Should You Bother With Neti Pots?

Accused of inflaming sinuses and exposing you to brain-eating amoeba, neti pot use has been called into question lately. Here's what you need to know about this popular natural allergy remedy.

March 1, 2012

Sinus soother or nasal nightmare?

For centuries, Neti pots have been the natural remedy of choice for people suffering from seasonal allergies, colds and wintertime funk. The practice, which stems from yoga traditions in India, helps flush out and clean your nasal passages with nothing more than saltwater, and given this globally warmed winter, they could be invaluable tools for fighting an overlapping flu and spring-allergy season.


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However, Neti pots, or saline nasal irrigation, could do more harm than good if not done properly. Saline rinses involve a small, teapot-shaped container (Neti pot is a popular brand), bottle, or tube to gently flush either a saline solution or a mixture of salt and water through the one nostril and out the other. In one study from the American College of Allergy, Asthma, & Immunology, overusing saline nasal irrigation was linked to an increase in sinus infections. The study's authors tracked 68 adults who used rinses regularly and recorded the number of sinus infections they got over the course of one year. After stopping saline nasal irrigation the following year, chronic sinus infections dropped 62 percent.

Aggressive nasal irrigation may be harmful to some people because it could remove natural antimicrobial agents that kill bacterial, viral, and fungal agents in the nasal passages, explains study author Talal M. Nsouli, MD, clinical professor of pediatrics and allergy and immunology at Georgetown University School of Medicine. "People using it on daily basis might deplete the nose of immune elements that are proven, published, and shown to be protective; modifying the chemistry of our nose, the concentration of our mucus can result in weakness of the immune system," says Dr. Nsouli, who disclosed he is a speaker for several pharmaceutical companies. He added that long-term saline nasal irrigation can result in a temporarily relief of symptoms, but could contribute to a low-grade or chronic infection.

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Then, in 2011, two people in Louisiana died after using contaminated tap water in Neti pots. The water was contaminated with brain-eating amoebas that caused encephalitis, and although exceedingly rare, the cases issued a warning from the Louisiana Department of Public Health: "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," said Louisiana State Epidemiologist, Dr. Raoult Ratard. "Tap water is safe for drinking, but not for irrigating your nose."

Even so, Neti pot use and saline nasal irrigation does have its up-sides. A 2008 study found that kids with severe allergies didn't need to rely on harsher steroid nasal sprays as much after using regular nasal irrigation. In 2007, a University of Michigan study published in the Archives of Otolaryngology Head & Neck Surgery found that within two months, adults with chronic sinus problems, including mucous problems like post-nasal drip, dry nose, and congestion, felt more improvements after using nasal irrigation than those using a spray.

Here are some things to consider when it comes to using a Neti pot or other saline nasal irrigation method:

•  Give it a rest. If you find you're plagued with chronic sinus infections and regularly practice saline nasal irrigation, consider laying off the pot for four to eight weeks, and see if your symptoms improve. If they do, you may have been overusing it.

•  Know when to use it. While Dr. Nsouli doesn't recommend long-term use, he does believe it's OK to use saline nasal irrigation pots for a few days or weeks if a person is experiencing a cold or nasal dryness. In fact, a study published in 2008 found that nasal saline wash use shortens uncomplicated colds in children 6 to 10 years old. Another published study found that saline nasal irrigation can prevent the reappearance of cold and flu in children. Melissa Pynnonen, MD, associate professor of otolaryngology at University of Michigan Medical School, prescribes saline nasal irrigation for many of her patients who have frequent or chronic nasal problems with much success. She usually recommends her patients start twice a day, in the morning and at night, and then experiment with the frequency until they find symptom relief. "For some people, that's once or twice a week," she says. "For others, it's every day."

•  Fill it correctly. To soothe mild symptoms, Dr. Pynnonen suggests making a saline solution by adding ¼ teaspoon kosher salt and ¼ teaspoon baking soda to eight ounces of comfortably warm water. Be sure to use pure, kosher salt to prevent irritation.

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•  Use filtered water. Follow the good Louisiana doctor's advice: Avoid plain tap water in any saline nasal irrigation method you choose. Boil your tap water first, buy distilled water, or use filtered water. Most countertop or pitcher water filters are designed to remove bacteria.

•  Keep it clean. Wash your saline nasal irrigation device regularly in hot, soapy water, and let it air dry. If you use a plastic bottle or pot, replace it every three months or so, just as you would a toothbrush, suggests Dr. Pynnonen.