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Neti pots – Ancient Ayurvedic Treatment Validated by Scientific Evidence

Nasal irrigation with salt water is recommended by 87% of family doctors as an adjunctive treatment to relieve the symptoms of nasal congestion and sinusitis. The simplest method is to hold salt water in your cupped hand, block one nostril while you inhale the water into the other nostril, then blow your nose. The high-tech version is to use a Neti pot, a little jug with a spout. You pour the salt solution from the Neti pot into one nostril and it drains out the other nostril. The technique is described here.  Neti pot

The Neti pot originated in India in Ayurvedic medicine. Neti is Sanskrit for “nasal cleansing.” Other related ancient techniques that have not been adopted by scientific medicine include using a string instead of water and a yoga technique where you close one nostril, pour the solution into the other nostril and allow it to run out of the mouth. 

Nasal irrigation provides short-term symptomatic relief and may improve nasal mucociliary clearance. It removes mucus not only from the nose but also from the maxillary and ethmoid sinuses.  

A randomized controlled trial in 2002 found that daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis.  Its effectiveness is supported by a Cochrane review.  

A recent review article in American Family Physician  gave nasal irrigation an “A” strength of evidence rating as an effective adjunctive therapy for symptoms of chronic rhinosinusitis, and  a “B” rating for irritant and allergic rhinitis and viral upper respiratory infections. 

Just don’t overdo it. A new study presented at the annual meeting of the American College of Allergy, Asthma and Immunology in November 2009 found that while short-term nasal irrigation is therapeutic, long-term use of nasal irrigation is harmful. Regular users of irrigation who continued using it had an average of 8 episodes of recurrent rhinosinusitis per year, while those who discontinued it only averaged 3 episodes per year.  The investigators hypothesized that the nasal mucosa serves as the first line of defense, and irrigation depletes the nose of its immune blanket of mucus, thereby increasing the risk of recurrent infection.

Posted in: Clinical Trials

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56 thoughts on “Neti pots – Ancient Ayurvedic Treatment Validated by Scientific Evidence

  1. LindaRosaRN says:

    An old treatment passed down in my family for several generations,was “snuffing salt water” for nasal congestion. My mom had me submerge my nose in a cup of warm water and “breathe” it in deeply. It was a big dose.

  2. Lawrence C. says:

    It is good to know something apparently as simple and inexpensive as this works as well as it does for some common complaints. It will be interesting to hear more new studies about this old method. It seems to be practiced in many cultures worldwide.

    As an aside, hearing the centuries-old neti pot described as “high-tech” is funny!

  3. DLC says:

    I think I’ll stick with my saline spray solution. It’s a bit less messy.

  4. DevoutCatalyst says:

    “Honey, don’t you ever wash that thing?”

  5. Scott says:

    An excellent example of how “alternative” methods are readily adopted by mainstream medicine if properly demonstrated to be safe and effective.

  6. trrll says:

    I tried this the last time I couldn’t sleep due to a bad head cold. It seems to work at least as well as the vasoconstrictor nasal sprays.

  7. windriven says:

    Neti pot: $14.99 at Target. Use, wash, repeat.

    Walgreens Saline Nasal Spray: $2.99

    Am I missing something here?

  8. It’s a pleasure to read about a treatment that works for once. Almost every topic I research for SaveYourself.ca is a disappointment: the evidence for the vast majority of manual therapies is inadequate and discouraging, and sometimes I feel like a stuck record reporting on them.

    Despite the good feeling I have after reading about the efficacy of sinus irrigation, I am never, ever doing that to myself again! Yuck! Water up my nose is worse than fingernails on a chalkboard!

  9. Harriet Hall says:

    This study showed that saline nasal spray was not as effective as irrigation:

    http://www.ncbi.nlm.nih.gov/pubmed/18025315?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=3

    The used the Sino-Nasal Outcome Test, whose initials conveniently spell SNOT.

  10. Zoe237 says:

    Very cool, Dr. Hall, thanks for posting. Any word on how effective other cold remedies are, either “natural” or commercial?

  11. I refer to a Neti Pot as the home water boarding kit. :)

  12. Diane Henry says:

    Just to clarify though–one email one mother-in-law forwarded me about the swine flu said that neti pot use would help prevent influenza. The neti pot is just useful to alleviate stuffy noses/sinuses, right? It has no preventative function.

