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Do Neti Pots Really Work?

Nasal rinsing has been used for thousands of years to relieve sinus inflammation, congestion, allergy symptoms and more. Here’s what the evidence says.

By Alice Callahan

To the uninitiated, the neti pot may seem like yet another wellness trend. After all, the teapot-like vessel was popularized in the United States by the celebrity surgeon Dr. Mehmet Oz, who called it a “nose bidet” on “The Oprah Winfrey Show” and has been criticized for promoting unproven supplements and health products.

Rinsing warm saltwater through your nose — in one nostril and out the other — as an antidote for a variety of woes like sinus inflammation, congestion and allergies may seem strange and possibly scary; especially if you’ve heard about its links to rare but deadly brain-eating amoeba infections.

But according to ear, nose and throat doctors, nasal rinsing, which traces back thousands of years to the Ayurvedic medical traditions of India, is an unusual example of a practice that is at once ancient, trendy and evidence-based. And, it’s safe and inexpensive to boot.

It has a “very, very high level of evidence, randomized controlled trial evidence, that shows that it does work and it does help,” said Dr. Zara Patel, an associate professor of otolaryngology at the Stanford University School of Medicine. Here’s what we know.

How is nasal rinsing beneficial?

When you inhale, the mucus in your nose traps all sorts of undesirable particles from the air, like viruses, bacteria, allergens and pollutants, said Dr. Rakesh Chandra, a professor of otolaryngology at Vanderbilt University Medical Center. Microscopic hairs in the nose then sweep those trapped particles, with the mucus, into the throat so they can be swallowed into (and largely neutralized by) the gut.

This filtering system generally works well, but sometimes, people “react to that stuff that’s getting caught up in the mucus,” leading to inflammation that can cause symptoms like congestion, pressure and pain, Dr. Chandra said.

This is where nasal irrigations can be so helpful. “One of their biggest functions is to sort of wash all that stuff out so that it doesn’t collect in the sinus cavities and elicit those reactions,” he added.

Nasal rinsing is also thought to thin the mucus and reduce swelling that can cause congestion, Dr. Patel said: “It’s like a sort of natural decongestant.”

What kinds of ailments does nasal rinsing help with?

In 2021, an international team of experts published a consensus on how best to manage common sinus issues, like chronic inflammation of the nasal and sinus passages that can cause runny nose, congestion, impaired sense of smell and facial pressure or pain. They concluded, based on the best yet limited evidence, that regular rinsing with saltwater was one of the treatments most proven to be effective.

Other small studies have suggested that saltwater rinses can help with seasonal or environmental allergy symptoms like congestion, runny nose, itching and sneezing.

And there is some evidence that rinsing can help soothe symptoms of acute upper respiratory infections, like those caused by common cold or flu viruses, though there is less research on this use. One of the largest studies to date, published in 2008, was conducted on about 400 children aged 6 to 10 with colds or flus in the Czech Republic. Among the children who used saltwater rinses several times per day, their symptoms resolved more quickly and they were less likely to use fever medications, decongestants or antibiotics, or to have to miss school, than the children who didn’t rinse.

Dr. Patel, who practices in California, said that rinsing can also help clear fine particles from wildfire smoke, which can be irritating.

Though the evidence that rinsing helps with these various nasal issues is of mixed quality, experts say there are few downsides to trying it. “The risk is so low and the potential benefit so high for rinsers” that it’s worth giving it a go, said Dr. Nyssa Farrell, an assistant professor of otolaryngology at Washington University School of Medicine in St. Louis.

For people with chronic sinus inflammation, Dr. Patel recommends rinsing twice per day — morning and evening. For those with milder symptoms, daily rinsing may be enough. “Doing it on a regular, preventive basis is much better at keeping inflammation under control and at bay versus trying to catch up once inflammation has already set in,” she said.

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How do you rinse properly?

First, choose your rinsing apparatus. The neti pot is just one of several devices designed for nose rinsing; Dr. Patel prefers a simpler plastic squeeze bottle (like the one she uses in this video) because it’s easy to use and offers slightly more pressure than a neti pot.

