Perspective Is Paramount
Given the strong reaction and concern that stories such as the Seattle fatality generate among patients, and the subsequent need for otolaryngologists to educate their patients about safe nasal irrigation in the context of rare infection and compliance issues, Timothy Smith, MD, MPH, professor and chief in the division of rhinology and sinus/skull base surgery in the department of otolaryngology-head and neck surgery at Oregon Health and Science University in Portland and a member of the ENTtoday editorial advisory board, urged otolaryngologists that perspective is paramount. “At what point do additional safety measures become more dangerous?” he questioned in a Letter to the Editor published in the International Forum of Allergy and Rhinology (Published online ahead of print January 18, 2019. doi: 10.1002/alr.22294).
He elaborated in an interview with ENTtoday: “While the recent death is very tragic, at what point do our recommendations to be as safe as possible to avoid an extremely rare infection actually create a situation where our patients will become noncompliant and be harmed by the noncompliance to their therapy?” he asked. “From a public health stand point, you can probably make the argument that more people will be harmed trying to following somewhat burdensome recommendations than are going to be harmed by a rare amoeba infection.”
In the published letter, Dr. Smith interviewed four other otolaryngologists on their thoughts regarding water sources for nasal irrigation. As a whole, he said, they all agreed that the safest irrigation water source is either distilled water or boiled water that has cooled. However, he also emphasized the shared concern to educate patients on how to weigh the rare risk of infections with noncompliance to the CDC recommendations of appropriate water sources for nasal irrigation. “We need to have a conversation with patients about the risks of an exceedingly rare but deadly infection versus the risk of noncompliance of their therapy,” he said. “There is probably room for shared decision making here.”