Advanced More Effective Nasal Irrigation (Jala Neti) Technique

[Hip]

Years ago I devised a more effective "advanced" technique of nasal and sinus irrigation.

In this thread I am going provide details of this technique, in case it is useful for anyone with chronic sinusitis or other sinus issues. My technique gets a lot more saline solution (salty water) into the sinus cavities, so this advanced technique should be better at clearing out sinus infections and sinus toxins.

I will call my method inversion technique nasal irrigation, to differentiate it from regular nasal irrigation.

Nasal irrigation has a long history in Indian yoga, where it is called jala neti. Medical nasal irrigation is effectively the same as jala neti. But the standard nasal irrigation / jala neti approach is not very efficient, because although it irrigates the nasal cavity well, it does not get a sufficient quantity of saline solution into the sinus cavities.

The images below show the standard approach to nasal irrigation / jala neti.

Left: nasal irrigation using NeilMed sinus rinse bottle. Right: jala neti using neti pot

When you irrigate your nasal cavity using the standard technique, not much saline gets into your sinuses because the sinus cavities are separate chambers connected to the nasal cavity by tiny openings or holes. These narrow openings connecting the sinuses to the nasal cavity are called ostia (singular: ostium).

In the nasal cavity image below, the black dots represent the sinus ostia. When you use nasal irrigation, the saline has to pass through these tiny holes in order to enter the sinuses. But because the holes are so small, it is difficult to get the saline solution to pass through them.

Furthermore, several of these ostia are located on the top part of the nasal cavity, which may thus be above the water line in your nose as you irrigate the nasal cavity with salty water. So it may be impossible to get the saline through these higher ostia.

Not only that, but since most of the sinus cavities are positioned above the nasal cavity, standard nasal irritation will get very little saline into these higher sinuses, as water does not travel upwards against gravity. But inversion technique nasal irrigation is able to irrigate these higher sinuses.

The nasal cavity: the black dots represent
the tiny openings (ostia) into the sinus cavities

Image source: here​

To try to get the saline to flow into these higher ostia in the nasal cavity, my first thought was to invert my head upside down while my nasal cavity was filled with saline.

To do this head inversion, I first filled my nasal cavity completely full with warm saline using a neti pot (done by looking upwards towards the ceiling while pouring in the saline). This I did while breathing through the mouth, because when you breath through the mouth, your nasal cavity becomes sealed off from your windpipe, so the saline you pour remains in your nasal cavity (it does not run down your throat). Once the nasal cavity was filled with saline, while still looking upwards, I then held my nostrils closed by pinching my nose with thumb and forefinger.

Finally, with the nose still pinched closed, I tucked my chin into my chest, and bent downwards until my head was level with my knees. This effectively inverts the head upside down. In this bent downwards body position, your nasal cavity is effectively rotated upside down like this:

Your nasal cavity when your head is inverted upside down
and filled with saline

​

If the nasal cavity is fully filled with saline before you invert your head, the sinus ostia will all then be immersed underwater once you place your head upside down (the blue area in the above image shows the salty water in your nasal cavity; you can see that all the ostia are well below the water line when the head is inverted).

However, even in this upside down position, I found that not much saline gets in to the sinuses. And I realized why: it is because the sinus cavities are full of air, and the air cannot get out very easily, as the sinus openings (ostia) are very small. So if the air cannot escape, this means the saline cannot get in to the sinuses.

But there is an easy fix to this: while in this head upside down position, and with the nasal cavity full of saline, and with your nose still pinched closed, you close your mouth also, and then exert a suction or vacuum within your nasal cavity, by strongly breathing in with your lungs. Note: as long as you are upside down, the saline will not run down your throat.

Hold this suction for say 10 seconds, and then release the suction, re-open your mouth, and continue to breathe normally through your mouth for 20 seconds or so. But remain with your head inverted, down by your knees. And keep your nose pinched shut. Then repeat the process: close you mouth again, and create the suction again. You want to repeat this cycle several times.

Let me explain what happens during this suction process: while you are holding that suction for 10 seconds, air is pulled out of your sinuses through the ostia, and bubbles out into the saline in your nasal cavity. Then when you later release this suction, the saline in the nasal cavity rushes back through the ostia, into the sinuses to replace the air just sucked out. So in this way, you are able to get saline into your sinus cavities very efficiently.

Once you have repeated this suck-release cycle several times, and your sinuses are then filled with saline, you are nearly done. You can now stand up straight again, and just gently clear the excess saline out of your nasal cavity, and take a break for a minute or two, allowing the saline in the sinuses to do its job of purging and cleaning out the sinus infection or toxins.

