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The Risks and Benefits of Neti Pot Nasal Irrigation

Though nasal irrigation with salt water has been found to an effective and inexpensive treatment option for sinusitis symptom relief, neti pot use may increase the risk of recurrence. A new study reveals why and what we can do about it.

December 16, 2011 |
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As described in a 2011 review in American Family Physician, nasal irrigation with salt water using something like a neti pot has been shown to beneficial for those suffering from sinus infections, “a safe and inexpensive treatment option for patients seeking symptom relief,” an opinion shared by none other than the Cochrane Collaboration, probably the most prestigious source of evidence-based medicine. So what’s the downside?
Well as with any alternative or complementary medicine modality there’s always a concern it could potentially delay treatment of serious disease, but for non-severe symptoms in immunocompetent individuals—just mild pain and fever, symptoms lasting less than a week—nasal irrigation can work wonders.
But the reason I bring it up is that an abstract presented at a medical conference in 2009 suggested chronic nasal irrigation may result in more frequent, recurrent attacks of sinusitis, and a new study appears to have figured out why.
People were reinfecting themselves with contaminated neti pots, called here irrigation bottles. They cultured bacteria out of 97% of the bottles collected from people who used them for recurring sinusitis. Under a microscope they demonstrated biofilm formation, bacteria stick to the inner surface so you can’t just rinse them out. The same bugs that caused your sinus infection in the first place may just be sitting there waiting to reinfect you later on. The good news is they found simple cleaning methods, washing them out with boiling water or microwaving them for 2 minutes did a good job of sterilizing them so they are ready and clean for their next use.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

To help out on the site please email volunteer@nutritionfacts.org

Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on alternative medicine, and for more on sinus health: Is milk and mucus a myth?

Check out my associated blog posts for more context: The Best Way to Prevent the Common Cold? and Probiotics During Cold Season?

  • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on alternative medicine, and for more on sinus health: Is milk and mucus a myth?

  • http://nutritionfacts.org/members/thea/ Thea

    This is such great info. I have never used one of these pots, but I was curious if they were really any good. I love that these are not superbugs and that they can be killed so easily.
    Thanks!

  • http://nutritionfacts.org/members/shellbelle/ shellbelle

    Dr Greger- I love your informative videos. Thanks so much. I have not missed a day of nosewashing since 1995. I rinse out my neti pots and have never had any trouble but perhaps I should clean them in the dishwasher ? I read an article about 2 deaths linked to a “brain-eating amoeba” called Naegleria fowleri in tap water used in a neti pot in the south. The article says that that amoeba is rare and usually found in the WARM fresh water
    lakes and rivers of the south – Florida and Louisana & around there. I’m in California – should I now boil my nosewashing water & let it cool?

    • http://nutritionfacts.org/members/mgreger/ Michael Greger M.D.

      I do recommend you effectively sterilize your neti pots using one of the two methods I describe in my Risks and Benefits of Neti Pot Nasal Irrigation video. In terms of Naegleria fowleri, it’s not really an amoeba but it does appear to eat brains. It apparently invades through the lining of the nose and climbs along the olfactory nerve fibers into the brain, causing an nearly invariably fatal meningoencephalitis (about 99% of reported victims die). Thankfully it’s extremely rare (only about 3 cases a year reported in United States). It is a thermophilic (warmth loving organism) and indeed most cases are reported in the South, but there was a case up in Minnesota last year, so I agree with the new safety advisory that one should only use distilled or previously boiled (and cooled) water to irrigate one’s nose.

  • http://nutritionfacts.org/members/sanfrantreat/ sanfrantreat

    I have to use a neti pot twice a day or I get really congested. Is it necessary to also use distilled or boiled water to wash out the neti pot or is tap water ok? I’m trying to figure out the logistics so it doesn’t take so much time out of daily routine.

    • fineartmarcella

      sanfrantreat, I also neti twice a day and it keeps my sinuses very healthy, quite a change from pre-neti times :), but after reading the doc’s remarks on needing to sterilize the water even from the tap, so I logically looked at it and I may consider boiling some water and then keeping it in the frig in a glass mason jar to use at my convenience, reheating to warm and then adding my neti salt at the end prior to neti’ing. I have those large 1500 size mason jars that would be perfect. I don’t keep anything I put in my body in plastic jars due to the leaching of chemicals (and you can smell it in the water that you neti with). Anyway, that is my opinion, goodluck

  • http://nutritionfacts.org/members/AlexSoury/ Alex Soury

    Hey Dr Greger

    Here is an article regarding deaths from neti pot use. Actually from an amoeba not the neti pot.

    http://www.npr.org/blogs/health/2011/12/19/143960631/second-neti-pot-death-from-amoeba-prompts-tap-water-warning?sc=fb&cc=fp

  • http://nutritionfacts.org/members/gabrielg/ GabrielG

    Good info. I always thought if we could use the microwave to disinfect things. Will that take 2 min at max potency? for larger objects more time?. Same for cloth?.

