Pulse
Magic for Sinus Sufferers?
An old remedy for chronic sinusitis finds new popularity.
By Kim Kiser
Give credit to Oprah. About five years ago, after Mehmet Oz, M.D., did a segment on her show demonstrating the use of a neti pot for sinus sufferers and sent everyone in the audience home with one, V. Stuart Cox, M.D., an otolaryngologist with Midwest Ear, Nose, and Throat Specialists in St. Paul, started hearing from patients who wanted to know more. They asked: Can pouring warm water into your nasal cavities really prevent or alleviate sinusitis?
Although the television show popularized the use of these small ceramic or plastic devices that look like Aladdin’s magic lamp, this Auryvedic medicine technique, known as jala neti, has been practiced throughout India for centuries. Cox says references to neti pots or other forms of sinus irrigation began appearing in the medical literature about 20 years ago. “There’s actually a fair amount of literature that shows it’s helpful,” he says.
The Correct Solution
Most people who use a neti pot to irrigate their sinuses use a solution of one-quarter teaspoon of uniodized salt to 8 ounces of lukewarm water, according to MayoClinic.com. Some use hypertonic saline—a solution that uses two to three times the amount of salt as normal saline solution. “There’s not a lot of information showing a big advantage to hypertonic,” says V. Stuart Cox, M.D., an otolaryngologist with Midwest Ear, Nose, and Throat Specialists. “And I find that people tolerate normal saline better.”
And what about adding grapefruit seed extract, oregano oil, or other substances to the water? “A lot of people ask about these things, thanks to the Internet,” Cox says.
He says there are a few anecdotal reports about grapefruit seed extract and oregano oil having a mild antifungal effect. “But there are no big studies showing any difference over saline. In general, most studies show that it’s the washing of the sinuses that’s making the difference, not the oregano or grapefruit seed extract.”—K.K.
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“If you look at the meta analysis studies of nasal irrigation—salt water, saline, or hypertonic saline delivered through a sinus rinse bottle or neti pot—the universal evidence is that it decreases sinus symptoms, and there’s some evidence that says it probably decreases the number of infections for people with chronic sinusitis,” he says. One 2009 report out of Watergate Allergy & Asthma Center in Washington, D.C., that received considerable press contradicted the literature and suggested that daily use of saline irrigation could actually cause infections, the idea being that it may wash immunoglobulins from the sinus cavity. But Cox says the study didn’t specify whether participants had acute or chronic sinusitis.
He says the people for whom nasal irrigation is most useful are those who suffer from chronic sinusitis—that is, their symptoms persist for most of the year, rather than just during the cold and allergy seasons. He says the theories are that mechanically bathing the sinuses clears away mucus and that it also may improve ciliar function so that the cilia can more effectively remove allergens or other irritants.
“Over the last 10 years, there has been a significant advance in our understanding of chronic sinusitis,” Cox says. “The new model is that it’s an autoimmune disease rather than one caused by an infection, so the new treatments hinge on that understanding.” He says about 20 percent of the chronic sinusitis patients in his practice undergo surgery to restore patency of their sinuses in cases where there is a blockage. They also are treated with frequent cleansings in the office and intranasal or oral steroids, as well as antibiotics when they have flare-ups.
As for where saline irrigation fits into their treatment regimen, “I tell patients if they have chronic sinusitis to use it daily,” Cox says. “For people who get occasional colds, I don’t recommend it. However, if they use it, it probably helps their symptoms; but it doesn’t shorten the duration of their cold.”