Counseling Patients on Safe Nasal Irrigation

by Mary Beth Nierengarten •

Others Weigh In

When ENTtoday asked three other otolaryngologists to weigh in, all emphasized the need to follow the CDC guidelines.

“As a rhinologist, I counsel patients to use boiled, sterilized, or filtered water when preparing saline to irrigate their nasal cavities and sinuses,” said Jamie Litvack, MD, MS, MPH, a rhinologist and acting assistant professor in the department of otolaryngology–head and neck surgery at the University of Washington in Seattle. “While this is a very uncommon event, it reminds me to be vigilant about educating patients about proper preparation of nasal irrigation.”

Jamie Litvack, MD, MSWhile this is a very uncommon event, it reminds me to be vigilant about educating patients about proper preparation of nasal irrigation. —Jamie Litvack, MD, MS

Edward McCoul, MD, MPH, director of rhinology and sinus surgery in the department of otorhinolaryngology at Ochsner Clinic and Health System in New Orleans, said his recommendation to use submicron filtered water, either distilled or boiled water that has cooled, has not changed. “This is a fundamental part of the treatment for sinus and allergies affecting the nose and with reasonable precaution it can be a safe and effective treatment,” he said.

He acknowledged, however, the rarity of such infections throughout the centuries of neti pot use and its more recent adoption in western populations and societies. As to compliance, he thinks “it is unclear the extent to which CDC recommendations to use filtered tap water interfere with compliance with neti pot therapy.”

Amy Anstead, MD, director of rhinology and endoscopic skull base surgery at Virginia Mason Medical Center in Seattle, emphasized the safety of neti pots when used properly. Proper use includes replacing the neti pot every three months, cleaning it between each use, and, as the CDC recommends, only using water that has been boiled or otherwise made safe. “At Virginia Mason we provide our patients with written instructions on how to clean their neti pot properly,” she said. “We recommend microwaving the clean empty bottle for about one minute before each use, rinsing the bottle with rubbing alcohol after each use, and storing it in a clean dry place open to the air.” 

Mary Beth Nierengarten is a freelance medical writer based in Minnesota.