Where does the water from the NeilMed (Nasal Irrigation) Netti Pot bottle go if it doesn't come out the other nostril?

Where Does Water from the NeilMed Netti Pot Go When It Doesn't Exit the Other Nostril

When water from a NeilMed netti pot doesn't exit the other nostril, most of it flows into the nasopharynx and is swallowed, with only about 2.5% (approximately 5.8 mL of a 240 mL irrigation) being retained in the nasal cavity. 1

Nasal Irrigation Fluid Dynamics

The path of nasal irrigation fluid depends on several factors:

1. Normal fluid pathway:

   • Most irrigation fluid (approximately 97.5%) flows through the nasal cavity and into the nasopharynx
   • From the nasopharynx, it continues down the throat and is swallowed
   • Only a small percentage (2.5%) is retained in the nasal passages 1

2. Factors affecting fluid distribution:

   • Head position (upright, tilted forward, or head back)
   • Nasal anatomy (pre- vs. post-sinus surgery)
   • Device type (neti pot vs. squeeze bottle)
   • Nasal cycle (congestion pattern in each nostril)

Anatomical Considerations

The European Position Paper on Rhinosinusitis and Nasal Polyps (2020) explains that nasal irrigation works through several mechanisms 2:

• Mechanical lavage removes mucus, inflammatory products, and bacteria/biofilm
• Improves ciliary clearance
• Disrupts and removes antigens and inflammatory mediators
• Directly protects the sinonasal mucosa

Research has shown that sinus surgery significantly enhances the delivery and distribution of nasal solutions throughout the sinuses 2. For patients who have not had sinus surgery, the fluid retention is even lower, at approximately 1.4% 1.

Head Position and Technique

The head position significantly impacts where the irrigation fluid flows:

• Upright position: Fluid tends to flow from one nostril through the nasal cavity and into the nasopharynx
• Head tilted forward (90°): Increases coverage of the nasal cavity on the side of irrigation 3
• Head back position: May increase maxillary sinus volume filling 4

For optimal irrigation technique, the 2015 Clinical Practice Guideline for Adult Sinusitis recommends 2:

• Using proper irrigation rather than spray (irrigation is more effective for expelling secretions)
• Following specific techniques for the device being used

Device Differences

Different irrigation devices affect fluid distribution:

• Neti pot: Works by gravity and provides greater coverage to the contralateral side (opposite nostril) and potentially better paranasal sinus coverage 3
• Squeeze bottle: Creates positive pressure and provides greater surface coverage on the side of irrigation 3

Common Pitfalls and Concerns

1. Contamination risk:

   • Nasal irrigation bottles can become contaminated with bacteria (45% contamination rate in some studies) 5
   • Common organisms include Pseudomonas, Enterobacter, and Staphylococcus 6
   • Devices with unidirectional flow (like the Sinugator) may reduce cross-contamination 5

2. Technique issues:

   • Improper head positioning can reduce effectiveness
   • Sniffing or inhaling during irrigation may cause discomfort

3. Safety considerations:

   • Using clean, sterile, or distilled water is important to prevent infection
   • Regular cleaning of irrigation devices is essential

While some irrigation fluid may not exit the opposite nostril as expected, this is normal and doesn't indicate a problem. The irrigation is still effective at cleansing the nasal passages, with the majority of fluid following its natural path down the throat.