Saline Sinus Rinses: What Good Are They? 4/4

Homemade Saline Nasal Rinses

homemade saline nasal rinses

Cooking Up Your Own Saline Recipe :)

This is part 4 of 4, listed here:

Ingredients for Homemade Saline Nasal Rinses:

  • Salt – pickling (“canning” salt) or Kosher salt are best because they are free of iodine and other preservatives.  Regular table salt is OK in a pinch if you can’t get pickling salt.
  • Water – use bottled, distilled water if possible.  Tap water or well water risk microorganisms, and are definitely NOT for anyone who is immunosuppressed.
  • Temperature – use the final saline solution at body temperature, or slightly luke warm.  NOT HOT.

The Recipe for Hypertonic Saline, for really stuffy noses, acute sinusitis:

  • 1 liter water (about 1 qrt)
  • 2-3 tsp salt
  • 1tsp baking soda
  • Mix, microwave to dissolve, allow to cool (don’t use it hot!!)

Mistakes to Avoid

  • If you make up a large quantity, store it in the fridg, warm-up only amount needed for each use – should last about 4 days.  Do not let sit at room temperature – refrigerate – or it will grow mold, fast.
  • If you add things like Manuka honey for antimicrobial benefit, don’t overheat – too much heat will kill active enzymes and proteins in the honey.  Don’t waste that expensive Manuka!

Last point:  use the saline misting sprays during the day – these will help keep your nasal epithelium moist and optimize nasal hygiene.  However, a study published in 2002 (Olson’s group) reported that these nasal nebulizers do not reach the sinuses.

To get the rinse into the sinuses where it can do some good, they found, requires active irrigation like that provided by the bulb syringe, the squeeze bottle arrangement, or the plug-in systems based on a small electrical pump.  Olson’s group did not compare the neti / netti pot, but I speculate that the n-pot might be a little less effective simply due to the passive nature of the flow of saline.  It doesn’t use a strong force to flush the sinuses out.  One the other hand, if that is all you or your child will tolerate, it is much better than nothing at all.

We’ll have more information about different additives to sinus rinses in future posts.


Together, in this series we reviewed the use of saline rinses to control allergic rhinitis, and to control sinusitis and chronic rhinosinusitis: the medical evidence that they make a difference, how to do the rinses, how to make your own, and some mistakes to avoid.

If you take a look at ealier post, Medical Evidence Supporting Saline Nasal Rinses, you will see some convincing evidence of the value of saline sinus rinses.  It has been my own experience with saline rinses over more than 10 years, and those of my patients, that have convinced me of the value of this natural remedy.

If you or your children are struggling with asthma, allergic rhinitis, or sinusitis, I urge you to give this a try.  This is a great alternative to swallowing more medications!  And WAY better than surgery.  Trust me: if you go with surgery, you MUST do the rinses.  So you might as well start with them – you might avoid surgery all together.

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Best health and success to you and your families.

Thank you for visiting, and see you here again next week.  Please post a comment so that we can all learn to achieve sinus health, and healthy airways.  And please, “be excellent to one another.”

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

Saline Sinus Rinses: part 4 of 4


Nasal saline for chronic sinonasal symptoms: A randomized controlled trial.  Pynnonen, et al.  Archives of Otolaryngology-Head & Neck Surgery. Vol. 133(11): 1115-1120; 2007.

Nasal rinsing with hypertonic solution: An adjunctive treatment for pediatric seasonal rhinoconjunctivitis.  Garavello, et al.  International Archives of Allergy and Immunology.  Vol. 137(4): 310-314; 2005.

Radiographic comparison of three method for nasal irrigation.  Olson, et al.  The Laryngoscope. Vol. 112: 1394-1397; 2002.


  1. Doctor Faust,
    Just wanted to add the NeilMed product that you mentioned has an excellent website that has a video clip that actually shows you how to rinse your sinuses and tips for caring for the bottle. Definitely worth checking out.

