Did your mother tell you to wash your ears? We’ll bet she did. Did she tell you to wash your nose? We’ll bet she didn’t! Moms and dads around the world, add this chore to your list. Teach your children to wash their noses. They’ll be healthy, and so will you.

Washing your nose with a strong saline solution, which we call nasal lavage or irrigation, protects against a variety of illness-causing pathogens, including COVID-19. For a summary of the research supporting this statement, see Your Nose: COVID-19’s Royal Road This post deals with the history of nasal irrigation or nose washing, the safety of nasal irrigation, and the techniques and devices that are available.

The image at the top of the post is an 18th century Nepali anatomical painting of the organs and vessels of the male body per the Ayurveda. The image is being viewed at a Wellcome Library exhibition.

Terms

We’ll use three terms here— nasal cleaning, nasal irrigation, and nasal lavage. The terms are interchangeable, but the most fastidious among us prefer the term nasal lavage.

A Quick Look at the Nasal Sinuses

Diagram of maxillary sinuses with and without a sinus infection. Diagram shows the size and location of the sinuses.

This image shows the healthy sinuses to the left and the infected sinuses to the right. This image is advertising by Vicks.

Your nasal sinuses are distributed from your eyebrows into your cheeks, and they are divided into frontal, sphenoid, ethmoid, septal, and maxillary. When a saline based cleansing fluid enters the nose, it fills all of the sinuses before exiting out of the other nostril or downward into the mouth. The sinus cavity holds approximately 40 milliliters of fluid.

Ancient Practice of Washing Your Nose

Are you ready to learn how to wash your nose? Nose washing is not part of the western tradition. Let’s start with where nose washing originates. As best we can determine, nose washing is part of the cleansing rituals of the East.

Picture of man cleansing his nose using the jala neti practice.

Yoga practice of the neti or nasal cleansing prepares the body and mind for meditation. Nasal irrigation to cleanse nasal sinuses is more than 5,000 years old. Sutra Neti practice is shown.

Introduction of Nasal Cleansing Devices

The two main types of nose washing are Jala Neti and Sutra Neti. In the Sutra Neti practice, a specially treated string is drawn from the nostrils through the mouth. Needless to say, a little supervision and training is recommended when using this method. This method will not be discussed here.

Picture of man cleaning his nose with a traditional neti pot.

Jala Neti uses a vessel to pour a fluid from one nostril to the other. The photo shows a traditional Neti Pot.

The traditional Jala Neti cleansing used ghee, milk, or water. Now, isotonic saline is the most commonly used nose washing fluid. In the traditional cleansings, sometimes the fluid was snorted in a rhythmic fashion. Neti Pots range from simple ceramic teapot like vessels to elaborately decorated vessels made of metal. See a simple pot in the photo.

Mass Marketing of the Neti Pot or Nasal Bidet

The Yoga International magazine introduced the Neti Pot to the U.S. in 1972. The pot was recommended to Hatha Yoga students as a way to improve spiritual practices. In 2007, Dr. Oz and Oprah Winfrey gave the Neti Pot a publicity boost and a new meaning. The “nose bidet” as Oprah called it could help people with sinus problems.

After the television publicity, the Neti Pot rose in popularity for sinus sufferers. Drug stores complained that they couldn’t keep the Neti in stock. Since the Neti Pot, all manner of machines, bags, pots, squeeze bottles are marketed to clean the sinus cavities.

Overcoming the Ick Factor!

If you watched the demonstration on the Oprah Winfrey show, you’ll remember the audience reaction. Everyone gasped in disbelief and a bit of disgust. We’ve been trained since childhood that we should keep things out of our noses! No sane person washes their nose!

You’re right to be a little reluctant to put fluid up your nose. Using a Neti Pot can help you, but improper use can kill you.

Medical History of Nasal Irrigation as a Treatment

Washing the nose with a salt solution found its way into Western medicine in the 1930’s. A Polish scientist, Alfred Laskiewicz, used nasal irrigation to treat a number of medical conditions as well as a way to improve hygiene. He described the Proetz procedure. For many years, this procedure has been used by ear, nose and throat surgeons to clear the sinuses.

Vintage drawing in black and white of woman using the traditional douche method for nose washing.

