Dear Dr. Peg,
I like to use a neti pot to wash out my sinuses when I have a cold or allergies, but I heard that some people died from doing this. Is this true? Should I stop using the neti pot?
-Nervous about Neti
Dear Nervous,
Yes and no. Yes, it is true that two people died after using a neti pot, and no, you shouldn’t stop. But you should make sure you use filtered, boiled or distilled water.
A neti pot is used to rinse out nasal passages and sinuses. This can also be done with a special squeeze bottle. The devices come with a salt powder that you mix with water. You then squirt or pour the solution up one nostril, where it circulates around the passages and comes out the other nostril.
Lots of my patients do this, especially in the spring when the air is full of pollen. If you rinse out your nose once or twice a day, not only does it physically remove the pollen from your body, it loosens up and hoses out mucus, keeping the airways clear. I have recommended this practice for years.
Last year in Louisiana, two people from different parts of the state died after using a neti pot. However, it wasn’t the pot that killed them. What happened was that they used unfiltered tap water, and their particular tap water happened to be contaminated with a very deadly amoeba, called Naegleria fowleri.
An amoeba is a single-celled organism, as you probably learned in high school biology. It is bigger than a bacterium but smaller than a bread box. Naegleria fowleri is one of several of the genus Naegleria and the only one that infects humans.
It’s slightly larger than one of your red blood cells, it loves warm water and soil, and has been found in lakes, streams, hot springs and rivers. It has been found in many animals and even fish. This amoeba lives all over the place, including New Mexico. It is not in our tap water, as far as I know, but it has been found in some of our hot springs.
Naegleria fowleri multiplies in warm weather and warm water. Most of the time this little critter doesn’t cause any trouble. We can even swallow it without consequence. But if it gets pushed or squirted up the nose, it can crawl up into the brain and cause PAM, or Primary Amoebic Meningoencephalitis. This is an infection of the brain that is very quick and very deadly. It is hard to diagnose and hard to treat. Victims almost always die within a few days.
Thankfully PAM is exceedingly rare. Only about three people get it each year in the whole country. These are often kids or young people who jump or cannonball into warm bodies of water, forcing fluid and amoebas up their nose. Here in New Mexico, a young man died about 15 years ago after swimming in the San Francisco Hot Springs near Silver City. That same year, a boy in Arizona got it from Lake Havasu. He died too.
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The probability of getting PAM from a sinus rinse is miniscule. The hazard is extremely low even from swimming in fresh water. Think about all the people who swim in lakes and visit hot springs every year and don’t get PAM. But nobody wants to be one of the three who does, so if you like to soak in nature’s bath, keep your head above water, and if you’re a cannonballer, plug your nose when you jump.
As far as your nose goes, most neti pots or sinus rinse bottles come with instructions to use filtered or distilled water, but it is easy to get lazy and just use tap water, adjusted to a comfortably warm temperature.
Resist this temptation. Filter the water through a standard faucet filter or use distilled or boiled water. Wash your neti pot or squeeze bottle between uses and make sure to let it dry completely. Amoebas can’t survive in air.
The risk of death by neti pot is vanishingly small. But there’s no need to chance it when it is so easy to avoid. Allergy season is coming up. Hang onto your neti pot or squeeze bottle and use it in good health.
_Dr. Peggy Spencer is a student-health physician. She is also the co-author of “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.
This column has general health information and cannot replace a trip to a health provider._
