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Hidden Dangers of Neti Pots

Plenty of people use the tiny vessels for relief from allergies and sinus problems. But using them properly is key.


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If you didn’t know better, you might think a recent report about brain-eating amoebae among sinus sufferers was taken from a horror movie, rather than a study from the Centers for Disease Control and Prevention (CDC).

But this wasn’t the first time the CDC has warned people who use neti pots to flush out their sinuses about the dangers of doing so with regular tap water. More than a decade ago, the horrors of another brain-eating amoeba tied to nasal rinsing made news. In the CDC’s new study, published recently in Emerging Infectious Diseases, researchers focused on 10 patients, average age 60, all of whom were infected with a life-threatening amoebae (Acanthamoeba spp.) commonly found in soil and many types of water, including lakes, rivers and tap water.

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Although the researchers can’t say for sure how the patients were infected, two clues helped point toward the likely culprit: All 10 patients had weakened immune systems and all 10 practiced nasal rinsing (aka nasal irrigation) , a practice otolaryngologists (ear, nose and throat doctors) consider safe and an effective alternative to prescription drugs for preventing and treating sinus woes — when done properly.

“What the CDC has done is look back and discovered that among the few people — and I emphasize few — with this rare cerebral amoebic infection, acanthamoeba, some of them got it by diving into lakes and streams” and some got it from using a nasal rinsing device such as a neti pot, says William Schaffner, M.D., professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine in Nashville.

The surprise, the researchers noted, wasn’t that three of the 10 patients died from the infection; the surprise was that so many survived. As the study noted, while infection with these amoebae is extremely rare — affecting only three to 12 people per year in the U.S. — 82 percent of cases are fatal.

Whether diving into a lake or stream, or practicing nasal rinsing, water is essentially pushed up into the nasal passages, giving potential pathogens like these amoebae an opportunity to work its way into your central nervous system, Schaffner explains. The risk of infection, though rare, makes sense if you’re diving into murky waters without using a nose clip or holding your nose. But how can a centuries-old practice of nasal rinsing expose you to the same dangers?

Two words: tap water. At least half of the patients in the CDC study used tap water in their nasal rinsing practices.

Nasal rinsing 101

Those little teapotlike vessels with long spouts — otherwise known as neti pots — are used to funnel a saline or saltwater solution through the nasal passages as an antidote to a variety of sinus problems such as the common cold, sinusitis and allergies. They also help moisten dried-out sinuses in the winter. But they are meant to be used with sterile water and that’s where confusion sets in. ​What constitutes sterile? In short: not tap water.

According to the U.S. Food and Drug Administration, water straight from the faucet is safe to drink, but it’s not adequately filtered or treated to use as a sinus rinse.

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“It may have pathogens and other substances in it that can be irritating and/or dangerous to put in the nose,” says Meha Fox, M.D., assistant professor of otolaryngology at Baylor College of Medicine in Houston.

So although tap water may be safe to swallow — thanks to stomach acids that kill such substances — that shouldn’t be confused with sterile.

And yet a study published in 2023 in Emerging Infectious Diseases suggests there is confusion. In a survey of 1,004 adults in the U.S., researchers found that even though most respondents said they know what constitutes sterile — and understand that tap water is not that — nearly two-thirds still responded that it is safe to use tap water with a nasal rinsing device like the neti pot.

About one-third believed, incorrectly, that tap water is free of bacteria and other microorganisms. 

In fact, tap water is safe to use for nasal rinsing only if you boil it for at least one minute — a minimum of three minutes if you live above 6,000 feet — let it cool to room temperature, the CDC advises. Then place it in a container with a lid and use it within 24 hours, suggests Schaffner, who added, “If you don’t want to boil water, buy distilled water or sterile water.”

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Also important to keep in mind:

  • If you have a weakened immune system, talk to your doctor first about the relative risks of using a neti pot.
  • Use a saline rinse prepared with the mixture that came with your neti pot, or make it yourself. The American Academy of Allergy, Asthma & Immunology recommends the following recipe: Mix 3 teaspoons iodide-free salt and 1 teaspoon baking soda. Add 1 teaspoon of the mixture to 8 ounces (1 cup) of lukewarm sterile, distilled or boiled water for a single use. Store the remaining salt mixture in a small airtight container.
  • Make sure the solution is at room temperature before using. Solutions that are too cold or too hot are hard to tolerate.
  • Wash your neti pot after each use and be sure to dry the inside thoroughly with a paper towel or let it air dry between uses. “These devices can build up bacteria or mold, so they need to be cleaned regularly,” Fox says. “Some manufacturers recommend placing the device in the microwave for a short time.”
  • Replace your neti pot regularly. “Most manufacturers recommend replacing the device every three months,” Fox says.
  • Don’t overdo it. Let common sense be your guide. “You’re trying to soothe the membranes of your nose and sinuses and doing this too frequently — I have no idea what too frequently is — can irritate mucus membranes,” Schaffner says. One clue you may be overdoing it? Your nasal passages are “getting dried and cracked,” he adds. Another clue: Trouble hearing. “Nasal rinsing is a safe thing to do,” Fox says. But “the rinse fluid can get into the eustachian tube — the tube that connects the ear to the nose — and cause muffled hearing. The fluid usually clears up on its own. If you experience this, I recommend pausing on rinsing for a few days.”

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