    • Russell A. Faust, PhD, MD says:

      Dear L,
      Thank you so much for visiting, and for the great tip. Yes – NeilMed products are great (I have NO financial or other arrangements with them), and they have a very informative website. Thanks for reminding me, and I will add their site to my ‘Link Luv’ list. RF

      • Kim Diedrich says:

        I also use the saline rinse recommended by only 1 ENT out of 7! I thank God for that Doctor because it really helps! I seem to get a lot of mucas that is sticky and I also have red colored blood that comes with it since I developed a deviated septum from a blow to the nose. I now have numbness pain and blockage in my ears am am on nasal steroids. They want my to try Gabapentin but I might try Gaba the supplement first. NeilMed Saline rinse really helps!

  2. Great advice…i have found in my pediatric practive that children should begin with isotonic and work their way up to hypertonic.
    i have also witnessed that most will wash routinely if the wash does not enter the sinuses but simply washes the sinus ostia and ET ostia….thus allowing the discharge to drain naturally and un blocked.
    i have 2 yr old patients who love to wash those ‘buggers’ out with my nasal wash system. i have written a book on the subject ‘clearing the air one nose at a time’.
    let me know if you would like a sample of my product or book.
    Be Well, Dr hana

    • Russell A. Faust, PhD, MD says:

      Dear Dr. Hana,
      Thank you so much for visiting and sharing your experience and expertise.
      Of course, I agree with the points that you make about saline rinses opening the sinus ostia (natural openings). I am impressed that you have 2-year-olds in your experience who will tolerate this practice – I have many 4-year-olds who are doing this, and a couple 3-year-olds. Two is impressive – perhaps your particular recipe for saline is particularly gentle and well-tolerated? I have not personally used the Nasopure saline system, and I will make an effort to try it out.
      I am so flattered that you visited.
      I hope you visit and contribute to our little community of “boogor-heads” often.

  3. Hi two points:
    1. Although you gave the recipe to be used for severe sinusitis you did not give the amounts for the ‘regular’ solution. I think it’s absurd to buy a packaged product (the Neilmed packets) that can easily be mixed up at home. I agree with you about the plastic bottles but what about all that waste packaging (cardboard boxes and foil packets)?

    My second point is that anytime I have done these rinses I have found that after the procedure is over, water drains out of my nose for quite a long time afterward. An hour or so. So the rinse is not something you can just do and go on with your day. Am I using too much water?

    • Russell A. Faust, PhD, MD says:

      Hi Janet,
      Thanks for joining us, and for a great question. The “regular” recipe is the same, without the honey: [1 liter distilled water (distillation purifies and nearly sterilizes it), 2-3 tsp salt (kosher canning or pickling salt), 1 tsp baking soda (‘buffers’ it so it doesn’t burn as much)]. For chronic, just add the honey [3-7 tablespoons Manuka Honey]. You are also absolutely right about modern packaging – wasteful!! When making your own saline, just keep in mind that you will need to store it in the ‘frig so that it doesn’t grow mold – that would not be a good thing to rinse your nose with. To use, let it come to room temperature, or gently heat over the stove to luke-warm (NOT hot, NOT cold). To answer your second question: No, I don’t think you are using too much rinse. What I do is rinse, wait a few minutes and vigorously blow my nose. Any saline that comes out following that must be from the sinuses – that’s actually a good thing, since it demonstrates that they are open (“patent”). You will likely find that this will reduce the more you do the nasal rinses, as the swelling goes down, and the sinuses open up more – if the sinus openings are wide open, they should drain immediately, not over an hour or so afterward.
      Please let us know how things go, and thanks again for joining and sharing. Your participation is GREATLY appreciated!
      Best in health, RF

  4. Hello Doctor,
    Your link to the article on some of the benefits of Xylitol doesn’t work. I’m interested in learning more about adding xylitol to saline nasal rinses. Also, wonder if you could explain post nasal drip and the accumulation of excess secretions in the back of throat in the morning. Thank you.

    • Russell A. Faust, PhD, MD says:

      Hi Wendy,
      Thanks so much for taking the time to give me a heads-up: I can’t find that link. If you don’t mind, please email the link to me at boogordoctor [AT], and I will fix it pronto.
      Regarding post-nasal drip (pnd), it’s pretty straight-forward: the lining of your nose and sinuses don’t stop making secretions just because you lie down to sleep. You swallow some of those secretions during your sleep, but some of those secretions accumulate in the back of your throat (“nasopharynx”). That’s why many people need to do all that “clearing” when they first wake up in the morning. This pnd is worse for those with allergic rhinitis.
      Thanks again!