Powered irrigation devices, which use a motor to flush saltwater through your nose, are also available, but they’re not necessarily more effective and are more expensive and trickier to keep clean, Dr. Patel said.

Next, prepare your saltwater solution. The Centers for Disease Control and Prevention recommends purchasing distilled or sterile water, or using tap water that has been boiled for at least one minute and then cooled.

Then, add the salt. It’s easiest to use premixed salt packets sold over the counter as a dried powder mix, but you can easily make your own salt solution using pickling or canning salt (don’t use table salt, which has too many additives).

To rinse your nose, stand over the sink or in the shower, bend forward, and tilt your head to one side. While breathing through your mouth, gently squirt or pour about four ounces of your solution into the upper nostril, letting it run out the lower nostril. Some may run into your mouth. Repeat on the other side.

The technique can take some getting used to, and may even feel uncomfortable or burn at first. But any discomfort should subside with time. “A lot of my patients, after they get used to it, absolutely love it, because they feel so much better,” Dr. Farrell said.

After you rinse, clean your device with soap and water or according to the manufacturer’s instructions.

Is nasal rinsing safe?

If you’ve heard reports of nasal rinsing causing fatal amoeba infections of the brain, it may be hard to wash that fear from your mind.

“That risk is real,” Dr. Farrell said, but it’s “exceedingly low.” To her knowledge, just three cases have been reported in the medical literature in the United States in the last decade or so. All were associated with rinsing with untreated or improperly treated water.

Tap water may contain low levels of amoebae and still be safe to drink, because stomach acid can kill these organisms. However, it’s not safe to put untreated tap water in your nose.

Can nasal rinsing help treat Covid-19?

The coronavirus primarily infects people through the nose, so early in the pandemic, researchers and doctors wondered if nasal rinsing could help treat Covid-19 infections.

In one study of recently diagnosed Covid-19 patients published this month, researchers found that when compared with participants who didn’t do any nasal rinses, those who rinsed with saline solution twice a day for 21 days had no improvement in their symptoms, and had the same amount of coronavirus in their noses.

Dr. Justin Turner, one of the study’s authors and an associate professor of otolaryngology at Vanderbilt University Medical Center, said he was surprised by these results, but another experiment in the study offered an explanation. “The virus is just produced so rapidly that no matter how much of it you wash away, the virus is continuously produced,” he said.

That finding leaves him skeptical of nasal rinse solutions marketed as protective against Covid-19. “Unless there’s good clinical data behind it, I think you have to be really careful about trying some of these things that are being advertised, of which there are several,” he said. Even substances that seem natural or innocuous could be toxic to cells in the nose. For example, a popular zinc nasal spray was recalled in 2009 after hundreds of users reported damaged or lost sense of smell.

So, if you’re rinsing your nose, stick with saline. For anything else, check with your doctor first.

Sinus Congestion and Pressure

Did you know chiropractic can help? Make an appointment with one of our chiropractors, and we will get to the root cause of your sinus condition. When we treat it, it will not only feel better but be less likely to return.

That is the Drummond Difference.

We have effective treatments for congestion sinus pain and can teach you how to self treat at home.

Let’s free up your sinuses, so you can get back to pain free living!
Be able to breath easier, sleep better, live life without pain.

You may be surprised to find out that your sinus pain is a symptom of a nerve being pinched in your neck, jaw, lymphatic back up, or maybe it is caused by something wrong with how tight the bones are in your skull. Your congestion may be due to allergies to not just pollen, but food. Regardless of the cause of your sinus pain, we will find it with a thorough history and exam, then determine the best treatment plan for it, even if it means referring you out. We are more affordable than surgeons and medical doctors, so start with us, and if able, we will get you relief as soon as possible.

All of our chiropractors are more than a spine specialist as chiropractors, but also a sinus pain specialists. They not only will work on your sinuses (cranium), but any issue that may be contributing to your sinus condition. They can train you on how to keep your sinuses well body so that you will be less likely to the recurrences of any sinus issues.

We love getting our patients feeling better in the new decade than they did in the past.
Here is to a healthier and happier you!

To see Dr. Karin Drummonds’s demonstration of self cranial work, check out:

Dr. Karin’s video on self cranial release for sinus headaches.

