Guest post by Alfred Iloreta, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery and member of the Division of Rhinology and Skull Base Surgery at The Mount Sinai Hospital.
As a skull base surgeon and a rhinologist, I commonly prescribe the use of the ‘Neti pot’ for the majority of patients and even myself. The practice of irrigating the nasal passages with water has been around for approximately 5,000 years with its origins South Asian culture within the practice of Ayurveda, an ancient practice of yoga. These Yoga Masters called the sinus cleansing technique “Jala Neti,” and it exists as one of the six main practices in cleansing the body to prepare for the higher practices of yoga.
Traditionally the sinuses were irrigated with various substances ranging from water, ghee butter, and milk. The Neti pot was introduced into western medicine in the 1970’s, but it’s popularity and use exploded in 2007 when it was showcased on the “Oprah Winfrey Show.”
This practice is helpful for those suffering from sinus problems and those who have just undergone sinus surgery, as it relieves crusting in the nasal passages. I get plenty of questions from patients and colleagues about it’s use, and more times than I care to share, it’s been the topic of several dinner parties.
Is the Neti Pot Safe?
The first question that people ask is…is it safe? The short answer is yes it is very safe; however, there are several precautions one must take to maximize its safety.
The dangers of neti pot use spread through social and mainstream media following two unrelated deaths in Louisiana linked to a lethal parasitic brain infection from tap water contaminated by an ameba called Naegleria fowleri. This amoeba is commonly found in warm freshwater lakes, rivers, and springs. The typical route of infection occurs when someone goes swimming in a body of water and gets water into the nose, the ameoba then travels directly to the brain and causes a nearly universally fatal brain infection. Both infected individuals used tap water in their irrigation.
All tap water contains very small levels of bacteria and other micro-organisms, so in general, I urge all my patients to use either boiled water or distilled water in their irrigations. The boiled water should be held at a boil for at least five minutes and then allowed to cool. In addition to that to prevent the risk of infection I also ask that my patients regularly clean their neti pots in the dishwasher or by microwaving them for approximately 90 seconds. As an added precaution I ask that they store their neti pots in the kitchen instead of the bathroom where there is more potential for contamination.
Importance of Irrigating Sinuses with the Neti Pot
I use a very simple analogy when I explain the importance of sinus irrigations to my patients…It’s like brushing your teeth or taking a shower – but for your sinuses. The primary function of the nose is to warm, humidify, and filter the air that we breath. Microscopic particles of dust, pollen, and smoke are filtered out by the lining of the nose. Our sinuses and nasal passages have a mechanism built in to it called ‘mucociliary clearance,’ where tiny microscopic hairs imbedded in the lining of our nasal cavity transports mucous that captures all these particles to clean itself out. The problem is that that the amount of particles trapped into our nose can easily overcome its ability to cleanse itself. The Neti pot assists our natural functions by washing away the excess particles that may be trapped.
How Often Should the Neti Pot Be Used?
Individuals suffering from daily sinus issues can use the Neti pot once a day. However, three times a week is sufficient for those with mild sinus symptoms.
Neti Pot Efficacy: Does Using It Really Improve Sinuses?
Many research studies have been conducted to assess the efficacy of saline irrigations on patients with sinusitis. Several of these random control trials compare saline irrigations to no irrigations in patients with chronic sinusitis. Upon examination of the data, the general consensus has been that the use of saline irrigations leads to an overall improved quality of life, compared to not using irrigations. The evidence indicates that saline irrigations are a great treatment option in both children and adults with chronic sinusitis. Plus, there were little, if no, complications.