      • Hello Dr. Faust,
        I found the link in the article “What is Sinusitis?”. The text reads: “Read this article on the Benefits of Xylitol” and the link goes to:

        Thank you for answering my question. Now I have another. I have post nasal drip that is most apparent to me in the morning after awakening. Sometimes the drainage is very lightly blood tinged and occasionally the blood tinge is more noticeable. This occurs regardless of time of year, i.e. cold or hot temperatures. This drainage quickly resolves and is not noticeable the rest of the day. I have mentioned this once to an ENT when I was seen for another issue and he thought it might be due to a superficial blood vessel. However this possible explanation was not really investigated and confirmed. Should I be concerned? Should I go back to the ENT for a closer look? Thank you.

        • Russell A. Faust, PhD, MD says:

          Hi Wendy,

          Thanks so much for that specific link! I’ve been trying to “clean up” the many broken links on this site, but with hundreds of articles, it’s taking me a while!
          Please take a look at this link:
          Hope that helps!
          And please: feel free to send me any more broken links, and I promise to take care of them (eventually :))

  5. Dr. I have been suffering from sinus problems since 30years. I have tried almost everything from regular rinse, antibiotics, anti histamines, got operated few years back. With recent scans. I was told that I have developed polyps and surgery recommend. I read that people who went through surgery redevelop ploys in 1 to 2 years. Looking to your input that could help.

    • Russell A. Faust, PhD, MD says:

      Hi Dale,
      I’m sorry to say that my adult patients who have nasal and sinus polyps usually re-form them within 1-2 years, that’s correct. And as a sinus surgeon, I can say that every one of those surgeries becomes more challenging, and has a higher risk for the patient. That means you should be doing everything in your power to avoid that! Recommended regimen: daily nasal saline rinses; consider including Xylitol for its natural antimicrobial activity, and for helping to achieve hyper-osmlar saline without a salt concentration that would be toxic for your respiratory cilia; saline containing Manuka honey, for its antimicrobial activity; both of those additives can help eradicate chronic infections by biofilm-forming bacteria; daily anti-inflammatory – either a non-steroidal anti-inflammatory drug (NSAID) or (my preference) a natural alternative combination that includes Curcumin and Quercetin/Bromolain.
      It’s inconvenient to rinse your nose every day, and to remember to take your anti-inflammatory regimen; it’s pretty inconvenient to have a nose full of polyps and undergo surgery ever year. It would be an easy choice for me :-)
      Thanks so much for visiting, and for taking time to share. Best success, and please keep me updated.

  6. Mfon Frank says:

    Dear Dr Faust,
    Thank you for the post. I have suffered from this stuff for more than 10 years. Virtually all antihistamines are no longer working for me. I am about starting d saline rinse now. Will you advise me to start adding honey right away?

    • Russell A. Faust, PhD, MD says:

      I usually recommend using Manuka honey for folks with chronic rhino-sinusitis; it is especially helpful for those with chronic biofilm-forming bacterial infections. Otherwise, regular use of Manuka honey is pretty expensive. A less expensive way to achieve hypertonic saline for daily rinsing is to simply add less water to the rinse bottle after adding the packet of saline. Even reducing the amount of water by a couple milliliters will increase the saline concentration and help reduce swelling of the tissues. Long-term, daily rinsing with hypertonic saline will make you cilia unhappy, however; so the recommendation is to return to “normal saline” concentration as soon as your congestion resolves.

  7. Hi Dr. Faust,

    So glad to come upon your wonderful site.

    I have a persistent nasal biofilm secondary to mold exposure a few years ago. Sinusitis has been acute at times. I’ve been doing the nasal rinse per your recipe, with Neilmed bottle. However, in addition to the basic method of in one nostril, out the other, I use an “advanced” method that I learned from a Neilmed blog years ago. It involves pinching one nostril closed, irrigating thru the open nostril, and comes out the mouth. Purportedly this improves irrigation of more sinuses, and it felt like that was the case. Do you have any opinion on this technique?

    I was recently prescribed a compounded antibiotic nasal spray by an MD certified in Dr Shoemaker’s mold protocol, with added Mucalox for better retention, but am wondering about the effectiveness given what you say about nasal sprays not reaching the sinuses?

