Is My Neti Pot Trying to Kill Me?

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My friend called my neti pot gross and dangerous. Is she right?

Nasal irrigation can be a godsend for people with nagging allergies or chronic sinus infections, since the fluid washes out mucus and other particles, reducing congestion and sinus pain. But stare into the depths of a neti pot or sinus-rinse bottle and it’s easy to wonder if some rogue microbe is just waiting to take up residence in your nasal passages and eventually, your brain.

It’s not a completely paranoid thought. In 2011, two Louisiana people died following brain infection with the amoeba Naegleria fowleri. A Centers for Disease Control and Prevention investigation determined that the victims likely infected themselves by using non-sterile water in their neti pots. While the parasite is found in lakes, streams, and other untreated water, the deceased hadn’t had any recent exposure outside of their homes, and their tap water tested positive for N. fowleri.

If you want to do a nasal cleanse because it’s January (New Year, new sinuses) or because you have a cold, sinus infection, or allergies, the water you pour into the little genie lamp or squeeze bottle absolutely needs to be sterile, says Benjamin Tweel, M.D., an otolaryngologist — ear, nose, and throat doctor — at the Mount Sinai Hospital.

Why? Because your nasal passages are extremely close to your brain and shooting tap water up there is not wise. As the Food and Drug Administration reminded people in a consumer alert prompted by the 2011 deaths, tap water can contain organisms like bacteria and amoebas. If you drink the water, stomach acid usually kills the critters therein, but your nose and sinuses can’t wipe them out.

Still, Dr. Tweel is pro–neti pot. “They work really well for a variety of complaints and I recommend them [to patients] pretty much every day for one purpose or another,” he says. Though he describes nasal irrigations as “a shower for the inside of the nose” — would you want to take a shower with dirty water?

The recommendation is to use water that is filtered, distilled, or has been boiled then cooled. Filters need to have an absolute pore size of one micron or smaller or the label must say “NSF 53” or “NSF 58,” according to the CDC. And, no, your Brita does not pass the test. Once filtered, you’ll need to add salt, which makes the sterile water like your tears and is easier on your nasal membranes than plain water; follow the instructions that came with your device. (You can also buy sterile saline solution and not worry about any of this.)

About those instructions: They’ll also tell you to clean and fully dry your teapot or bottle after each use. There have been some studies on bottle contamination, Dr. Tweel says, but they were fairly small and you can’t draw conclusions from them, though he theorizes that there probably are some people giving themselves sinus infections from dirty bottles. Bacteria love dark, moist places, so don’t let any of them hang around in your nose-flusher: Wash it by hand with soap and water, put it in the dishwasher if it’s dishwasher-safe, or zap it in the microwave after washing it if that’s advised (kind of like the sponge trick). Keep and follow the instructions. If you don’t have them anymore, look them up or just buy a new bottle.

And by the way, you should not keep using the same vessel for the entirety of your existence. One manufacturer suggests replacing its bottles and neti pots every three months. “There are some bacteria that are going to stick around in there despite good cleaning,” Dr. Tweel says, adding, “I think three months seems like a reasonable time frame if somebody’s going to be using it every day.” (If you’re irrigating every day and it doesn’t relieve your nasal symptoms, he suggests seeing your primary doctor or an ENT.)

If you’re going the air-dry route, you should also wash it with sterile water or rubbing alcohol — and maybe don’t let it dry on the soap shelf of your bathroom, especially if you or the people you live with don’t close the toilet lid before flushing. All of this advice is especially important for somebody who’s had recent nasal surgery or has a medical condition that compromises their immune system, Dr. Tweel says.

For those just getting started with a neti pot, know that there can be a gross side effect that has nothing to do with brain-eating microbes: retained fluid that can come out at “inopportune” moments. “You might use it and think everything’s cleared out and then half an hour later you lean over to pick something up and you get this gush of fluid out of your nose,” he says. Pro tip: Blow your nose after you’re done. (Then wash your hands, then clean the damn thing.)

Is My Neti Pot Trying to Kill Me?