Jala-neti

Jala-neti is the most traditional form of nasal irrigation. This method has been practised for hundreds of years by yogis (yoga practitioners). Saline is pushed into the nasal passages (positive pressure) which has the power to clear excess mucus that many be blocking the nasal passages. Jala-neti takes roughly four minutes to perform.[1]

Pros:
  • More effective and able to clear excess mucus to reach more of the nasal passages
  • Good evidence for efficacy
Cons:
  • Proper technique must be learnt in order to perform effective, comfortable irrigations

Jala-neti devices

Devices for jala-neti can themselves vary broadly in design, the main types are:

Comparison table

Neti-pots Bulb syringes Pulsatile devices
Cost 1st 2nd 3rd
Size 2nd 1st 3rd
Ease of use 2nd 3rd 1st
Ease of cleaning 1st 2nd 2nd
Control over flow 3rd 1st 1st
Volume of saline held 2nd 3rd 1st
Clearance of encrusted mucus 2nd 2nd 1st
Overall 2nd 3rd 1st

The jala-neti method

If one is to have a positive experience with jala-neti it is important that correct technique and correct saline solution is used. An incorrect solution may not only be lacking in beneficial effects but may also irritate the lining of the nose. Incorrect technique can lead to saline travelling down into the throat leading to great discomfort and coughing. What follows are descriptions of the technique to use and how to mix a good solution. It is our hope that armed with this knowledge your first experience with jala-neti will be a positive one.

Solutions

The water you use for jala-neti should be suitable for drinking and the temperature should be luke warm. The salt you use should be non-iodised (no added iodine) and should not contain anti-caking agents. Sea, pickling and kosher salt should be fine, but not table salt. The resulting saline solution once the two are mixed should be either isotonic or hypertonic (salt concentration equal to or greater than blood, respectively). Sachets of salt for jala-neti can be purchased, and provide peace of mind as the user can be assured that the salt is suitable and when mixed with the prescribed amount of water the tonicity will be as advertised. In traditional jala-neti, as performed by yogis for hundreds of years, isotonic saline is used, but there is greater evidence for the efficacy of hypertonic solutions for combating the symptoms of sino-nasal conditions (rhinitis, sinusitis etc.) though this comes at the expense of comfort. Luke warm water can be made either by mixing cold and boiled water, or by putting cold water in a microwave. One should always test the temperature of the saline before performing nasal irrigation to avoid scolding the nasal passages.

Technique

There are three main openings/exits to the nasal cavities, the throat and the two nostrils. When performing jala-neti one pours salt water into one nostril with the aim of having it flow back out through the other nostril (rather than down the throat). When water is poured in through one nostril it is possible for the water to exit through the other two exits, i.e. the other nostril and the throat. In order to ensure that water only flows out of the nostril the throat must be higher than the nostrils. The ideal position is when the lowest opening is the exit nostril, and the highest opening is the throat, with the entry nostril in the middle. This position can be achieved by leaning forwards, looking down slightly and then turning the head to one side. The saline (salt water) can then be poured into the elevated nostril and it should drain back out through the lower nostril. At the start of the irrigation you may notice mucus in the water, you should continue the irrigation until this ceases. At this point you may wish to turn your head the other way and repeat the process with the nostrils reversed. All this should take roughly four minutes to perform.[1]

Step by step guide:

  1. Mix your irrigation solution. The water should be luke warm and suitable for drinking. The salt should be non-iodised and should contain no anti-caking agents. When the two are mixed the resulting saline solution should be either isotonic or hypertonic.
  2. Lean over a sink.
  3. Insert nozzle of neti-pot or bulb syringe into a nostril. The connection between your nostril and the neti-pot should be water-tight, i.e. the nostril should be `plugged'.
  4. Look down at the plug hole.
  5. Turn head towards the neti-pot. So that the water pours into the nostril and flows through the nose and out through the other nostril. If using a bulb syringe you will need to squeeze it to start the flow.
  6. Breathe through the mouth whilst irrigating the nasal passages. Continue until you can no longer see mucus in the water, or until you believe you have used half of your pot (if you intend to repeat with the other nostril).
  7. OPTIONAL: Repeat steps 3 - 6 with the other nostril.

Drying

  1. Close one nostril with your finger.
  2. Snort outwards to expel residual water left in the nasal cavities.
  3. Repeat steps 1 - 2 with the other nostril.
  4. Keep leaning over the sink for a while with your nose facing downwards. This is to let any remaining water drain down towards the nostrils.
  5. Blow your nose. Consider repeating steps 1 - 3.
References
[1]
S. J. Rabone and S. B. Saraswati. Acceptance and effects of nasal lavage in volunteer woodworkers. Occup Med (Lond), 49(6):365-9, 1999.
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