Over the last 10 years, neti pots have become very popular with people who have problems with their sinuses. They are also used for relieving symptoms of a cold and various allergies.
Neti pots are small teapot-like devices which people use to rinse out their sinuses. Although they can be helpful, they must be used correctly to avoid health issues.
The United States Food and Drug Administration (FDA) warns that if they are not used properly, the user runs a risk of developing serious infections, even potentially fatal ones.
The FDA says that neti pots are not the problem, it is the way they are being used that is the issue.
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Fast facts on neti pots
Here are some key points about neti pots. More detail and supporting information is in the main article.
- Neti pots can relieve the symptoms of rhinosinusitis if used properly
- The earliest record of nasal irrigation comes from the ancient Hindu practice of Ayurveda
- Neti pots must be thoroughly cleaned before and after each use, and never shared
- If an individual is in any doubt about how to use their neti pot, they should speak with a doctor or pharmacist
What is a neti pot?
When using a neti pot, water is taken up one nostril and comes out of the other.
The user fills a neti pot with a salt-based (saline) solution, tilts their head back, and pours the solution into one nostril, the liquid goes up the nose and comes out of the other nostril.
The FDA, however, warns that the improper use of neti pots, as well as other devices for rinsing out the sinuses, including squeeze bottles, battery-operated pulsed water devices, and bulb syringes have been linked to a higher risk of infection.
The FDA says it is informing doctors, other healthcare professionals, device makers, and users about the safe practice of devices used for rinsing the nasal passages.
Dr. Steven Osborne, a medical officer in FDA's Center for Devices and Radiological Health (CDRH), emphasized that these devices are safe and useful overall, as long as they are properly used and cleaned.
Users have to make sure the liquid is a dedicated saline nasal rinse. Do not use tap water or any form of unsterilized liquid. Tap water generally has small amounts of bacteria, protozoa, and other microorganisms, including amoebas; these are fine to swallow because the stomach acid kills them, but they should not go into the nasal passages. If they do, they can remain there, alive, and eventually cause serious infections.
In 2011, two neti pot users in Louisiana lost their lives after using water tainted with Naegleria fowleri, a type of amoeba. In 2013, another individual met the same fate.
Naegleria fowleri is naturally found in warm, freshwater lakes and rivers. If the bacteria enter the nose, which most often happens while swimming, it can migrate to the brain via the olfactory nerve. This can cause primary amebic meningoencephalitis (PAM), which is almost universally fatal.
Commenting on the tragic deaths, Louisiana State Epidemiologist, Dr. Raoult Ratard, said:
"If you are irrigating, flushing, or rinsing your sinuses, for example, by using a neti pot, use distilled, sterile, or previously boiled water to make up the irrigation solution. Tap water is safe for drinking, but not for irrigating your nose."
Neti pot manufacturers need better and clearer instructions
According to the FDA, some makers of neti pots provide misleading and contradictory data; some have no guidelines at all. The Agency added that neti pots made by artists commonly have no instructions on their use.
A number of instructions have pictures or videos of people using plain tap water, while at the same time, write in the instructions that tap water should not be used.
Below are some details of how to go about rinsing the nasal passage with one of these devices (the exact method might vary, depending on which product is being used):
- Lean over a sink
- Tilt the head to one side so that the forehead and chin are at approximately the same level, this prevents the sterile water or saline solution from getting into the mouth
- From this point, breathing is done through the mouth
- Place the spout into the upper nostril and pour the solution so that it drains through the lower nostril
- Blow the nose (clear your nostrils) and do it again on the other side
Rinsing the nasal passage helps clear out pollen, dirt, and other trapped debris. The saline solution does not irritate or burn the nasal membranes, which are extremely sensitive and delicate.
If the instructions on a neti pot are not clear, individuals should check with a pharmacist or doctor. The potential consequences are not worth the risk.
Only use the following types of water for nasal rinses:
- Sterile or distilled water. When purchasing, check the label says "sterile" or "distilled."
- Boiled tap water. It must be boiled for 3 to 5 minutes, and then allowed to cool down. If it is stored in a clean, closed container, it will be good for use for no more than 24 hours.
- Water that has gone through a filter with an absolute pore size of 1-micron maximum.
Other neti pot warnings
It is very important to ensure that the neti pot is cleaned after each use, paying particular attention to the region where the spout connects to the pot; this area can attract a build-up of salts.
In the same way that people do not share toothbrushes, neti pots should not be shared with others. Even if the device is cleaned, certain bacteria from the upper regions of the nostril can sometimes survive and be passed on to the next user.
Overuse of neti pots might also be detrimental to overall health. Long-term users may be more prone to attacks of rhinosinusitis (an infection in the lining of the sinuses). This is thought to be because the salt gradually depletes the mucus, which acts as a protective blanket to the membranes.
As a general rule, a neti pot should not be used for more than 1-3 weeks at a time. If congestion continues, the individual should visit a doctor.
Can nasal rinsing be used on children?
According to Osborne, after the age of 2, if the doctor recommends it, children with nasal allergies may benefit from using nasal-rinsing devices. However, this should only be done if the doctor says so.