  13. Harriet Hall says:

    Zoe237,

    No cold remedy is effective. Nasal irrigation is not effective for colds, it’s just effective for relieving one of the symptoms. I wrote a SkepDoc column in Skeptic magazine about cold remedies. You can read it at http://findarticles.com/p/articles/mi_kmske/is_3_13/ai_n29381144/

  14. Harriet Hall says:

    Diane Henry,

    There is no evidence that nasal irrigation has a preventive function; in fact, the last article I cited showed that long-term use increased the number of infections.

  15. Pieter B says:

    I use a plastic squeeze-bottle thingy I got at Walgreens. NielMed is the brand name. It’s a bit more wieldy than the neti pot, and you can drop it more than once. Also makes it easy to mix your saline solution by shaking the bottle.

    They sell packets of salt and bicarb at a vastly inflated price, but it’s easy to mix your own. Use koshering salt, not regular table salt. 8 oz water, 1 tsp salt and 1/4 tsp bicarb.

  16. Michelle B says:

    *Sarcasm on*

    Well of course the neti pot works, traditional medicine gets things right because of infallible intuition, ritual, and gut feelings. So science caught up with traditional medicine. Big deal. We needed a study for this? Humph! And this means that all the other unproven remedies probably work also.

    *Sarcasm off*

  17. provaxmom says:

    @karl-
    We use the baby saline spray and suction when he gets sick. We call it waterboarding the baby and say “time to waterboard the baby!”

  18. Calli Arcale says:

    Harriet, I think Zoe may have been asking about what other remedies are effective at relieving one or more of the symptoms.

    As I understand it, it’s like this: decongestants are somewhat helpful. Antishitamines early on, but not later. Tylenol and ibuprofen can help control fever and relieve aches and pains. If it’s influenza, antivirals may shorten the duration if given early. If you get a bacterial infection secondary to the cold, antibiotics will help with that. Other than that, the common cold remains stubbornly untreatable.

  19. Kausik Datta says:

    “Home waterboarding kit” is bang on!!

    Scores of my friends into all that Yoga stuff swear by the Neti pot; in fact, one of my colleagues – long plagued by chronic sinusitis – was advised to use the Neti pot exercise and it helped her.

    I am not a fan. Somehow, the entire concept of inhaling water frightens me to no end (I almost drowned in a swimming pool once… Don’t ask!). Besides, my question has always been what if the water contains water-borne bacteria, virus or fungus – isn’t that a straight route to the brain via the ethmoid sinus?

  20. Harriet Hall says:

    Calli Arcale,

    Many of us use those things for symptomatic relief, but I’m not so sure they are supported by good evidence. For instance, this study found that antihistamines and decongestants were no better at relieving symptoms than placebo:
    http://www.ncbi.nlm.nih.gov/pubmed?termClinical=uri+decongestants&precision=specificity&strategy=therapy&term=%28uri+decongestants%29+AND+%28Therapy%2FNarrow%5Bfilter%5D%29&p%24a=&p%24l=PubMedStaticPages&p%24el=&p%24st=pubmedutils

  21. Zoe237 says:

    “Harriet, I think Zoe may have been asking about what other remedies are effective at relieving one or more of the symptoms.”

    Yes, that was exactly my question, particularly about decongestants and antihistamines. I seem to remember reading a study years ago showing that cough medicine was no more effective than water (could be wrong though). I guess I’m skeptical of all of the products out there claiming to relieve or help cold symptoms. But it’s not like I’ve researched it in depth either.

    I did read the Skeptic article and it confirms what I’ve thought for years, so thanks.

  22. Grinch says:

    I know this isn’t the right post, but will any of the SBM writers address the issue of climate change and how it pertains to the emails recently outed?

  23. EricG says:

    Nice. Do you take requests?

    Family members have recently touted the efficacy of DMSO (I searched the site, hopefully this is not redundant…in which case…is there a pos tor helpful link?).

    Message therapist uncle oversells the pros and fails to mention the cons of DMSO which leads to other family members readily adopting and thus DMSO is recommended to me blindly (didn’t know why its not approved by the FDA as an analgesic, didnt know of any risks or side effects, didnt know what its made of) leads me to sigh and dig a bit on my own.

    I found that it has some demonstrated effects as an analgesic, but is only FDA approved as a palliative treatment for interstitial cystitis. It has some mild risks and side effects (possible increased absorption of other possibly hazardous compounds) and a simple google search will reveal that it “cures” just about everything (including down syndrome, nice!).

    I used it, didnt work, not overly bothered by agitated by sore muscles anyway…so, I have no interest in using it again. However, what might you have to offer that is of significance that i missed on my little endeavor?

