Related Terms

• Antral lavage, antral washout, bulb syringe, endonasal mucosa care, hyperthermia, hypertonic Dead Sea salt, hypertonic saline, inhaler humidified warm air, intranasal douche, Jala Neti, jet lavage, nasal douche, nasal hyperthermia, nasal lavage, nasal saline solution lavage, nasal sprayer, nasal washing, nebulization, neti (irrigation) pot, power irrigation, respiratory hydrotherapy, Rhinomer®, saline lavage, saline nasal irrigation, Smiegelof's irrigation, steam inhalation.

• Not included in this review: Proetz displacement (saline irrigation combined with suctioning).

Background

• Yoga enthusiasts have used nasal irrigation for thousands of years to clear the sinuses and the mind. Today, nasal irrigation is becoming more widely accepted as a home remedy for allergies, colds, and sinus infections. Nasal irrigation can be performed up to twice daily at home or in a doctor's office, as long as it does not irritate the mucous membranes.

• Saline lavage is a type of nasal irrigation that uses a warm liquid solution. Humidified warm air lavage (hyperthermia) uses heated mist, steam, or humidified air. Large-particle nebulized aerosol therapy uses a saline solution nasal spray. Occasionally, antibiotics are added to the solution.

• There is variability in nasal irrigation techniques. Differences include the method of saline delivery, the strength of the saline solution, and the use of other additives. Delivery methods include the traditional neti (irrigation) pot, nasal sprayer, bulb syringe, cupped hand, and commercially available devices. The strength of the saline solution depends on the amount of salt added to the water. Additives have included antibiotics, substances that narrow the blood vessels (called vasoconstrictors), and buffers, which reduce acidity. Some practitioners recommend buffered hypersaline solution, although this may irritate the nasal tissues. Gravity-fed normal saline is often used in Jali Neti, one form of nasal irrigation.

• There is growing evidence to support nasal irrigation because it is more natural, soothing, generally safe, and less expensive than many over-the-counter medications. It also does not cause side effects often associated with these medications, such as drowsiness and nausea.

• The International Consensus Report on the Diagnosis and Treatment of Rhinitis recommends nasal irrigation for the treatment of swollen nasal airways (called rhinitis). There is good evidence for the use of nasal irrigation in allergic rhinitis and sinusitis. There is also promising early evidence that nasal irrigation may help treat the common cold, respiratory symptoms from occupational exposure, and wounds after sinus or nasal surgeries. Nasal saline irrigation is still the main treatment for acute rhinitis in infants because excessive use of nasal drops that narrow blood vessels is unsafe in early childhood.

Theory

• It is unclear how saline nasal irrigation may work. It has been suggested that nasal irrigation may clear mucus, improve the function of the tiny hairs that move mucus through the nasal passages, reduce the number of particles that stick to the inside of the nasal passages, decrease swelling, and/or decrease levels of chemicals that cause swelling. It has also been suggested that heat from nasal irrigation may directly interfere with allergens. Vapor may stabilize the mucosal surface and reduce symptoms of congestion and a runny nose.

• In traditional systems of healing, nasal irrigation is believed to help prevent against disease and improve symptoms of a variety of nasal and sinus conditions.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Asthma, dizziness, multidrug resistance (antibiotics), nasal septal deviation, swollen mucous membranes.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

• Nasal irrigation is likely safe for the general population when used daily with proper technique. There are some reports of nasal irritation, nasal discomfort, itchiness, earache, cough, sneezing, nosebleeds, increased allergy symptoms, dizziness, and pooling of saline in the paranasal sinuses.

• Some preparations include drugs that may cause side effects. Studies using saline plus ephedrine added have noted brief episodes of irregular heartbeat, lightheadedness, and nasal burning in a few people. Cystic fibrosis patients have experienced increased cough (that sometimes included blood), throat irritation, and chest tightness.

• Nasal irrigation should be used cautiously in people with frequent nosebleeds.

• After nasal surgery, nasal irrigation should be discussed with the surgeon.

• People with impaired gag reflexes, such as patients with chronic illnesses or recovering from surgery, may be at risk of fluid entering the windpipe or lungs (aspiration). A healthcare provider should be consulted before starting therapy.

• Irritation or burning of the nasal passage may occur if the irrigation solution is too hot.

• Bacterial infections from dirty equipment are possible.

• In children, nasal irrigation is sometimes performed by healthcare providers. Limited research suggests that nasal irrigation is safe in children older than seven years. However, the safety in children is unclear when nasal irrigation is performed outside of a doctor's office.

• To prevent bacterial infections, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.

• Nasal irrigation may affect the action of other drugs, herbs, and supplements, such as antibiotics, antihistamines, anti-inflammatories, antivirals, cough suppressants, and nasal sprays.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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