Neti pots: salt, steroids, baby shampoo?

People have used saline rinses for the nose and mouth for centuries, and doctors still recommend them for minor infections and pain. Rinsing helps to wash away bacteria and viruses and inactivates some of them, giving our immune system a better chance to overcome the invaders. But what's the best solution to use?

Chronic sinus problems...

When I first went to my doctor with a sinus problem that wouldn’t go away, she suggested trying a neti pot rinse with saline 3 times a day as a first treatment. While it helped clear away some of the excess mucous that was clogging my breathing, the relief was very temporary. I progressed to steroid nasal sprays that, again, gave only short-lived improvement and subsequently to an Ear, Nose and Throat specialist who gave me more steroids in a higher dose, this time in a form designed for inhalation but mixed with saline and used with a neti pot. You may remember the blog I wrote about the vertigo and tinnitus that developed after just three weeks on that regimen. On hindsight, it may have been because I used it at bedtime, thinking I would sleep better if I could breathe through my nose. Some of the solution probably stayed in my sinuses longer that it should have because I was laying down, increasing my exposure to the drug and worsening the side effects.

Through all this, I couldn’t help thinking that there must be bacteria or yeast that were the underlying problem but weren’t being addressed. My sinus problems had started right after a nasty chest infection--why would parents bring their terribly sick, coughing child into the pharmacy, infecting others, while waiting for his prescription to be filled?? We know now that masks are an excellent tool for preventing spread of infections--we should continue using them when we are ill even after the pandemic is under control. Sorry for the rant...

It took 2 courses of different antibiotics to clear my chest infection and I suspected it was a resistant organism that was at the root of my chronic sinusitis. However, I was told that we couldn’t do a culture of the sinuses to see what was going on. It was frustrating to be treating only symptoms and not the cause. Especially after my reaction to high dose nasal steroids, I didn’t relish using them for the rest of my life and worried I might eventually lose my hearing (a year later, I still have tinnitus in one ear…)

Adding baby shampoo...

So, it goes without saying that I read everything I come across about the nose and sinuses. And, a few weeks ago, I found an article about using baby shampoo in a neti pot for chronic sinusitis. Baby shampoo? Yes, but well diluted, of course, down to 1%, or one ml in 100 ml of saline. Normal saline, a solution of salt in water that is the same saltiness as tears and other body solutions, is used rather than plain water, as it is much less irritating to the sensitive lining of the nose. The writer described getting significant relief from his chronic sinusitis of many years, when nothing else had helped, by using soapy water as a nasal rinse.

Of course, I dug further into the science. Shampoos and other soaps contain surfactants, chemicals that break up surface tension, allowing oil and water to mix, and (as we all know in these days of COVID) they actually kill many infectious organisms. Some bacteria produce a “biofilm”, a film that protects them against our immune systems’ advances, making them more resistant. The surfactants in shampoo help to break up these films, allowing the immune system to do its thing more effectively. Baby shampoo is gentler than many other soaps, being designed for babies, so is chosen because it will cause less irritation in the sensitive lining of the nose.

I couldn’t wait to try it… in fact, I tried some liquid hand soap I had on hand but it was quite irritating. I don’t recommend this! But the baby shampoo didn’t irritate my nose, although I read some people do complain of this. Reducing to 0.5% might solve the problem if you experience irritation, but it might not work as well.

However, this has been a game-changer for me! I no longer have to take decongestants or steroid spray every day. In fact, I can’t remember the last time I used either. And, once the congestion was under control, I found I didn’t need to use the 1% shampoo in saline rinse every day. However, it’s safe to use daily if needed. I find that using a nasal rinse with 1% baby shampoo 2 or 3 times a week keeps everything under control for me.

So, here’s how I do it:

• I use 2 measuring cups (1 cup and ½ cup), measuring spoons (1/2 and 1/4 tsp), non-iodized salt, baking soda, and baby shampoo (preferably unscented). I find the shampoo bottle with pump attached is really convenient.

