Talal M. Nsouli, MD
Like brushing and flossing, nasal and sinus irrigation has become a daily ritual for many people who tend toward chronic nasal problems. Popular wisdom has it that removing mucus daily via nasal irrigation (also called nasal lavage) rids the nose of dust and other pollutants, eliminating a possible breeding ground for germs and infections while also allowing for easier breathing. It seems to make sense — but does it work? Not at all, according to a new study. In fact, long-term nasal irrigation actually contributes to nasal infections.
What’s Going On?
Talal M. Nsouli, MD, director of the Watergate and Burke Allergy & Asthma Centers in Washington, DC, has a lengthy résumé that includes having been personal allergist to President Clinton during his two terms, clinical professor at Georgetown University School of Medicine and former president of the Greater Washington Asthma, Allergy and Immunology Society. Dr. Nsouli says he began to question whether regular irrigation was helpful or harmful when he saw that patients who practiced regular lavage had nasal linings that looked hard and smooth, “like a piece of plastic.” He began to notice the trend toward more use of this practice about seven or eight years ago, and decided to investigate, recruiting 68 patients who had used neti pots for nasal saline irrigation at least twice a day for 10 months or more.
For one year, these patients continued irrigation as before. At the end of the year, they were instructed to suspend nasal irrigation for the next 12 months. Another group of 24 patients who used neti pots daily were used as a control group and monitored for 12 months. The results were startling, even to Dr. Nsouli: Patients who stopped nasal irrigation for one year had a 62% reduction in sinus infections from the previous year — and got half as many infections when not using sinus irrigation as those in the control group.
According to Dr. Nsouli, mucus contains aggressive antimicrobial agents that have antibacterial, antifungal and antiviral activity. One called lactoferrin, an immune system stimulator, has been shown to be effective against infection, including cold-causing viruses (rhinovirus) and, I was surprised to learn, even the HIV virus. Irrigating the nose regularly washes away the mucus and with it a valuable defense mechanism. When study participants stopped their nasal irrigation routine, they were astounded at how much better they felt and how quickly — even though it takes two to six weeks to fully restore the natural condition of the nasal passages.
Frequent irrigation does moisten nasal tissues, but this effect lasts just 20 minutes — in fact, notes Dr. Nsouli, the viscosity of mucus helps the nose stay moist. Some patients experience a yellow-green discharge after giving up lavage, but Dr. Nsouli said this is actually a symptom of a low-grade infection or chronic undiagnosed allergies. He advises them and anyone else with a chronic stuffy nose to see a doctor. Typically, the solution is a course of antibiotics and/or prescription nasal sprays that block symptoms while they improve the condition. Dr. Nsouli points out that it is the practice of rinsing that is problematic, not the solutions used, so this advice applies to over-the-counter nasal sprays as well.
Neti or Not?
Nasal lavage grew in popularity after the well-known physician/author Dr. Mehmet Oz sang its praises on Oprah a few years ago. Many adherents use a spouted, urnlike device (it comes from the Ayurvedic tradition) called a neti pot. It gets placed in the nostril and water is poured through it to flush out mucus. While previous studies have supported regular use of the neti pot, Dr. Nsouli says these were based on subjective, self-reported, short-term findings — unlike his study, which was carefully controlled with objective evidence provided through CT scans of the sinuses, fiber-optic endoscopy and detailed medical histories.
Dr. Nsouli emphasizes that he’s not completely against using the neti pot or any of the many other nasal-lavage devices on the market today including pumps, Waterpic-like devices and OTC saline sprays. In his opinion, these should be used only when specifically needed and for a short time, such as when you have a bad cold that makes it difficult for you to breathe. There also is a risk for contamination of whatever device you use and resultant chronic infections, so be sure to practice good hygiene. Use whatever device you like to wash out the mucus once or twice a day, but for one week only — that’s what Dr. Nsouli does and what he now advises his patients to do.
Talal M. Nsouli, MD, director of the Watergate and Burke Allergy & Asthma Centers, Washington, DC.