    This is primarily addressed to HH, but anyone may feel free to take a crack at it.

  24. Scott says:

    Besides, my question has always been what if the water contains water-borne bacteria, virus or fungus – isn’t that a straight route to the brain via the ethmoid sinus?

    You’re supposed to boil the water first. (And then let it cool, of course!) So it shouldn’t be a major concern.

  25. this treatment was presented to me by an allergy specialist – in traditional, science-based medicine. specifically, it was just a nasal rinse or whatever – not specifically called neti pot.

    I got tumbled in the waves at the beach once, and had the same effect.

    Here is the big diff: ask an ayurvedic advocate HOW this works. The simple, physio-mechanical, orderly view of the world says: it removes the snot. Ayurveda views the physical world as an epihenomena of the spiritual, cosmic world – the snot-removal theory will not fit in Ayurveda.

    Any Ayurveda fans willing to explain how the problem develops and how the Neti pot cures the karma?

  26. windriven says:

    @EricG

    Dimethyl sulfoxide (DMSO) is, as I recall, a byproduct of pulp processing. It has enjoyed spurts of fame, especially in the sports community. Former NFL QB June Jones, for instance, was a real believer. I did some research on this for a magazine article about 25 years ago and found that while DMSO was sometimes effective as a transdermal transport vehicle and as a potentiator of other agents, there was little evidence at that time to support its medical use.

  27. wertys says:

    Even if it works it’s still revolting ! It’s probably more psychologically acceptable to users to imagine evil humors being shoved out the nose than month-old bogeys….

  28. Chris says:

    Grinch, don’t you think there are enough contentious topics on Science Based Medicine just on medicine?

  29. Calli Arcale says:

    Harriet:

    Many of us use those things for symptomatic relief, but I’m not so sure they are supported by good evidence. For instance, this study found that antihistamines and decongestants were no better at relieving symptoms than placebo:

    Hence my use of the word “somewhat”. ;-) I remember when that study came out, and it didn’t terribly surprise me. Thing is, colds go away, and the snot levels vary naturally, so it’s easy to think something is working when, objectively, it isn’t. OTOH, I’ve also read studies saying that they *are* helpful for symptomatic relief, compared to placebo. *shrugs* Bottom line is there really isn’t any magic bullet. Not even the neti pot, though at least it really does remove snot.

  30. EricG says:

    windriven-

    thanks!

  31. antipodean says:

    I can suggest a delivery technique that is infinitely cooler than shoving a small teapot up your nostrils.

    Surfing.

  32. pmoran says:

    “You pour the salt solution from the Neti pot into one nostril and it drains out the other nostril. ”

    Has anyone actually achieved this? I am not sure that it is anatomically and gravitationally possible, without a finely coordinated series of contortions or a nasal septal defect.

    The nicely formed stream of fluid shown in the picture looks phony, too, for a flow that is supposedly finding its way out via the nasopharynx.
    It just doesn’t look right.

  33. pmoran says:

    OK, I’ve worked it out. If you had a good seal at the nostril and a pot that could sustain a sufficent head of pressure to flow over the back of the nasal septum, it would work. The tea-pot like device shown in the illustration might do this if the head is well positioned and the seal at the nostril was good.

  34. EricG says:

    pmoran

    i used a similar device that uses pressure from a squeezebottle to achieve that. yes, it is possible, i have achieved that. it is a horrible coughing mess, but i guess it works. I was quite surprised at the relatively short distance is had to travel before coming out the other end. I anticipated it finding its way everywhere…pretty much straight shot in one nostril and out the other.

    to 2nd anipodean’s idea, try swimming backstroke (the part when you do your flip turn and streamline under water for a piece) and stop exhaling from your nose. yep, that’ll do it too.

  35. EricG says:

    pmoran

    i used a similar device that uses pressure from a squeezebottle to achieve that. yes, it is possible, i have achieved that. it is a horrible coughing mess, but i guess it works. I was quite surprised at the relatively short distance is had to travel before coming out the other end. I anticipated it finding its way everywhere…pretty much straight shot in one nostril and out the other. (edit…your comment appeared, mine was eaten) – the seal/pressure is key, i think you got it.

    to 2nd anipodean’s idea, try swimming backstroke (the part when you do your flip turn and streamline under water for a piece) and stop exhaling from your nose. yep, that’ll do it too.

  36. Harriet Hall says:

    In the AFP they mentioned it was necessary to keep tissues handy for half an hour afterwards to cope with residual drainage.

    A beautifully ambiguous slogan just occurred to me: The Neti pot is snot effective.

