Nasal Rinsing: The Solution Your Sinuses Have Been Waiting For?

Nasal congestion, runny nose, and sneezing. None of these is life-threatening, but ask anyone with allergies, sinusitis, or a bad cold, and you will soon understand their impact on quality of life. One possible solution frequently mentioned online is nasal rinsing.

Jonathan Overdevest, MD, PhD, is an assistant professor of rhinology and skull base surgery at the Vagelos College of Physicians and Surgeons. As an expert in the anatomy and proper functioning of the nose and sinuses, we reached out to Dr. Overdevest for insight into the potential benefits of nasal rinsing. Here’s what he had to say.

Nasal rinsing, which appears on just about every social platform, is attracting increasing attention. What exactly is nasal rinsing?

Nasal rinsing, sometimes called nasal irrigation, is simply flushing the nostrils and sinus cavities with a warm saline solution. It’s popular because it can be done at home and offers a natural, non-pharmacologic way to relieve or reduce three common upper respiratory symptoms: nasal congestion, runny nose, and sneezing.

For many people, OTC cold and allergy medicines are the first line of defense against these symptoms. Who might benefit from nasal rinsing?

Everyone has a tried-and-true regimen for dealing with allergies and colds, ranging from home remedies to widely available cold and allergy medicines. The real challenge in adequately achieving symptomatic relief is knowing the underlying cause of the symptoms and treating them accordingly.

Nasal rinsing offers a way to broadly address some of the most common nasal symptoms regardless of their origin. And it doesn’t have to replace your current medications. It could be additive.

We also use nasal rinsing as a platform in the treatment of sinusitis. While the overall volume of a rinse that enters the sinuses is limited among individuals without prior sinus surgery, rinsing may still serve as an effective way to distribute medications throughout the nasal cavity and sinuses. So, nasal rinsing can notably improve symptoms for many individuals with sinusitis.

Beyond allowing for advanced delivery of medication, simply rinsing the nasal cavity may help reduce environmental debris and pollen deposited in the nose. And from recent studies on the climate’s impact on allergy trends, we can expect pollen concentrations to get even worse because of extended flowering seasons for plants and trees responsible for many common allergies.

Nasal rinsing can be done a few different ways, right?

Yes. Some of our readers may have heard of neti pots. They look a little bit like a teapot with a long spout. Over a sink, turn your head to the side. Then, pour warm saline into one nostril and let gravity draw the solution through and out of the other nostril. The amount exiting the nostrils or the perceived potency is not indicative of how well the rinse is working.

In my practice, I encourage patients to use a squeeze bottle. I have found that more complicated mechanisms and machines are often unnecessary.

For all these methods, the trick is to separate the nasal cavity from the mouth and throat. Otherwise, the saline will run down your throat. (Which isn’t dangerous. It’s just a little uncomfortable.) To do this, say the word “hung” and hold the “ng” sound. This closes the soft palate and blocks the throat.

The other thing to remember is to use warm saline. Notably, cool or cold saline will feel very unpleasant and can irritate the mucous membranes of the nose and sinuses. Premade saline can be warmed in a microwave or on a stovetop.

Saline can be made at home with distilled water or with tap water, provided you boil the tap water and then let it cool to lukewarm before using. This practice prevents the unlikely scenario that a pathogen in the tap water causes an infection.

How about nasal rinsing as a routine, preventive strategy? A good idea? Any downside?

If you find the nasal rinsing regimen to be therapeutic and not a hindrance to your daily routine, by all means, use it on a regular basis. Some of my patients use the rinse every morning, others every evening or even twice a day. It becomes part of their personal hygiene, just like brushing their teeth.

There is no downside other than the time it takes. Warm saline will not irritate or harm the mucous membranes in the nostrils or sinuses. Of course, it’s important to maintain the cleanliness of your neti pot or your squeeze bottle.

Does nasal rinsing present any risks? Are there some people (with certain conditions, for example) who should NOT try it?

Good question. Some people have issues of feeling a sensation of fullness in their ears, which may reflect a Eustachian tube issue. You should avoid nasal rinsing if you have severe pressure in one or both ears. Additionally, if you notice that rinsing causes fullness in your ears, refrain from blowing your nose for at least ten minutes after finishing the rinse.

The other thing to be mindful of is the composition of your saline. If you get your saline from the pharmacy, there’s no issue. If you make your saline at home, be sure to use distilled water or boiled and cooled tap water. It’s exceedingly rare, but there have been cases of individuals contracting a very serious infection by using untreated tap water for nasal rinsing.

What about children? Is nasal rinsing safe for kids?

Yes, nasal rinsing is safe for kids ages two and up. Ask your child’s pediatrician if you’re not sure. And keep in mind the precautions I mentioned earlier.

Finally, could you recommend any resources for more information on this topic?

Certainly. The FDA has a webpage dedicated to nasal rinsing with a special section on children. The CDC is another excellent resource. It has a webpage dedicated to explaining and mitigating the risk of infection associated with nasal rinsing.