Taking pain pills, decongestants, or anti-inflammatories for your sinus pain?
STOP!
Prescription pills and nasal sprays do not fix the problem and are harmful to your health (think of their side effects).
Instead, talk to us about alternative home remedies.

The following is general advice. Before attempting, talk to us or your health care provider to confirm it is appropriate for your specific condition.

Sinus pain and general advice:
All of our chiropractors specialize in sinus pain.

Sinus Headaches

Sinus headaches are often described as having pain behind the frontal bones (the bones in your forehead) or cheekbones.

Inflammation of the sinuses can cause headaches, as in acute sinusitis. Allergies can also cause head pain. Generally, sinus pain is caused by pressure on the mucous membranes (the lining of the sinuses) because they are unable to drain well.

Using a nasal irrigation system, like a Neti PotTM, may help as well. By cleaning out the nasal passageway, you rid the sinuses of the irritants that may be causing the swelling and remove the excess mucous that may be obstructing the drainage.

Mobilization of the skull (cranial) bones helps improve drainage of the sinuses. The skull is made of multiple flat bones that articulate with each other. There are no muscles that move these “joints,” so they are considered “immovable.” However, the flat bones of the skull are not fused together. A healthy skull has the ability to expand and contract to keep the pressure off the brain during changes of barometric pressure or sinus pressure. If the sinuses are filling up with fluid from sickness or allergies, the skull should expand with this pressure, allowing the sinuses to drain with this extra space. If restricted, the sinuses can’t drain, pressure builds, and pain results in the form of a sinus headache.

Mobilizing the cranial bones allows for the expansion of the skull, allowing the drainage of the sinuses. This relieves the pressure on the mucous membranes, and the headache resolves.

Again, if your sinus pain is not responding to your treatment, or if it is worsening in any way, see your healthcare provider (hopefully that is one of us here at Drummond Chiropractic).

Allergy Advice

MANY sinus issues are triggered when you eat certain foods. In some cases, you may have a food sensitivity; in other situations, sinus congestions may be triggered by chemicals added to food (preservatives, flavorings, etc.). You may also experience sinus pain because of seasonal allergies. Here is my dietary advice.

A Teaspoon of Honey a Day Keeps the Allergies Away

Allergies cause the sinuses to inflame, causing sinus headaches. If you suffer from seasonal allergies, try eating a teaspoon of local honey; the beehive should be within 25 miles of your home (as the crow flies). Honey from a hive close to your home is filled with the antigens of the pollen you are breathing in your area. When you eat it, the body learns that the pollen antigens are “self”—something good that you assimilate into your body for energy—and not a “not self”—a foreign thing that needs to be attacked.

Honey works even better if you get honey made in the spring for your spring allergies and honey made in the fall for your fall allergies. Farmers markets are a good place to find locally produced honey.

Inoculation to Overcome Allergies

Another way to overcome allergies is through inoculation. Some people get allergy shots. You can treat an allergy by being exposed to a very small amount of what you are allergic to every week (but not enough to cause a reaction). Over time, the amount to which you are exposed is increased. Eventually, you are able to handle more of the allergen without a symptomatic response. I advise this be done under the guidance of a healthcare professional.

Eat a Variety of Foods

Food sensitivities are often the result of eating a limited variety of the same foods every day. This results in the body being underexposed to good antigens, which are the markers on organic material that our bodies use to determine if a substance is self or not self. Whenever the body is exposed to a new antigen, it attacks the new antigen like it’s a virus or bad bacteria. This explains why unfamiliar pollen or foods can make you feel sick.

When your body is exposed to a variety of antigens, more antigens are marked as self and are not attacked. If you eat the same foods every day, not only do you limit your body’s exposure to good antigens, but you make yourself more vulnerable to adverse reactions should you try something new.

The Rotation Diet: Keep Your Triggers from Accumulating and Turning into a Sinus flare up

For food sensitivities, consider the rotation diet. This diet will ensure that you get a variety of foods, and it will lessen your likelihood of developing food sensitivities, which is a growing problem in our culture.