After a minute or two's break, the final task is getting the saline out of the sinus cavities. This is easy, all you do is this: continue standing upright, and again pinch your nose closed so it is airtight, and again suck to create a vacuum in your nasal cavity. Create a nice strong suction, and this will pull most of the saline back out of your sinuses and into your nasal cavity. Then you can just blow this saline out into the sink, or into a tissue.

You can also choose to wait a little longer than just a minute or two before you suck out the saline from your sinuses. You might like to wait say 20 minutes or so, to give the saline a longer time to do its job in the sinuses.



I have used this inversion technique nasal irrigation hundreds of times over many years, and find it works well for cleaning out the nasal and sinus cavities.

Note: after doing this advanced nasal and sinus irrigation, you may find little runs of saline occasionally coming out of your nose over the next few hours. This is a good sign, as it means you did a good job in filling your sinus cavities with saline, and it's just the last remaining drips of saline from the sinuses that are coming out slightly later.

It is advisable to use distilled, sterile or previously boiled water (boiled for 3 to 5 minutes) when performing nasal irrigation, as tap water (even when chlorinated) can contain organisms which very rarely may produce a serious infection in the nose and brain.

I decided to create a website detailing this: Nasal Irrigation (Jala Neti) — The Inversion Technique.

 

[Hip]

Great diagram showing the locations of the various sinus cavities:

Image source: here

Note that several sinus cavities (the frontal, ethmoid and sphenoid) are located above the nasal cavity, and since water does not travel upwards against gravity, standard nasal irritation will not get much saline into these high sinuses. But the inversion technique nasal irritation is able to fill all the sinus cavities with saline.



And this is an excellent YouTube video showing the positions of the various sinus cavities (worth watching the first minute of this video):

 

[YippeeKi YOW !!]

@Hip
Thank you for posting this technique, which I'm definitely going to try tonight if I can. May have to wait til my balance is a little better.

Your usual excellent post, and very helpful for those of us constantly battling nasal/sinus congestion.

 

[Rebeccare]

One thing I'd like to add to @Hip's suggestion is that, if you do irrigate your sinuses it's a good idea to use either distilled water, sterile water (you can purchase these by the gallon at most pharmacies), or water that you have boiled for at least a few minutes and let cool. There can be small levels of bacteria and other organisms in tap water, and although these are safe to drink it is possible that they could cause infection in the nasal passages and sinuses.

Also, it's good practice to rinse out the neti pot or bottle and dry it completely after each use to discourage bacteria growth. If you irrigate you want to make sure that you're getting rid of infection in your sinuses, not inadvertently causing a new one!

 

[junkcrap50]

This is very similar to the "Flip Turn Sinus Flush" technique (see link below), but creating a vacuum to get water to enter the other sinuses is a great insight.

https://www.medhelp.org/user_journals/show/2322/The-Sinus-Flush

 

[Hip]

if you do irrigate your sinuses it's a good idea to use either distilled water, sterile water (you can purchase these by the gallon at most pharmacies), or water that you have boiled for at least a few minutes and let cool. There can be small levels of bacteria and other organisms in tap water, and although these are safe to drink it is possible that they could cause infection in the nasal passages and sinuses.

That's a good point. I've always used tap water (which in my area contains both chlorine and chloramine as disinfectants) in which I place some salt, and never had any trouble, but it's probably wise to use distilled or sterile water.

Looking at the FDA website, they say that nasal irrigation is usually safe and effective products, but they recommend using distilled, sterile or previously boiled water (boiled for 3 to 5 minutes). They say some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections.



Interestingly enough, about 25 years ago, I managed to completely cure my pretty bad hay-fever by using this advanced inversion technique of nasal and sinus cleaning, along with taking lots of echinacea, vitamin C and gamma hydroxybutyrate (GHB), a supplement which was legal to buy at that time (GHB is also known as sodium oxybate or Xyrem).

Though I suspect GHB did most of the work, as GHB greatly increases growth hormone output, and growth hormone has been shown to prevent autoimmune diabetes, so perhaps may also modulate the immune system to quell allergies.

 

[Hipsman]

I tried this technique 3 times with 0.5% NAC. It helps noticeably, but It's really hard to keep my head inverted between knees, I have to support myself with a chair, but last time I gave up after 10 sec in that position. Also, I feel pressure and pain on forehead and sinuses for about an hour after. Have you experienced something like this too? And is 0.5% NAC supposed to taste salty?

 

[Hip]

Also, I feel pressure and pain on forehead and sinuses for about an hour after.

I have not experienced any side effects like that myself, but the Wikipedia article on nasal irrigation says:

Adverse effects include nasal irritation, nosebleeds, headache, and drainage after the irrigation is done. It is generally well-tolerated.

