Can Neti Pots Increase Your Risk of Infection?

One of the body’s most important lines of defense against illness are our nasal passages, and so it is no wonder that neti pots, or little teapots with long skinny spouts, have become a common household item. However, the US Food and Drug Administration (FDA) recently released a Consumer Update on how these pots—used to flush out nasal passages—may potentially increase the risk of infection if they are not cleaned properly or used appropriately.

Neti pots are just one of the nasal irrigation systems available for individuals to treat sinuses, colds, or allergies from home. These devices include “bulb syringes, squeeze bottles, and battery-operated pulsed water” and use either a saltwater or saline solution to flush out nasal passages. If used correctly and cleaned properly, these devices are “usually safe and effective,” according to Eric A. Mann, MD, PhD, ‎Clinical Deputy Director at FDA.

The FDA reminds individuals that part of what makes these devices safe, is using the right kind of water, mainly water that has been filtered or purified. Individuals should not use tap water in their nasal rinse devices. According to the FDA, “Some tap water contains low levels of organisms—such as bacteria and protozoa, including amoebas—that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections. They can even be fatal in some rare cases.”

For example, an amoeba commonly known as the “brain-eating amoeba,” Naegleria fowleri, is capable of causing primary amebic meningoencephalitis (PAM), a rare brain infection. Normally found in soil and lakes and rivers with warm freshwater, this amoeba is capable of infecting individuals when contaminated water enters through the nose. Once it enters the nose, it can travel to the brain; once there, it causes PAM, which is “usually fatal.”

Distilled or sterile water can be found in a number of stores for purchase; labels on the water will specify if they are “distilled” or “sterile.” The FDA says that in addition to purchasing this water, boiling tap water for 3 to 5 minutes and then letting it cool until it is at a lukewarm temperature will also work. The Centers for Disease Control and Prevention (CDC) also shared information on how individuals can filter their water, thus removing any harmful germs, using filters with labels that may read “NSF 53” or “NSF 58,” for example. “Filter labels that read ‘absolute pore size of 1 micron or smaller’ are also effective,” according to the CDC.

Following the directions is just as important as using safe water in these devices. In a press release on the FDA Consumer Update, Dr. Mann explained, “There are various ways to deliver saline to the nose. Nasal spray bottles deliver a fine mist and might be useful for moisturizing dry nasal passages. But irrigation devices are better at flushing the nose and clearing out mucus, allergens and bacteria.”

Each device usually comes with instructions, but these devices typically work much in the same way. First, the FDA recommends that individuals wash and dry their hands and that they ensure that their device is also cleaned and dried. Then, they should prepare the saline mixture, or whatever is provided with the device. Then, typically, the individuals will need to tilt their head sideways, over the sink, and breath through their mouths. The spout of the device is then inserted into the upper nostril and the saline or saltwater solution will drain through the lower nostril.

After clearing one side, the individual will then repeat the process to clear out the other nasal passageway. By doing this, individuals are able to loosen thicker mucus in their nasal passages or remove any debris in their nostrils, such as dust or pollen. In addition, the neti pots can sometimes “relive nasal symptoms of sinus infections, allergies, colds, and flu.” Where regular water can cause a burning sensation or irritate nasal passageways, saline solutions allow the water to flush out the debris with minimal irritation, if any.

The FDA noted that the neti pot might not be appropriate for younger children as they “might not tolerate the procedure.” Therefore, individuals should “make sure the device fits the age of the person using it.” The best way to do that? Check with a pediatrician.

The FDA recommends that individuals contact their healthcare providers to figure out if these nasal devices are a good match for your condition or if they have any questions on the safe use of their device; if they are immunocompromised, they should contact their healthcare provider before use of any nasal irrigation systems. If any symptoms become worse after using the device, individuals should stop using the device and return to their healthcare providers.