Abstract, Summary and Conclusions of the Report into

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Abstract

Aims
1. To determine if SNI decreases prevalence and/or severity of nasal and general symptoms amongst woodworkers
2. To determine woodworkers' acceptability of SNI.
3. To determine the effects of SNI upon: snoring, predisposition to and recovery from colds, sense of smell, nasal airflow patterns, mouth breathing.
4. To discover: the participants' reasons for trialing SNI and attainment of these reasons; any unexpected benefits or side effects; personal experiences of the technique; problems in learning and performing the technique; usage patterns; usual location and times of nasal cleansing; time taken to perform; lifestyle impositions caused by the method; likelihood of longer term usage.

Methods
A group of 46 volunteer woodworkers were randomly divided into 2 groups. One group used the intervention technique twice daily for 8 weeks whilst the other group was the control. Groups were crossed-over after the 8 weeks. At 16 weeks all participants were free to choose to cease or continue usage of the technique for a further 12 months follow-up period. Self reporting questionnaires were filled in by all participants at the beginning, crossover, and at the end of the follow-up periods of the trial.

Results
1) The procedure of SNI was shown to be significantly (p=0.0001) associated with a perception of decreased nasal problems during both the crossover period and the one year follow up period. Beneficial changes in other aspects of health and well being appeared to associated with the procedure but inconsistently.
2) Acceptability of the procedure indicates that 21 of the 46 subjects were still using the procedure regularly after 1 year. Additionally, perceived usefulness of SNI showed a favourable response with 34 subjects saying they found the procedure quite useful or very useful.
3) Data was weak and inconclusive on the effects of SNI upon snoring and its effects upon catching and recovering from colds. There was strong evidence for improvements in the sense of smell, gross nasal airflow, nasal airflow imbalances and reduction in mouth breathing.
4) Most participants attained their intentions for entering the study group. There was a high number (124) of unexpected benefits. Side effects were shown to be minimal and overcome by time and experience with the procedure. Nearly all subjects had favourable impressions prior to and after first learning the technique with some apprehension and difficulties showing up whilst first learning SNI. Overall satisfaction after 16 months was 90%. Difficulties with the technique at some stage were reported by between 30 and 54% of users. Average usage of the practice varied from a high frequency of 10.8 times weekly at the beginning to a low of 2.8 times weekly by the end of the trial. When optional, 57% of the subjects adopted regular use, 28% as needed and 15% not at all. Usual location of nasal cleansing was at home for 95% of users. The average time taken to perform SNI was 4.3 minutes. 87 - 97% of users found the technique to be of no inconvenience to their usual lifestyle. Intention of usage beyond the 16 month study period was 41% on a regular basis, 30% on a need to basis, 29% not at all.

Summary & Conclusions
The study provides reasonable evidence that SNI significantly improves nasal symptoms in volunteer woodworkers. It shows that most woodworkers who wish to try the procedure will regard it is a useful aid and will adopt the technique with varying usage according to their own needs.

The study also gives indications of SNI's potential usefulness in other areas of health and well being. The effects of SNI upon wood dust in woodworkers should be the starting point from which to explore the wider ramifications of a clean and well functioning nasal system.

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Summary Details

Out of 46 volunteers commencing the study, after 8 weeks of twice daily usage, at the time of changeover to optional usage, 39 (=84%) chose to purchase a Neti Pot and continue using the technique in the future.
Of those 39, by the end of the 12 month follow up period, 33 of them (=85%) or 72% of the original 46 were still using the technique at some frequency, leaving 13 (28%) drop outs no longer attracted to the technique.

56% of respondents reported an improvement in nasal airflow during the crossover period and 39% reported further improvements during the 12 month period.

22% of respondents reported an average decrease of 8.5% in frequency of nasal airflow imbalance during the crossover period. 22% of users reported a further average decrease of 10% over the 12 month period. These numbers are of doubtful significance.

13% (9 out of 46) showed a normalisation of circadian nasal airflow patterns (i.e. lessening of acute and chronic unbalanced nasal airflow) over the 16 month period

28% of users reported an average reduction of 14.5% in mouth breathing during the crossover period with 24% reporting a further reduction of 9% over the 12 month period.

23% of respondents reported an improvement in sense of smell during the crossover period and a further 13% reported improvement during the 12 month period.

