Many ENTs (Otolaryngologists) encourage their patients to wash their nose with saline for nasal care and treatment for various kinds of rhinitis and sinusitis; it is also recommended for to be used for post surgical recovery. Many medical researches also support the effectiveness of warm saline nasal irrigation for sinusitis, allergic rhinitis, post nasal drip, rhinitis, common cold…etc. However clinic patients often ask: “Some nasal irrigator retailers claims that you have to use their natural sea salt, not saline for nasal irrigation, it that true?”
In reality, this is just a marketing scheme. None of the solutions used is completely identical to the nasal fluid, but we will want to use something similar. Traditionally, saline is used as a standard, which of course is not identical to the human tissue fluid, but contains similar elements and osmotic pressure. Using saline for nasal irrigation, eyes irrigation, vagina irrigation, urethra irrigation…etc will not cause mucosal tissue damage.
When I tried to get a better understanding of the use of sea salt, I researched many medical research reports and nasal irrigator manufacturer websites, I discovered something interesting. The manufacturers, who claim the need to use natural sea salt, and many of the published medical researches are both from Europe, yet these medical researched published by Kiehl, MD. and others suggests that using natural sea salt has no effective advantage over regular saline. Many doctors from the US suggest using saline or isotonic saline solution. Researches show that these two solution are equally effective, but isotonic saline solution is slightly basic (saline slight acidic), which makes it more comfortable to use. I have consulted several doctors with extensive studies on this matter; Dr. Grossan suggests that since sea salts have no advantage over saline, it’s more expensive, and the possibility of containing feces and waste from ocean organisms might damage the delicate nasal mucosa, he doesn’t recommend using natural sea salt for nasal irrigation. Dr. Davidson from UC San Diego ENT suggests that the important thing is to use nasal irrigation diligently, and he also suggests using regular saline.
Confirmed in laboratory studies, the only solution that is better for nasal ciliary movement than saline is the Ringer solution, which is commonly used in clinical studies. The Ringer solution is more complex than isotonic solution, however there is currently no clinical reports comparing the effectiveness of the Ringer solution and regular saline. Since it is not easy for most people to prepare their own Ringer solution, I would still recommend using saline or isotonic saline for nasal irrigation. The recipe for saline is 9 grams of salt mixed in 1000 cc of water; isotonic saline contains 6 grams of salt and 3 grams of baking soda in 1000 cc of water. Non-iodine salts and baking soda can both be bought from your nearby grocery stores. For treating rhinitis or sinusitis, we recommend using 1000 cc for every morning and evening. Making your own saline is cheap, safe and effective, however if you buy those natural sea salt for nasal irrigation, the cost could burn a hole in your wallet. As an advocate for nasal irrigation, and for the sake of the patients, I would recommend using saline or isotonic saline for nasal irrigation.
Shyhung Clinic, Dr. Tseng Hung-cheng