• I boil tap water and let it cool, but you can also use distilled water. Boiling kills any organisms that might be in the water and evaporates chlorine that is usually added to city water supplies. I do a kettle full, pour it into a glass jar while still hot, and store it in in my washroom with the rest of my equipment.

• Mix up some salt and baking soda–I mix 1 tablespoonful of baking soda with 1 cup of sea salt. They recommend avoiding iodized salt, as the iodine can be irritating. Note that proportions of salt and baking soda vary in different recipes, up to half and half, but I find the mixture above works fine.

• To prepare the solution, I use 2.5ml (1/2 tsp) of the salt mixture in 250ml (1 cup) of water and stir well until dissolved. Some recommend warming the water to body temperature, but I find room temperature is fine (and simpler!)

• I pour half the solution into a 125 ml (1/2 cup) measuring cup, then add 1.25 ml (1/4 tsp) of baby shampoo to the remaining ½ cup and stir well. It takes a couple of minutes of stirring for the shampoo to mix in thoroughly.

• I do a rinse with the soap solution first, then usually do a few other things, like rinsing off the equipment I’ve used and brushing my teeth (letting my sinuses “soak”, so to speak), then I rinse the soapy solution out of my nose with the remaining non-soapy saline solution.

• Make sure your equipment is thoroughly cleaned after each use. I rinse everything with hot tap water immediately after using then let air dry, and I spray with alcohol then let dry after every 2 or 3 uses. You can also just put the equipment in the dishwasher to clean everything well.

• And here is a video of how to actually do the neti pot rinse.

What about COVID-19? Can nasal rinses help?

Of course, in these days of the coronavirus pandemic, many are wondering whether nasal rinses can prevent or treat COVID-19. While it is unlikely that it could be a cure, studies have shown that saline rinses can reduce viral shedding in ordinary coronavirus infections like the common cold, making the infection less likely to spread to others. Adding a surfactant, like baby shampoo, would be expected to have a better chance to neutralize the coronavirus as it is an enveloped virus (surfactants can disrupt virus coatings, as they do when we wash our hands properly). Studies on the effects of nasal rinses on COVID-19 are ongoing (so no conclusions yet), but it's interesting that we do know the spread of influenza and common colds could be reduced somewhat, along with congestion symptoms, by using a nasal rinse with baby shampoo when infected. So, while it’s not likely to be a cure, using nasal rinses when infected may be able to reduce the risk of spreading the novel coronavirus.

Of course, wearing a mask is almost certainly far superior at preventing infection than trying to rinse the virus away could be. Once the virus has entered the nasal passages, rinsing could only be expected to temporarily reduce the virus count, even if effective, so we want to prevent it from getting into our bodies through proper use of masks and physical distancing from others.

Sore throats and minor mouth infections

Saline solution (without shampoo!) can also be used as a gargle for minor sore throat or sore mouth (such as a canker sore). It is less important to use purified water and normal saline, as the lining of the mouth is not as sensitive as the nose. I like to use lots of salt and warm tap water so it will dissolve faster when using as a gargle or mouth rinse.

My hubby swears by using salt for a sore throat or mouth sores (something he's done since he was a child), and he’s right—it really works quite well to relieve soreness and speed healing. Of course, if the pain is severe or you don’t get relief from milder pain within a couple of days, see your doctor. You may have a more serious infection. Although the solution is safe, it is recommended not to swallow it, especially if you have high blood pressure, as salt can increase pressure in some people.

So, have you tried saline rinses or gargles? Is it a family tradition? I’m wondering how many know about and use this simple at-home treatment…

References:

Impact of Nasal Saline Irrigations on Viral Load in Patients With COVID-19—U.S. National Library of Medicine

No, Mouthwashes and Nasal Rinses Aren’t Cures for COVID-19—Healthline

Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient—American Journal of Rhinology

What to know about gargling with salt water—Medical News Today

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#netipot #sinusrinse