Vicks marketed its version of a nasal irrigation device in the 1920’s

Nasal cleaning devices used through the years include gravity flow vessels, pressure bottles, pressure machines, misters or nebulizers, IV bags, squirts, flushers, bulbs, syringes, squeeze bottles, and turkey basters. These devices were used to relieve discomfort among sinus sufferers, and the medical literature supporting their clinical use in treating sinus infections or to improve recovery after nasal surgery is established.

Use of Nasal Lavage to Prevent Illness

Recently medical science has recognized that washing your nose might prevent illnesses such as viral infections and bacterial infections. Here medical science has lagged behind alternative medicine. The literature supporting the use of nasal lavage as a preventive treatment is more limited as a result. Nasal lavage is important in the new age of animal to human viruses such as COVID-19. As humans crowd into animal populations, we are exposing ourselves to new viruses with which our bodies are unable to contend. Read more on COVID-10 and nasal lavage in this post. Your Nose: COVID-19’s Royal Road

A Historical Aside

Here’s a bit of history which you can skip if you’re eager to get to the recipes. The historical aside shows how new infectious diseases can destroy populations. This literature shows us the importance of learning new hygiene procedures. Nasal lavage is not a trick or a gimmick. It is a potentially life saving procedure which we are likely to need as new populations of viruses move through the countries of the world.

Small Pox and the Native American

Vintage Hudson Bay blanket made in England.

Vintage Hudson Bay Blanket is an iconic symbol in Canada. Do you want to wear this blanket? Some don’t.

The influx of Europeans into relatively virgin land brought two different human immune systems into direct communication with devastating consequences to the native population. While smallpox was a difficult disease for the acclimated European, Lady Smallpox did not necessarily kill its victims. The situation was different for the indigenous population. They had little immune defense against the pathogens.

The story of smallpox is not always told in U.S. history books, but it is well known to Canadians. A common story is that the Hudson Bay Company traded smallpox infected blankets to the Native Americans. Follow the link to a website and podcast on this history.

https://www.cbc.ca/radio/secretlifeofcanada/why-some-folks-feel-weird-about-hudson-s-bay-blankets-1.4846059

Smallpox May Have Been the First Biological Warfare

In June 1763, Chief Pontiac besieged Fort Pitt. Soldiers and civilians in the fort had smallpox. During a parlay, Native Americans were given two blankets and a handkerchief brought out of the the Smallpox Hospital. Those who provided the blankets wanted to get rid of the troublesome Indians by infecting them with a highly contagious and lethal disease. One of the participants said the following about the distribution of infected blankets:

“I hope it will have the desired effect.”

From land speculator William Trent’s diary.

Decide if you believe that disease was used as a weapon in the U.S. https://daily.jstor.org/how-commonly-was-smallpox-used-as-a-biological-weapon/

Exposure to Unfamiliar Viruses can be Catastrophic.

Vintage drawing of Aztec Indians infected with smallpox.

Smallpox and the Aztec Indian (vintage drawing)

Whether or not using disease to kill off the opposition was used, the Native American Population was decimated by European arrival on the continent. From the initial contact between the populations in 1500, the Native American population declined significantly. Early estimates of the number of Native Americans are unreliable. Numbers range from one million to 19 million in 1500. By 1900, counts were more reliable, and there were 530,000 Native Americans (or approximately a loss of 50 to 95% of the Native American population). The spread of disease to a population without immunity was not the only cause of Native American population decimation.

Read more about this history in Wikipedia. https://en.wikipedia.org/wiki/Native_American_disease_and_epidemics

Which Type of Nasal Lavage Is Better?

Sad to say, but there is no clear answer to this question. The sinuses may be cleansed with positive or negative pressure. Positive pressure devices bring the fluid into the sinuses. Negative pressure devices (nebulization) pull fluid from the sinuses. In general, nebulization devices do not work as well as positive pressure devices (Bastier et al., 2015).

The widely advertised Navage nebulizer is shown below. The device uses suction– in one nostril, through back of nose, and out the other nostril.

Navage nasal care device photo

Navage Nose Cleaner | Lowest Price starter kit is $89.95

Disadvantages of Navage System

To use a Navage, you must buy their nasal protection pods to make the system work. This restricts you to an isotonic solution that is insufficient for flu and cold protection. Their solution is okay for sinusitis. The machine requires batteries, and there are lots of parts to keep clean.