    One other question. I understand you recommend adding xylitol when nasal rinse is done regularly. How much to add for a liter? Does it need to be any specific type, organic?

    Thanks so much!

    • Russell A. Faust, PhD, MD says:

      Hi Barry:
      Nasal sprays generally do not reach the sinuses in the acute infection situation, mostly due to the swelling of the sinus ostia (openings). As the offending agent – virus, bacteria, mold, allergen, whatever – is rinsed away by daily nasal saline rinses, that inflammation subsides, and along with it the swelling. As that happens, the rinses DO reach the sinuses. At least, this has been my personal experience.
      Re Xylitol: the ideal concentration, at least according to the clinical studies that have been done, is 10%. That is the concentration that is present in the “Xlear” (pronounced “clear”) products – their nasal sprays and sinus rinse packets. That’s 10% by weight / volume. So in a one-liter bottle, that would be 100 grams of Xylitol. I have to admit, I don’t have a gram-scale, and simply add a couple tablespoons to my rinse bottle.
      Thanks for visiting and sharing.
      And best success!

  8. Catherine M says:

    In desperation I bought a Neil Med [I live in UK, where these are expensive, £9.99 for a little squeezy bottle and 10 sachets…but to my amazement they were not painful to use.
    I have a nasty ”dead mouse” smell in one nostril that gets suddenly worse on bending down and standing up again..and the mucous that blows out of my nose is sticky and lemon curd like with blood streaks..
    Have a temperature too, and feel generally low, and have done for over two weeks.
    Phoned my G.P [doctor] ans he said ‘sounds like a bacterial infection of the sinuses..I am willing to prescribe antibiotics, but only 1/13 people find they work for this..saline rinses are the best thing to do.
    He suggested I watch soem You Tube vids on nasal irrigation.
    I do ‘invert’ my head over the bath so the saline reaches my sinuses-
    I ran out of the neil med sachets so mixe up my own saline [additive free sea salt] 2grammes per 8floz of boiled and left to cool tap water [tap water in UK is generally of a high standard]

    However…at first when mixing my own saline, I mixed in far too little salt.
    The solution ‘burned’ so much I couldn’t continue.
    I thought I’d used ”to much” salt, so used even less…and the ‘burning’ was just as severe.
    Looked up how to make an isotonic solution and the sea salt needs to be 2g -which looks far bulkier than the neil med fine ground salts.
    The isotonic rinse does not hurt at all.
    Osmosis lesson quickly learned!
    The manuka honey sounds interesting… how much manuka to an 8floz saline bottle?

    • Russell A. Faust, PhD, MD says:

      Hi Catherine:

      Yes, I have made that discovery also – that hypo-tonic solution burns worse than hyper-tonic saline solution!

      Regarding Manuka: I add a couple tablespoons per 8oz bottle; it’s not a firm science. I have also used Xylitol, which is a naturally-occurring sugar, found in vegetables and other plants; Xylitol also has antimicrobial properties. Be sure to search for articles here on the benefits of Xylitol; you can also order it through Amazon and other places. The optimal concentration is 10% Xylitol. I have also tried making my saline solution using weak green tea as the basis, since there are well-executed scientific research reports that green tea is antimicrobial, too.

      Thank you for sharing, and best success!

  9. Les parker says:

    HI. doctor i make my own salin rinse,i use pickiling kosher salt from local grocery store.also using reccomended formula l fine the kosher salt does not disolve completely, is it ok if some of the dissolved material stays up my nose?

    • Russell A. Faust, PhD, MD says:

      Hi Les:

      I have used kosher canning / pickling salt for my own saline recipe, have not experienced failure to dissolve; I boiled the water (to help dissolve, and for sterility). For the concentrations suggested for “iso-tonic” saline, ALL of the salt should dissolve. Consider heating the water. Please do now allow undissolved material to remain in your nose/sinuses.

      If you still have undissolved material, please consider buying pre-mixed saline packs (my own source is

      Thanks for visiting, and best success!

  10. Pam Forrester says:

    Thank you Dr. Faust for this wonderfully informative site. I have tried to come up with nasal rinse recipes using the various items you recommend. Do you have a blog post with all of your recipes? I could not find it. Here is what I came up with. Please make corrections. I would appreciate it.

