Long-term Nasal Saline Irrigation: Helpful or Harmful?
November 14, 2009
For many people with obstructive sleep apnea, nasal congestion and chronic sinus infections are a common problem. Nasal irrigation with saline is a natural way of clearing nasal and sinus passageways. The Neti-Pot is a yogic variation of saline irrigation that became much more popular after Oprah’s recommendation. Many of my patients that have tried this method report good results, with better breathing and less sinus pressure and headaches.
A recent study showed that contrary to popular belief, irrigating the nose on a daily basis over a long-tern 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 of my patients report, but there may be some good reasons to follow their recommendations. Besides the reasons mentioned above, saline acts as a mild decongestant, 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 bad as Afrin, also has a mild rebound effect. This is why some people use it 2 to 4 times every day.
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.
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 see what happens.
Since this study didn’t look at cultures or x-rays, there’s no proof that these were true bacterial infections. 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.
Do you irrigate your nose with nasal saline every day? If so, for how long? Are you having less sinus "infections" as a result of irrigating on a regular basis? Please enter your answers in the comments box below.