Are you using saline for your nasal irrigation, or just water? Water alone can be slightly irritating to the mucous membranes, because of the osmotic effects. Fluids within the body have the same salinity as physiological saline (physiological saline has 9 grams of sodium chloride per liter). So to minimize irritation it is best to make up some physiological saline and use that for nasal irrigation.

Then if you also want to add the NAC to the saline, you can do so. But it might be an idea to start with pure saline first, and see how that goes for a few weeks, before adding NAC.


You do not have to stay a long time in the inverted head position, just enough time to allow the saline to be sucked into your sinus cavities. Even 10 seconds I think should be enough.

 

[Hipsman]

Are you using saline for your nasal irrigation, or just water?

I was using boiled water, I will try it with sodium chloride now, thank you.

 

[Hipsman]

I tried this with only sodium chloride 0.9% and didn't feel any side-effects at all, also standing with my head inverted was easy this time. later the day I tried 3 more irrigation solutions:
1)sodium chloride with salt - it was the same as with sodium chloride only.
2)Boiled water only - also the same as sodium chloride only.
3) sodium chloride with NAC - I got immediate reaction, a very salty and acidly feel in nose. I immediately had to stop.

Ether I can try NAC 0.2% solution or problem is in NAC that I'm taking (this one), one capsule has:
NAC 600mg
Selenium (from L-Selenomethionine) 25 mcg
Molybdenum (from Sodium Molybdate) 50 mcg

Maybe Molybdenum or Selenium are causing side effects?
What NAC would you recommend for this? I though of this one.

 

[gbells]

One thing I'd like to add to @Hip's suggestion is that, if you do irrigate your sinuses it's a good idea to use either distilled water, sterile water (you can purchase these by the gallon at most pharmacies), or water that you have boiled for at least a few minutes and let cool. There can be small levels of bacteria and other organisms in tap water, and although these are safe to drink it is possible that they could cause infection in the nasal passages and sinuses.

Also, it's good practice to rinse out the neti pot or bottle and dry it completely after each use to discourage bacteria growth. If you irrigate you want to make sure that you're getting rid of infection in your sinuses, not inadvertently causing a new one!

According to the neti pot instructions they recommend tap water sterilized in the microwave.

 

[Hip]

I got immediate reaction, a very salty and acidly feel in nose.

Anything that is acidic (has a tart taste) will sting like hell if the pure compound is placed in the nose (I once experimentally snorted a small amount of ascorbic acid powder into my nose, and had to immediately rush to the bathroom in excruciating pain to try to wash it out!).

If you taste N-acetyl-cysteine (NAC) powder from a capsule, it has a strong acidic taste, so you know this will sting in the nose unless greatly diluted. It may be that your 0.5% dilution is not sufficient. Perhaps try 0.05% or lower and see if that is better tolerated.

Remember with this "advanced" nasal irrigation technique, you get a lot of liquid into the sinus cavities, and this liquid can remain in these cavities for hours afterwards. When I have finished doing this nasal irrigation, I usually blow most of the liquid out of my sinuses. I do this by turning my head through various angles (especially ear-facing-towards-the-floor angles) and blowing my nose, which flushes a lot of the liquid out. Even then, you still get small runs of liquid coming out of your nose in the subsequent hours.

But you can also choose to leave the saline liquid in the sinus cavities for some hours afterward, by omitting this flushing step. So then the liquid will be present in your sinuses for some hours. So although you may use a low concentration of NAC, it will be working for some time in the sinuses.


I would not have thought the molybdenum or selenium would be an issue, as these are not acidic. But it might be better to obtain a pure NAC supplement like the one you linked to.

 

[Hipsman]

Perhaps try 0.05% or lower and see if that is better tolerated.

Yea, I tried around 0.2-0.1% and it's tolerable.

 

[Cipher]

@Hip Have you compared the effects of hypertonic saline to isotonic saline in the context of nasal irrigation?

 

[Hip]

@Hip Have you compared the effects of hypertonic saline to isotonic saline in the context of nasal irrigation?

You can increase the amount of salt you place in your solution (up to a certain point, after that it starts to become uncomfortable, and then painful). However, whether that results in increased benefits is hard to say.

But I just found this study which concluded hypertonic is better.

 

[glazevedx]

Naphazoline nasal sprays solves this problem in 2 minutes. No sinusitis problems for a year now.

