How to Make a Saline Nasal Rinse (and the Water Rule That Actually Matters)

Category: Respiratory

How to make a saline nasal rinse at home: exact salt and bicarb measures, the technique, and the water safety rule that makes it safe. Never use tap water.

Traditional uses & benefits

• A constantly blocked nose, sinus pressure, and mucus sitting at the back of the throat
• A salt water rinse physically flushes the nasal passages clear
• Not swallowed, and nothing is absorbed

Ingredients

• Distilled water, or tap water boiled for 1 minute and cooled (240 mL (approximately 1 cup))
• Non iodised salt (sodium chloride) (0.5 tsp (approximately 2.5 g))
• Bicarbonate of soda (baking soda) (0.5 tsp)
• Neti pot, squeeze bottle or bulb syringe (1 device)

How to prepare

1. Prepare safe water. Use distilled or sterile water from a sealed container, OR boil tap water at a rolling boil for 1 minute (3 minutes above 2,000 metres) and let it cool to lukewarm. Never use water straight from the tap, not even in a country with a safe drinking supply. This step is not optional and it is not negotiable. 2. Dissolve 0.5 tsp non iodised salt and 0.5 tsp bicarbonate of soda in 240 mL of the prepared water. Stir until fully dissolved and clear. Aim for lukewarm, roughly body temperature. Cold solution is unpleasant and hot solution burns. 3. Stand over a sink and tilt your head sideways, so one nostril is above the other, and tip your chin slightly down. Do not tilt your head back. 4. Breathe through your open mouth throughout, and keep breathing through your mouth. This keeps the soft palate closed and stops solution going down your throat. 5. Place the spout gently against the upper nostril and let the solution flow in. It should run out of the lower nostril. Use about half the solution on this side. 6. Blow your nose gently, one nostril at a time and without pinching hard, then switch sides and repeat with the remaining solution. 7. Blow gently again to clear residual solution. Do not blow hard, which can push fluid into the ear. 8. Wash the device with soap and safe water, rinse, and leave it to AIR DRY completely before the next use. Do not put it away damp. 9. Use once daily while symptomatic. For ongoing allergic or sinus symptoms, once daily is a reasonable maintenance routine. Discard any unused solution rather than storing it.

Why it works

It is mechanical rather than medicinal. The flow physically washes out thickened mucus and inhaled allergens, thins what remains, and rehydrates the tiny hairs that sweep the nose clean.

Time to effect

For chronic sinus or allergy symptoms, daily use over 2 to 4 weeks. Symptoms lasting beyond 10 to 12 weeks, or with facial pain and fever, need a doctor.

Not right for

Not for anyone who cannot get distilled or properly boiled water, which is a hard requirement rather than a preference. Not for a completely blocked nostril, a perforated eardrum, an active ear infection, or after recent nasal or sinus surgery unless your surgeon agrees. Not for infants.

What the evidence says

Little et al. (2016, CMAJ): in a pragmatic primary care randomised trial for chronic or recurrent sinus symptoms, advice to use nasal irrigation improved symptom measures, while steam inhalation showed essentially no benefit.

Who it suits best

Best for someone with persistent congestion, sinus pressure or mucus at the back of the throat, especially with allergies, who wants a drug free option and can reliably use distilled or boiled water. Also a good fit in pregnancy, where drug options are limited.

When to take it

both

Common mistakes

• Using tap water. This is the one that can kill you and it is the most common shortcut. Distilled, sterile, or boiled for one minute and cooled. There is no version of this remedy where tap water is acceptable.
• Tilting the head back instead of sideways with the chin down. Head back sends solution into the throat rather than through the nasal passage.
• Holding your breath or breathing through your nose during the rinse. Mouth breathing keeps the soft palate closed. Nose breathing is how people end up coughing and spluttering.
• Using iodised table salt. It stings considerably more than plain non iodised salt, and the sting makes people give up on a remedy that was working.
• Skipping the bicarbonate of soda. It buffers the pH and is the difference between comfortable and unpleasant for most people.
• Blowing the nose hard afterwards, which can force fluid into the middle ear.
• Putting the device away wet. It must air dry completely between uses.
• Using a steroid nasal spray first and then rinsing, which washes the medication straight back out. Rinse first, spray second.

How we read the research

Reviewed for clinical practice in American Family Physician, and tested against steam inhalation in a UK primary care randomised trial where the rinse helped and the steam did not.

Sources

• Saline nasal irrigation for upper respiratory conditions (Rabago and Zgierska, American Family Physician) (2009): Rabago D, Zgierska A. Am Fam Physician. 2009;80(10):1117-1119. Clinical review summarising the evidence for saline nasal irrigation across chronic rhinosinusitis, allergic rhinitis and upper respiratory infection, covering technique, tonicity and adverse effects. The source for the mechanism and technique described here.
• Nasal irrigation and steam inhalation for chronic or recurrent sinus symptoms: pragmatic randomised controlled trial (Little 2016, CMAJ) (2016): Pragmatic RCT in UK primary care testing advice to use nasal irrigation and steam inhalation for chronic or recurrent sinus symptoms. Nasal irrigation showed benefit on symptom measures; steam inhalation showed essentially none. Used here both for the irrigation evidence and for the honest contrast with steam.
• FDA consumer update: Is rinsing your sinuses with neti pots safe? (2024): Standing FDA consumer guidance. Specifies distilled, sterile, or previously boiled and cooled water only, never untreated tap water, because of the risk of serious and potentially fatal infection with organisms including Naegleria fowleri. Also specifies device cleaning and air drying. This is the source of the blocking water rule.

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*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.