The rule is simple: When you eat something, you can’t eat it for four consecutive days afterward.

Think about that. How many times have you eaten the same food for weeks? How much variety do you really have in your diet? If you eat the same types of foods all the time, you will likely develop sensitivity to those foods.

Some studies suggest that you need to eat dozens of different types of vegetables to maintain a healthy gut flora, which is imperative to your overall good health. The better your overall health, the more likely you can tolerate your triggers without getting a sinus flare up. So if you make a big meal, freeze the leftovers and only eat one serving of it no more than once a week.

Another thing I like about this diet is that after a week or so, you have to start hunting the vegetable aisle for something you haven’t eaten in four days. Your veggies should expand from cucumbers, celery, carrots, broccoli, and cauliflower to include kale, leeks, radishes, spinach, water chestnuts, bok choy, Brussels sprouts, cabbage, red beets, squash, and more. The more varied your diet, the less likely you’ll suffer from a nutrient deficiency—another potential trigger for headaches.

If you already have a food sensitivity, the rotation diet should help decrease your sensitivity to it. If you avoid foods you are sensitive to, you will become hypersensitive to them, and you may even develop a strong allergy to them. If you eat a small amount of something you are sensitive to and then avoid it for four days, your body has time to get it completely out of your system. Then when you eat a small amount of that food again, your body can tolerate it. Over time, your body should even be less sensitive to it. This process is similar to how an inoculation works.

The Question of Eating Organic

When it comes to my vegetables, I am not too picky about them being organic because I feel that there is no such thing unless you grow veggies in your own garden and control how they are cultivated. Not all of us have that leisure, but if you do, eating fresh from the garden is the best way to get your vegetables.

However, when it comes to meat or any animal product (like milk or eggs), I am stricter. I try to avoid eating animal products that are not certified organic. Most meat sold at large chain grocery stores comes from an animal that has eaten who knows what foods, has been injected with who knows how many drugs and hormones, and has been subjected to potentially bad conditions that fill the animal’s tissues with stress hormones. So I choose not to eat meat from those animals.

Good Bugs Can Help

Another remedy you may want to try is taking probiotics. Good bacteria are essential to the well-being of your immune system. If you do not have good gastrointestinal flora health, your immune system will suffer, leading to immune issues like food sensitivities. Feed the flora in your gut with a variety of vegetables and grains to keep it healthy. As previously mentioned, some studies suggest that you need dozens of different types of vegetables to maintain a healthy gut flora.

If you take a probiotic supplement, make sure it contains more than one type of probiotic. You need a variety of good bugs in your digestive tract for it to be well. Many probiotic capsules contain only acidophilus because it is easily obtained from dairy products. This is not as therapeutic because acidophilus is the least deficient bug in our gut, especially if you eat dairy products like yogurt.

Additionally, purchase your probiotic from a reliable source. If you get it from a store, it may have gotten too hot or cold during transportation, rendering the probiotics useless (because they likely died in transport).

If you have to take an antibiotic, remember that it kills good bugs along with the bad. So take a probiotic during the antibiotic treatment and afterward to help replenish the good bacteria. Antibiotics make your gut vulnerable to a hostile takeover if not replenished with good bugs.

A lot of medical doctors say not to take probiotics while taking an antibiotic because the antibiotic will kill them. While it is true that antibiotics kill probiotics, I recommend replenishing the probiotics faster than the antibiotic can kill them. This way, the good bugs can overrun the bad bugs, and keep secondary infections at bay. If you find yourself getting sinus infections regularly, try taking probiotics to see if the number of sinus infections you get reduce if not stop all together.

Digestive Enzymes

Food sensitivities may also suggest your digestive juices are weak. Ask your healthcare provider if taking a digestive enzyme daily with your heaviest meal is an appropriate treatment option. Bonus, digestive enzymes also act as an anti-inflammatory, which also helps with sinus congestion.

Stress can affect your sinuses. If you are under emotional stress, don’t hold back. You may be surprised to know, holding back tears can suppress your healing. Plus, tears are a great way to drain the sinuses! To learn more about the healing effects of tears, check out:

Again, you do not have to suffer with sinus pain or congestion.