    Also, is there any way to reduce bacteria in liquid solutions e.g. nasal drops containing naphazoline (as I seldom use them they get old and I am not sure if they have a disinfectant in the ingredients). Can I microwave or freeze them?

    Thanks

  • http://nutritionfacts.org/members/gabrielg/ GabrielG

    OT no need to publish. An RRS for the comments would be nice to have.

  • http://nutritionfacts.org/members/gabrielg/ GabrielG

    Will the microwaves kill fungi too?

  • http://nutritionfacts.org/members/adah/ adah

    for years used neti pot with good effect (dumb luck, i always cleaned w hot water from tea pot) – but recently when i use it, the saline goes into my ear canal somehow

    anyone every experience that? i have my first cold in years, and would like to irrigate but can’t!!

  • http://nutritionfacts.org/members/shellbelle/ shellbelle

    Do you mean your nose is so congested with mucus the neti pot water can not get IN? If so you can get some Afrin nasal spray–blow nose first–then spray in the Afrin. wait 10 min – then try the neti rinsing. Afrin works to open your nose up and the effect lasts 12 hours – so if you try this at say 8 a.m. you can irrigate 3 or 4 times before 8 pm. My ENT doc says it’s ok to use Afrin for 5 days if you are irrigating each day. But long term use of Afrin is not good. Another thing you can use is Xlear with xylitol nasal spray. Google it or check Amazon – Amazon sells it and my local health food stores carry it. It’s like soap for the nose – clears out mucus and is safe, non addicting and natural

  • Carla

    Is this type of cleansing necessary for commercially sold saline solution nasal wash dispensers? I find it more effective than the neti pot, because of the pressure.

  • Lew Payne

    For reasons I have yet to understand, every time I take my B12 lozenge (1000 mcg TIW) my sinuses begin to tingle, and clear within thirty (30) minutes. I do suffer from rhinitis, with pseudoephedrine being my only effective means of relief. The neti pot (squirt bottle actually, which works better and is less messy) just stuffs my nose up.

  • LynnCS

    Stopping the eating of Dairy has been shown to make a big difference in congestion, colds, sinusitis etc in me. I have read that it is true in studies too, altho I can’t find a link right now. I have also eliminated all animal products after what I have learned about it’s effects on the body. I now know I can get everything I need from a plant based diet. Congestion is 99% better. It takes time. So glad I’ve discovered this option.

  • LynnCS

    …a little more on my journey is that I suffered for most of my life with chronic bronchitis and chronic sinusitis and now not. A nice side effect of eatin this way is that it also helped me lose a lot of excess weight and I feel better than ever. I have found wonderful tasty foods that I never knew existed and I am stronger in my workouts than ever. No problem building muscle either.

  • Marie

    I’ve used the sinus irrigation previously but the last 2 times I’ve tried it, it burned my nose sooo bad I had to stop. I’ve had a sore throat and earache on the left side-only at night. I use a steroid nasal spray. I don’t understand why I’m having such burning when previously I could irrigate with no problem.
    Thanks,
    Marie

    • suzan

      Make certain you are not using just plain water – as it will sting like crazy! Use the saline packets and mix that with your water before nasal washing.

  • Mary

    Since this was posted 2 years ago, not sure anyone will respond. This makes perfect sense, And yes, now it will take more time to do the process, but better safe than sorry.

    I am thinking this would be also true for other items that enter body orifaces – douche and enema nozzles – could probably reinfect, even grow a super bug!!! Am I right? Wondering if silicone can go in the microwave?

  • LittleCher

    How does one restore healthy bacteria in the nose?

  • Yvonne

    My husband, who is a vegan, suffers from nasal/sinus polyps. When they are large he can’t even use the Neti Pot. His
    doctor is recommending surgery, which we’ve discovered can have some pretty
    severe risks. Also, the polyps will most likely grow back anyway. To get
    them under control, he’s gone through two series of Prednisone. His
    doctor won’t prescribe any more, however. What natural ways are there to
    control sinus polyps? We do know that he is allergic to cats (we
    have two) and grasses. What natural methods are available to get the polyps under control?

  • CJ

    Dear Dr. Greger, I am suffering from what the medical community calls nasal polyps. I was diagnosed with this when I was in my early teens and I have been living with this for the past 15-18 years. Its an inflammation within my nose and causes me to have a painful, congested and runny nose when my nose is irritated whether by allergens like tobacco smoke, dust, water, cold weather, etc… At its worse, the polyps would block both of my nasal passages and cause me to be unable to breathe thus forcing me to breathe through my mouth. I would like to find out if Neti Pot Nasal Irrigation will help my condition or do I need to consider another form of treatment to look to… Preferably, I would not like to go for a surgery to remove it as the doctors have mentioned that there is a potential of 70% relapse of the condition… Is there a safer, easier and natural way to cure or reduce this inflammation to manageable levels? Thanks.

  • Linda

    Is a saline spray also risky?