 

[Hipsman]

I have found a way to improve this technique by using a different position: You have to lay on bed and your head hang off of bed side like in this image:

Next use 10ml or 20ml syringe with boiled water and 0.9% salt to fill the nasal cavity completely with liquid, you would need around 25ml of liquid to do this, you can refill the syringe yourself or with someone's help while remaining in this position. It should fill like this:

Then you can remain in this position for up to 10 minutes safely and use the suction/vacuum method to get liquid inside sinuses. You have to use large bowl placed under your head like in image below so the nasal drip doesn't make a mess on the floor:

I tried this two times for 5 and 12 minutes, it works well. Things to note:

1) Do this on empty stomach.
2) While in this position you cannot swallow saliva due to head being upsidedown, so I suggest getting some napkins to remove saliva from time to time.
3) After 5-10minutes have passed, slowly bring your head up and lay in bed for 1 min so the pressure stabilizes and you don't cause any potencial damage.
4) check which nostril is more open/less congested and use that one

Next I plan to try this with antibiotic solution so that bacteria can be killed more. I have post nasal drip for very long time now... I plan to buy pure ceftriaxone powder and make a solution, maybe 1 gram of ceftriaxone in 30 ml?

Why ceftriaxone you might ask, it's because lab test I had showed streptococcus pneumoniae in my post nasal drip and it's sensetive to ceftriaxone.

 

[datadragon]

Some good info in the thread. I mainly just use Neilmed sinus rinse adding DISTILLED water and adding 1 drop only of J Crows Lugol's solution of iodine 2% along with the neilmed sinus rinse packet. Its very simple to use, pour in the packet into the bottle. Fill it with distilled water to the line and then drop the 1 drop of iodine in and put your finger over the hole and shake to mix. I open my mouth, insert the nozzle into one nostril, and breathe out through the mouth as I squeeze gently and 500 micronized nano robot surgeons go in and remove all the gunk and the water comes out the other nostril. Pretty amazing for such a low price I generally alternated squirting one nostril then the other and when you dont get a full squirt left, I open the bottle and pour the remaining solution in my mouth and then gargle for 30 seconds. You can use it typically without the iodine but I had positive results adding it here and there.

 

[Hip]

I have found a way to improve this technique by using a different position: You have to lay on bed and your head hang off of bed side like in this image:

That's an interesting approach.

Then you can remain in this position for up to 10 minutes safely and use the suction/vacuum method to get liquid inside sinuses.

I find it only takes about 1 minute to get the warm saline solution into the sinuses.

But once the saline has entered the sinus cavities, I find it can remain in there for hours afterwards, until such time as you blow you nose hard to remove it. This is because the entrance tubes (ostia) to the sinuses are very narrow, so once the sinuses are filled with saline, the saline remains partially trapped.

I often leave the saline solution in my sinuses for a good 30 minutes before blowing it out, via blowing my nose, just so the saline has time to give the sinuses a good soak.

To do a good job of filling all your sinuses full with saline, I find you need to top up the level of saline in your nasal cavity 2 or 3 times, as you are filling the sinuses with saline.

This is because every time you perform the suction/vacuum method of pulling saline into your sinuses, the level of the saline in your nasal cavity will obviously go down, as the saline liquid is transferred to the sinuses.

So to begin, I fill my nasal cavity completely full with saline while looking up towards the ceiling and breathing through my mouth. Then while holding my nose closed by pinching my nostril between my thumb and forefinger, I place my head upside down by going into this inverted pose:

While inverted, I keep my nose closed by continuing to pinch the nostril between thumb and forefinger.

In this inverted position, I then create a vacuum/suction with my lungs, which pulls the air out of the sinuses. Then when you release the suction, the saline liquid in your nasal cavity will be pulled into the sinus cavities due to the vacuum created in the sinuses by the suction. I repeat this suction – release process a couple of times to transfer saline solution from my nasal cavity to the sinus cavities.

After doing this suction – release process, if you stand back up, and looking up at the ceiling release the pinching of your nostril, and you will find that the saline level in your nasal cavity has gone down a bit, because some of the saline has transferred into the sinuses by the suction – release process.

So I then top up the level of the saline in my nasal cavity with some more saline, while looking up at the ceiling. Then pinching close my nose, I go back down into the inverted position, and once again perform the suction – release process a few times.

After doing the suction – release once more, you will again find that the saline level in your nose has gone down, as more saline is transferred to the sinuses. So then I once again top up the level of the saline in my nose by pouring some more saline into my nose while looking upwards towards the ceiling, and then invert my head a third time to perform the suction – release process.

By topping up the saline level in your nose as the saline gets transferred to the sinuses, you may find you get more saline into your sinus cavities.

 

[Hipsman]

@Hip have you thought about adding antibiotics to the saline solution like ceftriaxone?