  37. desiree says:

    i tried the neti pot when i was all stuffed up from a cold and it did relieve some of my sinus pressure, but i also trapped some water in my ear that was super painful and took about 3 weeks to totally drain. i googled “neti pot ear fluid” and i am not the only one that’s had this problem. was there anything in the study about people messing up their ears with the neti? i’m never doing it again! back to good old fashioned snarfing up water from a cup for me.

  38. Grinch says:

    Chris, that was a very clever usage of bolding of the words to drive your point home. However, the question is a valid one and since, IMHO, these are the best SCIENTIFIC minds (see my use of capitalization). Besides I think if we can discuss evolution, I think I can ask the question about climate change.

  39. Grinch says:

    Chris, that was a very clever usage of bolding of the words to drive your point home. However, the question is a valid one and since, IMHO, these are the best SCIENTIFIC minds (see my use of capitalization). Besides, I think if we can discuss evolution, I think I can ask the question about climate change?

  40. trrll says:

    The Neti pot works exactly as pictured. It is not a matter of inhaling water, although I gather that some people do snort salt water into their nose (but presumably not their lungs) as an alternative method. You can even breathe through your mouth while using the pot. If the water is at body temperature, it is not particularly unpleasant, although slightly disconcerting at first. The water, of course, should be clean and boiled to be free of microorganisms. I suspect that the decongestant effect is not so much due to washing out of mucus as to the hypertonicity of the saline reducing tissue swelling. You blow your nose gently afterwards to clear out the remaining fluid. As in blowing your nose generally, I imagine that it is possible to force fluid into your ears if you blow too hard.

  41. Chris says:

    Grinch, it is obvious that my creative bolding did not help. Try the discussion at http://www.realclimate.org/ .

  42. keleton says:

    pmoran asked: “You pour the salt solution from the Neti pot into one nostril and it drains out the other nostril. ”

    Has anyone actually achieved this? I am not sure that it is anatomically and gravitationally possible, without a finely coordinated series of contortions or a nasal septal defect.

    The nicely formed stream of fluid shown in the picture looks phony, too, for a flow that is supposedly finding its way out via the nasopharynx.
    It just doesn’t look right.

    Yes, I have achieved this and it is not hard. My allergist first suggested using a bulb syringe for irrigation but it wasn’t working well enough. I switched to a neti pot when needed, and got a nasal adaptor for the Water Pik for when it’s a real stubborn chunk. I only found it slightly weird the first few times. Not unpleasant. Also I use distilled water, as tap water can be irritating. I prefer my water cool but most people I know like to use warm. I find cool water to be much more soothing.

  43. AppealToAuthority says:

    Separately to whether it works, nasal irrigation is easy for some people, feels like drowning to some, feels like applying acid to the brain to others, and some just can’t seem to get geometry and gravity working together.

    I found it easy to get the water in (and out). Much less erky than many medical procedures I have had to do.

    And it was great for when I had sinus trouble (which in turn was a side effect of hay fever).

    As you can see from the pic, a ‘neti’ pot is very similar to a teapot, and in fact most small teapots will work just fine.

    Even though it seemed to work for me, I was somewhat alarmed when the person who originally recommended it said it would work better if I used urine. I declined this suggestion.

  44. AppealToAuthority’s description “feels like applying acid on the brain to some people” effectively describes my reaction to the neti pot. I am thrilled it works, but I would never ever be able to use it myself, any more than I could self-administer a dental drill.

  45. edgar says:

    That is surprising, I have recommended the bottle to many people, and no one has reported discomfort. it was surprisingly comfortable. The solution makes it it isotonic, no?

  46. AppealToAuthority says:

    Most instructions use a hypertonic solution at body temperature. The Cochrane review was equivocal as to whether hypertonic vs isotonic made any difference in effect.

    I have no idea why some people have such a dramatic reaction — but it sounds similar to what I have experienced during particularly bad hay fever, when large volumes of liquid containing very little mucus slosh about into my sinuses while asleep, waking me up with an intense burning sensation which seems to be located in the frontal sinuses.

  47. edgar says:

    That sounds awful.
    But you’ll pry my neil-med sinus rinse out of my cold, dead, nostril!

  48. *shudder*

    I suppose it’s like the fingernails plus chalkboard reaction– who can say why some find it mildly annoying and others find it soul-searingly torturous. I imagine it comes down to sensory processing differences.

  49. edgar says:

    I have no idea why some people have such a dramatic reaction

    maybe some folk’s tonic is less than iso?

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