You can follow this link for an excellent review of the Navage system. Navage Nasal Irrigation Review 2020 and Tests – Does it Really Work? (sinuscure.org)

Sinupulse Advanced Nasal Irrigation System Elite

The Sinupulse uses a pulsating water source. It has tongue, throat, and sinus applicators. It uses large packets of isotonic saline, and these aren’t good enough for flu protection.

The cost of the Sinupulse starter system is approximately $79.95. Research on the Sinupulse may be found here. Clinical research into nasal irrigation and the SinuPulse Elite – SinuPulse UK

SinuPulse Elite Review 2019 -The Best System for Nasal Irrigation? (sinuscure.org)

Other Advantages and Disadvantages

The Sinupulse is heavy, and it weighs more than 3 pounds. It takes up precious bathroom counter space and an electrical outlet. The device isn’t good for travel or wall mounting. Lots of parts to keep clean. The device does hold a large amount of fluid, and you can use the Sinupulse to clean your tongue and throat as well as the sinuses. The machine uses isotonic saline, and this is good only for sinusitis.

Costs $89.95 Nasal Irrigation System | SinuPulse

Douche Delivery

The squeeze douche delivery bottle and the Neti Pot are the most widely used delivery systems. Watch the YouTube video of the NeilMed squeeze bottle system.

You can’t beat the price of the NeilMed. The starter kit is $6.99.

The Netipot style is demonstrated on Your Nose: COVID-19’s Royal Road

Nasopure Douche Delivery System

The Nasopure system, its use and its benefits are described in the YouTube Video. The major difference between NeilMed and Nasopure is the direction of the water delivery. NeilMed pushes saline solution up into sinuses. The Nasopure system directs saline back rather than up. It isn’t clear whether there the flow direction makes any difference in cleansing.

The Nasopure starter kit sells for approximately $15.00.

The Nasopure reference link is Nasopure Studies & References

Other Advantages and Disadvantages of Nasopure

The Nasopure starter kit is inexpensive, and it is available in both child and adult sizes. Nasopure is not sold by as many pharmacies, so you may have to buy online. Nasopure does sell a solution..

What’s Wrong with an Isotonic Solution?

If you are treating a sinus infection, an isotonic solution is just the ticket. The solution is at the same pH as the body fluids, so you won’t further irritate sinus membranes.

If you are using nasal lavage to reduce the likelihood that you will contract a virus or to reduce the severity of a viral infection in the nose, an isotonic solution may help a little. However, research results are clear. More salt in the solution or a hypertonic solution kills more viruses. You want as much salt as you can tolerate in the solution. Read more about salt content and virus survival here. Your Nose: COVID-19’s Royal Road

Is Nasal Lavage Enough to Slow a Virus?

The answer is “No.” Nasal lavage works best against viral infections when it is paired with hypertonic gargling. Gargle with a warm hypertonic solution.

Does Time Make a Difference?

The best time to do a nasal lavage is in the evening. The boluses of infected mucous move into the lungs at night. You can do nasal and mouth lavage as often as you want, but don’t skip the bedtime wash.

Contraindications to Nasal Lavage

Don’t use nasal lavage when

  • You have an ear infection
  • You are prone to nosebleeds
  • You have nasal obstructions or tumors
  • You are about to go outside.

Some experts suggest that it is best to wait 30 minutes before going outdoors to avoid supercooling of the sinuses.

Making Your Own Solutions

We’ve gathered a few recipes. The recipes share two things in common.

  • The recipes do not use tap water. They do not use filtered water. They use distilled, purified, or boiled then cooled water.
  • The recipes call for kosher or sea salt. Table salt contains iodine and is an irritant.

You must boil water before using it in a nasal rinse formula. You must use the water as soon as it has cooled. You cannot use filtered water to substitute for distilled or purified water.

Never Use Tap Water or Filtered Water to Wash Your Nasal Cavity

What Can Happen If You Use Filtered or Tap Water as a Nasal Lavage Solution?

Organisms in water can make their way into your brain and throughout the body. Once in the brain, these critters cause all kinds of trouble. Let us introduce you to Balamuthia Mandrillarius, an amoeba that lives in soil and ought to stay there.