    To one liter/quart of sterile water add:
    Salt: 2-3 tsp.
    Baking Soda: 1tsp

    FOR BIOFILMS- Vary the above saline rinse with one of the following:
    Manuka Honey: 3-7 Tbs.
    Baby Shampoo: 1-2 drops
    Xylitol: 100 grams/1/2 Cup
    Make Regular saline recipe with weak green tea (??? 1,2 or ? bags per liter?)

    • Russell A. Faust, PhD, MD says:

      Wow, Pam:
      Thank you for your kind comments.
      I can’t recall whether I have a single post with all recipes listed.
      And because I personally use Nasopure or Xlear purchased packets, I don’t make my own any more.
      I will say that I never mixed all of the “additives” in the same nasal saline rinses. That is, I alternated adding Manuka, with adding Xylitol, or very rarely baby shampoo. But your quantities seem correct.
      I will try to put together a recipe page.
      My other recommendation is to check out this website: – Jim is a super-smart herbalist (way smarter than me; hoping he will write a couple articles for this blog), with some great advice on sinusitis from an herbalist’s perspective.
      Thanks again for your comments, for visiting, and for sharing.

  11. Hi, thanks for the post, I’ve just recently started using the Neilmed nasal rinse, however do not want to buy their packets due to the cost. Im in New Zealand and can’t really find pickling salt or even Kosher salt in most retail stores. Is it alright to use sea salt or Himalayan rock salt (fine version) which do not have additives?I’ve looked online and other have done it, but just want to make sure. Thanks

    • Russell A. Faust, PhD, MD says:

      Hi Hayden:

      You are very welcome. And thank you for visiting, and sharing your question.
      Sea salt and Himalayan salt(s) both contain mostly sodium-chloride, with small (usually less than 3-4%) of other minerals. None of those other minerals should be a problem, and I have used both in my own saline rinses without problems. Table salt is generally ok, but find it without iodine added for use in saline rinses.

      Thanks again for sharing. And best success!

  12. could i ask. What are the measurements to make a less strong solution (not hypertonic, i think isotonic solution). If i am making a 250ml solution would i use 0.5tsp of salt and 0.5tsp of baking soda. Or would i use 0.25tsp of each.

    • Russell A. Faust, PhD, MD says:

      Buffered Isotonic Saline:
      – Put two cups of tap water in the microwave and bring it to rolling boil (6 to 7 minutes in my microwave)
      – Stir in one teaspoon of sodium chloride (I use sea salt, but the recipe says that picking salt is also acceptable)
      – and 1/4 teaspoon of sodium hydrogen carbonate (baking soda, sodium bicarbonate).

      • hi doc,
        may i ask what is the function and benefit of kosher salt and baking soda in the solution ?.
        and would you please detail your explanation ,
        thank you.

        • Russell A. Faust, PhD, MD says:

          Kosher salt is without chemical additives.
          Also, the recipes are made by volume (table spoon is a volume, not a weight).
          Because Kosher salt is made up of larger crystals, there is less of it per tablespoon than the finer-grain table salt.
          If you substitute table salt for Kosher salt, you will be nearly doubling the amount of salt that you add.
          The baking soda is a buffering agent: it stabilizes the pH of the solution. That helps make the solution more comfortable, because different people will be using different water sources, with different pH; adding the baking soda helps buffer the solution to keep it from burning quite so much.

  13. Hi can the sinuses cause bad breath and if so can the saline rinses help as I have been assured by dentists that it is not coming from my mouth
    Thank you

    • Russell A. Faust, PhD, MD says:

      Yes, chronic, smoldering sinus infection can cause bad breath. More commonly, a chronic, indolent infection of the adenoid tissue is the cause of bad breath. The adenoid pad at the back of the throat/back of the nose (above the soft palate) has many nooks and crannies for bacteria to make their home. If these bacteria make a “bio-film,” our immune system has a very difficult time to eradicate the infection, even without any apparent sign of infection; yet these bacteria can cause bad breath. They are also a common cause of recurrent sinusitis. Also note: if you have regular gastro-esophageal reflux during your sleep, that can cause bad breath.

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