Nervous Neti? Not If It’s Nice!

Overcoming fears about nasal washing
By Hana R. Solomon, MD

For years we have been reading about and recommending nasal washes for the maintenance of good health. We know that it makes sense to clean the body’s respiratory filter and to keep the cilia healthy so they can function well. Washing with saline solution removes offending particles caught in the nose, helping prevent allergic reactions and respiratory illnesses. And while all this makes perfect sense, many of our patients still resist the idea and the actual practice of washing their noses.

Fear is usually the first obstacle. Many people with nasal woes are scared of pouring water into their nostrils. They fear a feeling of drowning, they may not understand that the water cannot get into the brain, or they simply gross out at the idea of mucous and boogers.

I have found that the key to teaching this to someone else is to be comfortable with washing your own nose. Before you talk to your kids about it, practice and get your technique down pat. It only takes about three minutes to demonstrate if you have the right equipment handy. The right nasal wash system can make all the difference, not only in compliance but in comfort and effectiveness.

First, let’s look at the neti. These can be easy to use, but have a downside. The neti requires gravity for an effective wash. The washer must bend over, turn their head to the side, and pour the solution into one nostril hoping it will flow out the other side. This maneuver is difficult for some people.

One solution is to use a power system that pulses water through the nose. Not user friendly, these systems eliminate the need to rely on gravity, but at the cost of patient control and ease of use.

A variety of squeeze bottles are available, and some can provide great control and convenience, though not all are comfortable and effective. Well-designed tips can create an effective seal against the nostrils to prevent backflow. Some have straws and encourage the patient to direct the flow straight up into the nasal cavity. This is misdirection because straight-up flow is more likely to shoot the contaminated contents of the nose right into the sinus cavities.

The best, most comfortable, and most effective systems I have found encourage flow along the floor of the nasal cavity (aimed to the level of the ears, not the eyes). This washes the solution past the sinus openings, effectively drawing out the contents and washing them away. The right direction of flow also washes past the Eustachian tubes, opening and decongesting the ears instead of filling them with solution.

I get a lot of patients asking if they can just make their own solution with table salt. My answer is, “Yes but the magic is in the mix. You may not create the right concentration so it may irritate your sensitive mucous membranes.”

For the best experience, I encourage everyone to use high quality premeasured packets of buffered salt, mixed with warm clean water. Start out with an isotonic (the same pH as the nose) mix to get used to it, and then gradually move on up to hypertonic (saltier than the nose) for the most effective washing experience. This works even with my two-year-old’s stuffy noses!

Keep yourself healthy by getting a good washing system, learn to use it well, and then share your talents with others. They will thank you for it.

 

Hana R. Solomon, MD, (aka Dr. Hana) is a board-certified pediatrician and the author of Clearing the Air One Nose at a Time: Caring For Your Personal Filter.