Microscopic picture of brain that was infected by amoeba. The patient had washed her nose with tap water.

Green arrow shows one of many amoebas in the brain of a patient who’d died of brain infection.

Balamuthia Mandrillarius was discovered in 1990, and the amoeba has been associated with more than 100 cases of disease in South, Central, and North America, Asia, Australia, and Europe.

Case Study 1: Filtered Water

A 69-year-old Swedish woman developed acute recurrent maxillary sinusitis. She was tried on medication, but she did not get relief. An otolaryngologist suggested that she try saline irrigation. She was told to use only sterile water, but she used tap water which she had filtered with a Brita water filter. After a month, she developed a quarter-sized red raised rash on the right side of her nose. Medications were tried, but these did not help.

Approximately one year later, the woman had a focal seizure with left arm weakness. A 1.5 cm lesion was identified on a CT scan, so she underwent removal of the lesion. The lesion was biopsied, and the biopsy identified Balamuthia Mandrillarius (Piper et al., 2018).

Cases 2-4: Tap Water

A woman and a man from Louisiana died from brain infections caused by another amoeba, (Naegleria fowleri). The only thing they had in common was using tap water in a Neti Pot to clean their sinuses. https://www.cbsnews.com/news/tap-water-in-neti-pots-behind-two-brain-eating-amoeba-deaths-in-2011-investigation-finds/

A Seattle woman developed a brain infection due to sinus cleansing with contaminated water. The amoeba was Balamuthia. https://www.usatoday.com/story/news/health/2018/12/07/neti-pot-tap-water-caused-womans-deadly-brain-infection-report/2236681002/

No matter how busy you are, do not take a chance of getting something perhaps more lethal than COVID-19 or the flu. Never use tap or filtered water!

Buffered Isotonic Saline Formula for Sinusitis

  1. 1/4 teaspoon kosher salt
  2. 8 ounces or 1 cup distilled water (boil it and cool it for extra safety)
  3. pinch of baking soda

The baking soda buffers the salt. We’re not sure what this does to efficacy of salt against viruses. We do not use buffered solutions for that reason.

Hypertonic Saline Formula for Prevention

  1. 8 ounces or 1 cup of distilled water which has been boiled and cooled or purified water.
  2. 1/2 to 3/4 heaping teaspoons of kosher salt
  3. 1/4 teaspoon baking soda (if you want a buffered solution)

Baby Shampoo Formula

Baby shampoo is a safe additive to saline washes. It functions as a surfactant when a small amount is added to an isotonic saline rinse. The baby shampoo may clear the sinuses and nasal passages. Viruses hate soap!

  1. 1/2 teaspoon baby shampoo
  2. 8 ounces or 1 cup isotonic saline solution made from purified or distilled water (Boil it!)

A Word About Humidity

To optimize the health of the mucous level of the nose, pay attention to the humidity level in your environment. Dry air decreases mucous thickness and cilia mobility and the associated protective immune responses of your body. A humidity level of 45% is ideal.

Are You Ready to Wash Your Nose?

Add nose washing to your personal hygiene routine. Whenever you feel that little tickle at the back of your throat or find yourself sniffling or sneezing, increase the amount of salt in the cleansing solution and wash your nose several times per day. Don’t forget to gargle. Happy snuffing!

References

Bastier, P.-L., Lechot, A., Bordenave, L., Durand M., de Gabory, L. (2015). “Nasal irrigation :From empiricism to evidence based medicine. A review.” European Annals of Otorhinolaryngology 132: 281-285.

Piper, K. J., Foster, H., Susanto, D., Maree, C. L., Thornton, S. D., Cobbs, C.S. Fatal Balamuthia Mandrillaris brain infection associated with improper nasal lavage. Int. J. Infect. Dis., 77, 18-22.

Linda J. Gummow

Linda J. Gummow

L. J. Gummow, Ph.D. and Robert E. Conger, Ph.D. are Clinical Psychologists. L. J. lost 25% of her body weight by following by reducing carbohydrates. In the process, she learned that much of what we're taught about weight loss is wrong. She and her co-author researched weight loss diets and the results show that sugar consumption is our public health enemy number one. R. E.

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