3 Counseling Tips for Neti Pot Users

Neti pots have become popular for the treatment of sinus congestion, colds, allergies, and moistening nasal passages. These devices resemble teapots with long spouts that are used to rinse the nasal passages. Neti pots can be an effective nonmedication approach for clearing the sinuses; however, they must be used properly to prevent serious infections. Pharmacists can play an important role in educating neti pot users with these 3 counseling points:

• Tap water isn’t safe for use since it is not adequately filtered.

Naegleria fowleri is a climate-sensitive amoeba that is frequently found in natural bodies of warm freshwater including lakes, ponds, rivers, and hot springs.¹ Additionally, this amoeba can be found in tap water. It is safe to swallow these organisms; however, the amoeba can stay alive in the nasal passages. This can lead to the potentially deadly condition known as primary amebic meningoencephalitis (PAM).²

Naegleria fowleri enters the nose and moves along the olfactory nerve and travels to the brain.³ Signs and symptoms of infection are similar to bacterial and viral meningitis, which include headache, fever, stiff neck, anorexia, vomiting, altered mental status, seizures, and coma. Onset of symptoms typically occurs 1-7 days after exposure.³ The first 2 reported cases of PAM resulting in deaths associated with sinus irrigation using contaminated tap water occurred in Louisiana in 2011.³ These cases demonstrate the need for education on the following appropriate types of water to use for nasal irrigation:

• Distilled or sterile water-label will state “distilled” or “sterile”
• Boiled and cooled tap water-boiled for 3 to 5 minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container but must be used within 24 hours
• Water passed through a filter designed to trap potentially infectious organisms-label may read “NSF 53” or “NSF 58” or filter labels that read “absolute pore size of 1 micron or smaller”²

• Educate patients on the appropriate use of neti pots.

• Wash your hands with soap and water and dry them.
• Lean over the sink and tilt the head sideways with forehead and chin level to avoid liquid flowing into the mouth.
• Breathing through your open mouth, insert the spout of the saline-filled container into your upper nostril so that the liquid drains through the lower nostril.
• Clear the nostrils then repeat the procedure on the other side.

• Counsel patients on the importance of cleaning the neti pot to prevent infections.

The neti pot device should be rinsed after each use with safe water, and the inside should be dried with a paper towel. It should be left to air dry between uses.

References

• Is rinsing your sinuses with neti pots safe? FDA website. http://www.fda.gov/forconsumers/consumerupdates/ucm316375.htm. Accessed January 31, 2017.
• Sinus rinsing and net pots. CDC website. https://www.cdc.gov/parasites/naegleria/sinus-rinsing.html. Accessed January 31, 2017.
• Yoder JS, Straif-Bourgeois S, Roy SL, et al. Deaths from Naegleria fowleri associated with sinus irrigation with tap water: a review of the changing epidemiology of primary amebic meningoencephalitis. Clin Infect Dis. 2012;55(9):e79-85.