As we transition from fall allergy season to the winter cold and flu season many people are looking to alternative solutions for relief from mucus and nasal congestion. Nasal saline irrigation, often administered with a neti pot, has become a popular adjunct therapy. Reports of deaths from amebic brain infections linked to neti pot use were widely publicized in the media and raised some concern about this therapy. Before you take the plunge it is worth asking – are neti pots effective and are they safe?

A neti pot is a container with a spout that is designed to irrigate the nasal passages, usually with a salt water solution. The spout of the neti pot is placed in one nostril as the head is tilted and the solution flows into one nostril and out the other, flushing out mucus and particulate matter with it. They are used for head colds, sinus problems, allergies, and some people irrigate their nasal passages daily as part of their general health routine.

Though there are many enthusiastic neti pot users out there, the evidence for the true benefit of nasal saline irrigation is sparse and inconsistent. In one study of chronic rhinosinusitis (inflammation of the nasal and sinus passages persisting over 12 weeks) daily use of nasal saline irrigation showed a 64% reduction in overall symptom severity. However, there is some concern that ongoing daily use of nasal saline irrigation may make a person more susceptible to infection by washing away the protective layer of “good” mucus that acts as a first line of respiratory defense. For use with allergies, acute upper respiratory infections (colds), and nasal inflammation of pregnancy there is even less data on efficacy but, overall, safety and tolerability across the board looks good.

Fewer than 10% of people using nasal saline irrigation report adverse effects. The most common include a sensation of ear fullness, stinging of the nasal passages, and in rare occasions nosebleeds. The most serious concerns related to neti pot use have to do with the solution that is used in the neti pot, not the technique itself. You can make your own solution at home with purchased salt packets or by adding ¼ tsp salt per cup of water. The water you use to prepare the solution is very important and the CDC recommends it be bottled water that has been distilled or sterilized. Tap water can be used but only if it has been boiled for 5-7 minutes then allowed to cool.

There are organisms in bottled and tap water that are okay for drinking but can be harmful if introduced deeply into the nasal or sinus passages. In the deadly cases of amebic brain infections linked to neti pot use evidence of the causative ameba was found in the home plumbing. Other organisms cultured from hot water heaters have also been implicated in cases of chronic sinus infections in regular neti pot users who did not prepare their water correctly. You should make up fresh solution each time you use your neti pot. Care must also be taken to clean and completely dry the neti pot after each use.

Since it is generally well tolerated and safe when the proper solution is used, nasal saline irrigation, including the use of neti pots, can generally be recommended. Though hard evidence is lacking it is unlikely to hurt you and it just might help so go ahead and give it a try.