Do Neti Pots Really Work?

In the ever-fascinating field of mucus studies and sinus health, the revolutionary technology of the 21st century is not a fancy nasopharyngoscope–it’s a simple, $10 ceramic pot. Neti pots have been getting a lot of press over the past two to three years as sinus sufferers and alternative health aficionados have rediscovered a therapy used in yoga for centuries. While the buzz has generally been positive, recent research hints that there could be unwanted side effects.

Neti pots are small containers with a nozzle designed for easy insertion into your nostril. Fill the pot with lukewarm saltwater, made with non-iodized salt instead of table salt–such as pickling salt, or salt sold by neti pot suppliers online or in health stores. Stand over the sink, tilt your head to the side, and insert the nozzle into the upper nostril. Pour the saltwater in, and let it drain out of your lower nostril into the sink. Avoid looking at yourself in the mirror if your dignity is important to you. Check out this link for an entertaining music video starring the neti pot.

Theoretically, rinsing your sinuses breaks up thick mucus and cleans out germs and allergens, thereby improving your health. Several studies have examined nasal saline irrigation (NSI), as neti pots and similar devices are called in the medical literature. The data do show benefits in people who suffer from sinus-related symptoms such as stuffy nose, cough, and facial pressure. These studies are small and vary in quality, but generally show that NSI is safe and improves symptoms in many patients who have acute and chronic rhinosinusitis. The research also suggests that NSI reduces the need for steroid nasal sprays. These findings led this review to conclude that NSI can play a role in the treatment of chronic sinus disease.

However, a more recent study presented last month showed that long-term neti pot use might actually make people sicker. A team led by Dr. Nsouli, an allergist, followed 68 people with chronic sinus problems who were using neti pots. The researchers asked them to stop using NSI and counted how many sinus infections they had. Compared to the prior year, the group suffered 62.5% fewer cases of sinusitis during the year they didn’t use neti pots. Compared to a different group of 24 patients who continued using neti pots into the second year, the group suffered 50% fewer cases of sinusitis. I asked Dr. Nsouli why he thought neti pots might increase rates of sinusitis. “NSI will deplete the nose from its immune elements,” he wrote, “resulting in chronic sinus disease.” By rinsing sinuses every day, not only are you washing out allergens and bacteria, you’re also washing out proteins such as immunoglobulins that help protect the nose and sinuses. These findings are preliminary and the study has yet to be published in a peer-reviewed journal. However, they suggest that further research is needed before neti pots should be unreservedly recommended.

So what’s the bottom line? In the short term, using a neti pot for a few days will probably not do any harm, and it’s likely to help relieve the symptoms of acute sinusitis and nasal congestion. However, current medical research does not provide a clear answer about long-term use, and it is possible that daily use of a neti pot over several months can do more harm than good.

Gregg Miller, MD is a board-certified emergency room physician. Not nearly as good-looking as the doctors on the TV show  ER,  lacking the charisma of Dr. House, and much less scandalous than anyone o more


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