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Q: I've been using a neti pot to clear my nasal passages. Is it safe?

A: The neti pot is a device recommended frequently by physicians for irrigation of the nasal passages. The goal is to remove debris, preventing recurrent sinus infections and to provide symptomatic relief in people with seasonal allergies. Interest in these "genie lamp"-like devices is on the rise in the US, thanks to recommendations from celebrities like Oprah and Dr. Oz.

The idea is basically this: the thick mucus that builds up when you have chronic inflammation as a result of a sinus infection or an allergic response is what causes the symptoms of facial pressure and pain. Several small studies have found that the use of nasal irrigation can effectively reduce symptoms and reduce the necessity for steroid nasal sprays in the short-term.

However, regular long-term nasal irrigation may do more harm than good. It can wash away the protective mucus that serves as a defense mechanism, actually worsening sinusitis.  A team in Washington, DC led by Dr Talal Nsouli, a clinical professor at Georgetown University School of Medicine recently studied 68 patients who had been using Neti Pots at least twice per day for a period of more than 10 months. For one year, these patients continued nasal irrigation as before, and then for the next 12 months they were instructed to suspend all use of Neti Pots. This group of patients was compared to a second group of patients who continued to use Neti Pots daily for that second year. Patients who stopped the nasal irrigation had a 62% reduction in sinus infections compared to the previous year, and had 50% fewer infections compared to the group who continued use of Neti Pots. Keep in mind, though, that this is a relatively small study and the results have yet to be duplicated.

Additionally, there are certain dangers associated with the use of Neti Pots. Two people in Louisiana recently developed fatal infections, caused by Naegleria fowleri, more affectionately known as brain-eating amoeba. The bug enters the body through the nose and destroys brain tissue, causing an infection known as primary amoebic meningoencephalitis (PAM). Symptoms include headache, stiff neck, and fever, which can progress to seizures, vomiting and delirium. If left untreated, the infection can cause death within two weeks. In these particular cases, it was later found that the Neti Pots had been used with tap water, rather than sterile water as indicated in the instructions.

So what is the bottom line?

Neti Pots may be beneficial in the short-term. Use for up to one week when symptoms are most severe, and make sure you use sterile or distilled water, which is available over the counter. You can also just use boiled water that has been cooled. Immediately discard any unused saline solution because it can make a great growth medium for scary bugs. Make sure you rinse and dry carefully between uses, and disinfect it intermittently. Don't share your Neti Pot with anyone else. If you develop symptoms such as headache, stiff neck, confusion, balance problems or vomiting, make sure you see your doctor right away.

Krupa Bhojani Playforth, MD, Pediatrician from Arlington, VA

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