Thirty-six million Americans have chronic sinus troubles. Millions more—perhaps 1 in 7 people—suffer from rhinitis, a fancy name for stuffy nose. All together, that's a lot of people who could benefit from fast, easy, cheap symptom relief. As it turns out, one of the most effective treatments for nasal and sinus problems is also the simplest, safest, and cheapest: a saltwater nose rinse. Squirting salt water into the nose works much better at relieving symptoms than commercial saline nose sprays, new research says.
Granted, the idea of squirting water up one's nose has a certain "ick" factor. But "almost all of the patients I see, no matter how I treat them or what I treat them for, benefit from nasal irrigation," says Melissa Pynnonen, an assistant professor of otolaryngology at the University of Michigan who specializes in treating chronic sinusitis. Most doctors who don't specialize in it tend to recommend over-the-counter nose sprays to their patients, Pynnonen says. She and colleagues at the University of Michigan tested saline nose sprays and saline rinses in 121 adults, all of whom had stuffiness, sinus pain, and other chronic nasal and sinus symptoms. All reported fewer symptoms after eight weeks of treatment with either saline nose spray or a twice-daily rinse with 8 ounces of salt water, using a plastic squeeze bottle. But the nasal rinse group showed far greater improvement in severity and frequency of symptoms, with 40 percent of the rinse group saying they still had symptoms "often or always," compared with 61 percent of the spray group.
"Most patients, by the time they come to my office, they're so bothered by the symptoms that they're beyond the ick factor," Pynnonen says. "I tell them that it's a strange sensation; nobody really likes the idea of doing it. But most patients, once they try [a rinse], they realize that it helps, and they don't want to stop doing it." Her study was published in the November Archives of Otolaryngology.
Otolaryngologists and allergists say they've known for decades that saline rinses help, and they often recommend them, particularly for people with sinus infections or who have had sinus surgery. Recent research, including a July 2007 analysis by the Cochrane Review, finds consistent benefits. Indeed, the whole idea of nose washing as good hygiene is thousands of years old. Indian neti pots have been sold for years in health-food stores, and drugstores now stock an assortment of saline sprays and squeeze bottles.
"A lot of people just have a plugged nose," says Sheldon Spector, a clinical professor of medicine at UCLA and head of the California Allergy and Asthma Medical Group in Los Angeles. A few years ago, Spector reviewed older studies of saline rinses and found that rinsing improved air flow and also reduced the number of eosinophils, white blood cells that play a key role in inflammation and allergic symptoms.
The allergists and ENTs agree that people aren't as aware of the virtues of saline rinses as they should be. Doctors often forget to mention it, says Brad Marple, a professor and vice chairman of the department of otolaryngology at the University of Texas Southwestern Medical Center in Dallas. "It doesn't have the glamour and panache of surgery or many of the pharmaceutical products," Marple says. "There isn't a company that's making a huge amount of money off of salt water. But the bottom line is, you'd be hard pressed to find people who don't benefit." Not only can patients reduce the need for antibiotics or surgery, he says, but it's one of the rare medical treatments where patients are in control.
Nose washing can be a do-it-yourself affair. Here's Pynnonen's home recipe:
Mix and squirt gently in each nostril with a squeeze bottle.
Drugstores stock squeeze bottles designed for nasal rinsing; brand names include NeilMed, Grossan, and Ayr. These companies also sell premeasured saline packets, which are particularly handy for traveling. Some doctors recommend using distilled water or boiling the water first and letting it cool, particularly if the home water supply comes from a well that may have bacteria. The squirt bottles need to be washed periodically with hot soapy water and should be replaced "as often as you replace your toothbrush," Pynnonen says, because bacteria gradually build up in them. There's a lot of debate on Internet sites on what saline solution works best, hypertonic (more salt) or hypotonic (less salt). The studies conflict on that point, and Pynnonen thinks it doesn't really matter. The take-home point: A well-washed nose is a happier, healthier nose.