Neti Pot Deaths Spark Tap Water Warnings

Reading time: 3 – 5 minutes

Sinus irrigation — the use of a saltwater solution to “wash” the sinuses — is recommended by allergists and other physicians as a mechanism for reducing symptoms of seasonal cold, allergies, and nasal or sinus irritation [1]. Research also suggests that sinus irrigation, generally performed at home using a special sinus irrigation bottle or a device called a neti pot, is safe and isn’t associated with any serious adverse effects [2].

However, there have been two neti pot-associated deaths in Louisiana recently, both of which were caused by infection with the “brain-eating amoeba,” Naegleria fowleri. Naegleria itself isn’t particularly rare, but infections are, because the amoeba doesn’t cause harm if it’s ingested through contaminated drinking water, according to the U.S. Centers for Disease Control and Prevention (CDC) [3]. Instead, most Naegleria infections result from swimming in warm water — generally in the Southern or Southwestern U.S. states — which allows the amoeba to enter the nose. From there, Naegleria makes its way into the brain. Symptoms of Naegleria infection begin anywhere from a day to a week after exposure, and are similar to meningitis. They include nausea, headache, and vomiting. The symptoms progress into seizures and hallucinations, and the resulting meningoencephalitis, or inflammation of the brain and its membranes, causes death within days.

Drinking water (i.e. tap water), generally speaking, shouldn’t contain Naegleria, as it’s killed by chlorination. However, small quantities of Naegleria may survive the chlorination process, meaning that tap water in Southern and Southwestern U.S. states could potentially contain the amoeba. While this doesn’t make the water unsafe to drink, it does pose a small risk if tap water is used in a nasal irrigation device.

The CDC acknowledges that there’s a risk, albeit a very small one, of Naegleria infection associated with neti pot use, though there is no risk at all if sterile water is used for irrigation purposes. The State of Louisiana Department of Health and Hospitals warns that it’s best to use distilled water in neti pots, or to boil (sterilize) tap water before use.

The neti pot originated in India, though when it was first used is a matter of debate. A neti pot looks a bit like a teapot or genie’s lamp, with a reservoir and long spout. It is filled with warm saline (water and table salt). The spout is put up against one nostril, and by tipping the neti pot, the user pours water into the nostril. The solution flows through the sinuses and back out the other nostril. This procedure is repeated on the other side. This flushes excess mucus, dust, and allergy-causing particles from the nasal passages and sinuses.

Nasal irrigation can help to reduce sinus congestion. Although saline sprays are also available, a recent study found that saline nasal irrigation is more effective thn spray for chronic sinus symptoms.

References

1. Tomooka et al. Clinical Study and Literature Review of Nasal Irrigation. Laryngoscope. 2000 Jul;110(7):1189-93.
   View abstract
2. Rabago et al. Saline Nasal Irrigation for Upper Respiratory Conditions. Am Fam Physician. 2009 Nov 15;80(10):1117-9.
   View abstract
3. Naeglieria – Frequently Asked Questions (FAQs). Centers for Disease Control and Prevention. Accessed 2011 Dec 22.