely depend on individual preference, but some experts recommend a squeeze bottle.

The flow from a neti pot may not “coat the inside of the nose as robustly as the squeeze action,” Bleier said. A squeeze bottle “allows you to get a lot of that saline into the nose, but under relatively low pressure.”

Additionally, simple squeeze bottles can be easier to keep clean than neti pots, which have narrow spouts, or more complicated battery-powered devices that use gentle pressure or suction to move the saline solution through the nose, experts said.

The saline solution you’re rinsing with is also important. You can purchase premade packets that already have the proper amount of salt and baking soda or you can mix it yourself using a reliable recipe, such as the one provided by the American Academy of Allergy, Asthma, and Immunology.

When preparing the solution, you should use distilled or sterile water. If you’re using tap water, the Food and Drug Administration recommends boiling it for three to five minutes and letting it cool to the appropriate temperature. “Some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them,” guidance from the FDA states. “But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections.”

Although there have been some reports of nasal rinsing leading to fatal infections from a brain-eating amoeba that can be found in fresh water, Bleier and other experts emphasized that those cases are “extremely rare.”

In addition to making sure your water is clean, it should be room temperature or slightly warm, experts said. Avoid water that’s too hot or too cold.

How do I do it?

Stand over a sink or some type of basin. Tilt your head slightly forward and down to minimize the chance of swallowing the solution, put the spout of the neti pot or squeeze bottle in one nostril, and start rinsing. Squeeze gently if you’re using a bottle. Repeat the process for the other nostril. Steele recommended that first-timers start with a smaller volume of solution as a test. Be prepared for water to come out of your nostrils or your mouth.

“Make sure that you are doing it where it’s comfortable and that you have a towel on or something, or you don’t mind getting wet, because it does take a little while to get the technique down,” Steele said. For more detailed guidance on how to rinse, it may be helpful to watch a video tutorial made by an ear, nose and throat expert or allergist.

After rinsing, you can gently blow your nose, Bleier said. But avoid completely closing your nostrils and using too much force. “Now that you have a little bit of that fluid sitting in there, if you forcefully blow your nose, you can still drive some of that fluid into the ear space,” he said.

In addition to using distilled, sterile or boiled water for the solution, you should wash your device well with soap and water between uses and keep it dry, experts said. Check to see whether your product comes with instructions for cleaning.

Cleaning regularly is important, because there will inevitably be some backwash in your rinsing apparatus after use, which can contain virus particles, bacteria, allergens or other irritants that were flushed from the nose, Lane said. “Unless you clean the device, you are likely reintroducing germs the next time you rinse.”

Bacteria can also easily develop in many rinsing tools, Bleier said. “If you took an irrigation bottle and you put a drop of water in it and left it out on your counter for an hour, you’d be able to culture bacteria out of that, because there are bacteria that are floating in the air, and they settle in the bottle.”

If you notice visible wear or discoloration on your device, it’s probably time to replace it, Steele said.

Are there side effects?

Some users report feeling as if the solution is “backing up into their ears or their ears feel clogged afterward,” Lane said. You might also notice a burning sensation or irritation inside your nose. These side effects are often mild and go away after you stop rinsing.

If you’re experiencing nasal irritation, check the water temperature and the salt level of your solution, Lane said.

And if nasal irrigation doesn’t help, consider seeking professional care.

“You’re not going to do any harm by trying saline on your own,” Lane said. “But if your symptoms persist or get worse, then you should see a doctor for it and not just rinse more.”