Nasal Saline: Myths & Facts

For many people with nasal congestion or chronic sinus infections nasal irrigation with saline is a natural way of clearing nasal and sinus passageways. There are various ways of getting salt water into your nose and sinuses, including mists, sprays, squeeze bottles, pumps, aerosol cans, and irrigation systems. The Neti-Pot is a yogic variation of saline irrigation that became much more popular after Oprah's recommendation. Many patients have tried nasal saline and report good results, with better breathing and less sinus pressure and headaches.

It's also been shown that if the salt concentration is a bit saltier than your nasal membranes' concentration, the cilia that help to move the mucous blanket down into your throat become paralyzed. This is why you want isotonic saline, where iso-means same or similar to your body's plasma concentration. Some pre-made salt packets or readily available recipes are hyertonic, meaning that it's saltier than your body's normal plasma.

A recent study showed that contrary to popular belief, irrigating the nose on a daily basis over a long-te
period may actually make things worse. Researchers studied 68 people who used nasal saline irrigation every day for one year. In those that stopped after one year, 62% had a significant drop-off in the number of infections compared with those that continued irrigating their noses.

The authors of the study proposed that the likely reason for this finding is that frequent irrigation depletes nasal mucous, which contains several important defense mechanisms, including antibodies, lactoferrin, and lysozyme. It's also known that the nose produces nitric oxide, which also has antimicrobial properties.

These results are a bit conflicting with what many people report, but there may be some good reasons to follow the study authors' recommendations. Besides the reasons mentioned above, saline can act as a mild decongestant (especially if hypertonic), which is similar to the over-the-counter decongestant, Afrin, but not as strong. This is why you can breathe better after irrigation. One of the reasons why you can't use Afrin for more than 3 days is because of the rebound effect, where after the medicine wears off, your nose gets stuffy again, making you use it more and more frequently. Nasal saline, although not as strong as Afrin, also has a mild rebound effect. This is why some people use it 2 to 4 times every day.

If used for short-term periods, such as during an acute sinus infection, it can be useful (just like Afrin), but this study's result shows that long-term use may be more harmful.

My feeling is that if you feel better and you don't get as many infections, keep doing it. After a few weeks or months, you can experiment by stopping the irrigation and seeing what happens.

Recent studies also show that the vast majority of what may feel like sinus infections are actually a variation of a migraine headache. Furthermore, it's been shown that nasal saline doesn't really go into your sinus passageways. It works by decongesting your nasal passageways, which indirectly opens the passageways to your sinuses.

Here's simple saline recipe (0.9% isotonic) that you can make on your own:

1 teaspoon canning/picking salt (not table salt) pinch of baking soda (not baking powder) 2 cups of lukewarm water. For a hypertonic recipe, just double amount of salt. The baking soda (sodium bicarbonate) makes the saline less irritating. You can store this solution at room temperature for up to one week. Hypotonic saline or water is not recommended, as it can make your nasal membranes swell, just like if you sit in a bath for too long. It's also best to use this solution as close to body temperature as possible. You can use a bulb syringe, such as for infants or a turkey-basting type for adults. A Water-Pik machine can also be used with a nasal adaptor called the Grossan nasal irrigator tip, found online or at various pharmacies. Instructions for how to use a Neti-Pot can be found online and on YouTube.

There's no recommended frequency of use. For some people they use it a few times with a severe sinus infections. Others who suffer from chronic sinus problems use it on a daily bases, some even 2-3 times every day. If you're using it regularly for weeks to months and your sinus problems don't improve, try giving yourself a break to see what happens. You can also experiment by using differing concentrations of salt.

While saline irrigation can help lots of people, it won't help everyone. Some people are very sensitive to any form of liquid in the nose, no matter how dilute it is. With continued use, some get used to it, but for many others, it can make things worse.

If your sinus problems don't improves significantly with frequent saline irrigations, see an ear, nose and throat (ENT) doctor. Remember, saline irrigation should be part of a holistic regimen, including allergy management, regular exercise, a healthy diet, eating early and avoiding alcohol within 3-4 hours of bedtime. If you continue to have problems breathing through your nose, then discuss this issue with your ENT doctor, since you could have structural issues that need to be addressed.