83% of participants rated their overall impression of SNI as positive after their first 8 weeks of usage. 90% of respondents rated their impression as positive at the end of the 12 month period.

72% of all participants reported they had gained satisfaction in their original aims for joining the study by the end of the 16 month study period.

40% of participants reported improvement during the crossover period in (some or all of) the symptoms which they had listed as having at the beginning of the trial. 74% had reported improvements in symptoms mentioned by the end of the 16 month study.

In addition to the desired benefits achieved during the trial (a total of 52), many participants also reported additional unexpected benefits arising from use of the technique (124).

Only 5 participants out of the 46 (11%) reported no benefits at all had been gained during the trial.

43% reported positive experiences during the first lesson of SNI
39% reported neutral experiences
17% reported negative experiences.

80% reported improvement in nasal airflow function straight after the first lesson in SNI
11% reported no change
9% reported worsening

At the first lesson, 21 (=46%) reported no difficulties at all with the technique.
In their first week at home, 32 (=70%) reported no difficulties at all with the technique.
During the rest of the crossover period, 31 (=67%) reported no difficulties at all with the technique.
During the next 12 months, 30 (=65%) reported no difficulties at all with the technique.

During the first 8 weeks of usage:
34 users (=74%) reported no adverse side effects
12 users (=26%) reported a total of 16 symptoms which are considered the usual side effects of inexperience with the technique.

During the 12 month follow up period:
1 user reported only one adverse side effect possibly due to overuse of the technique.

During the crossover period:
There were 46 positive effects/benefits from SNI reported. These were (in decreasing order of reportage) :
Clearer nostrils, clearer head, better breathing, improved sense of smell, better sleep, discontinued nasal sprays, clearer sinuses, less nose bleeds, no colds, fresh & clean feeling.
There were 3 negative effects reported:
worsening of sinus, increased nasal blockage, cold symptoms
There were 4 reports of no effects, either positive or negative.

During the 12 month follow up period:
There were 37 positive effects/benefits reported (in decreasing order of reportage) :
Clearer nose/nostrils, clearer head & better thinking, better sleep, better breathing, clearer sinuses, stopped nasal sprays, less sneezing, more relaxed, peace of mind, well being.
There was 1 negative effect reported: "changed my sense of smell and taste for a few hours"
There were 7 reports of no effects at all.

During the 16 week crossover period when SNI was recommended twice daily, the average compliance rate for both groups was 77% which equates to an average weekly usage rate for the whole group of 10.8.

During the 12 month follow up when compliance was optional, the average weekly usage rate for the 33 remaining users was 3.3.

95% of users preferred place of performing SNI was at home.
26% of these worked at their home.

87% of SNI users considered SNI to be of no inconvenience to their lifestyle during the twice daily phase.
97% found it of no inconvenience during the 12 month optional phase.

The average time taken to perform the technique was 4.3 minutes.

Prior to the 12 month optional period, participants stated they intended to continue SNI:
34 (=74%) on a "regular basis"
11 (=24%) on an "as needed basis"
1 (=2%) "never again".

In actual fact, over the 12 month period, usage by those (40) who had bought pots to continue usage was
23 (=57%) on a regular basis
11 (=28%) on an as needed basis
6 (= 15%) not at all.

Intended future usage by the 33 users remaining at the end of 16 months, beyond that time was:
19 (=58%) on a regular basis (equates to 41% of all original participants
14 (=42%) when needed. (equates to 30% of all original participants)

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Conclusions

The data collected in conjunction with many comments made by the participants over the 16 month trial period have shown that the technique of SNI is effective in varying degrees for particular individuals for:
* clearing the nasal passages to allow for clearer breathing
* reducing mouth breathing
* restoring the natural nasal airflow rhythms
* improving the sense of smell
* relieving a range of symptoms associated with wood dust
* promoting clearer thinking
* reducing nose bleeds caused from nasal particle irritation
* improving quality of sleep
* reducing dependence upon nasal sprays
* relieving some of the symptoms of sinusitis
* reducing sneezing caused by nasal or sinus irritation.

Study participants indicate that the technique, once taken up:
* has a high level of long term acceptance and satisfaction amongst it users
* is not particularly difficult to learn, unpleasant or become accustomed to in a short time
* has an immediate and positive effect upon the user in most cases
* has few, if any side effects beyond the initial accustomisation
* usually takes only 4 - 5 minutes to perform
* is of little or no inconvenience to most normal lifestyles