nasal irrigation safety tips

Amebic meningoencephalitis.

That’s a mouthful.

In layman’s terms, you may have heard it referred to as the “brain-eating amoeba.” This microscopic organism is found in lakes, rivers and hot springs. People are infected when contaminated water enters the nose.

But what does that have to do with nasal irrigation and sinus infection treatment? In rare cases, using contaminated tap water for nasal irrigation for sinus infection treatment –such as using a neti pot - can lead to infection. 

The first two cases of amebic infection from nasal irrigation occurred in Louisiana in 2011 as a result of using contaminated tap water. 

In 2018, there was another case in Washington state. Although a Brita filter was used in this case to purify the water, the water was still not sterilized enough.  In order to be effective, all water purifiers must meet the microfiltration requirements specified in the guidelines from the CDC.

Fortunately, this amebic disease is incredibly rare, but it has a terrifying fatality rate. The CDC states that out of 145 Americans who were infected from 1961 to 2018, only four survived. 

But what lessons can we learn from this, and how does it affect how you should irrigate your sinuses?

Nasal Irrigation Hygiene is Vitally Important

Are you sure that the water you’re using for your nasal irrigations is clean enough? A mere tap water filter doesn’t work.  The recommendations from the CDC are to boil water for at least one minute and then let it cool. Other recommendations are using microfiltered water, distilled water or sterile water. 

You’d think that the chance of obtaining a serious amebic disease—no matter how remote--- would encourage more diligence, but despite recommendations, 48 percent of patients say they use regular tap water to irrigate their nasal passages, according to information from the International Forum of Allergy and Rhinology

Tips For Nasal IrrigationShould I Stop Irrigating My Nose? 

No. The benefits of nasal irrigation far outweigh the risks. Just remember to be sure your device is properly maintained and the water that you use is sufficiently sterilized. If you use a device like a neti pot, be sure it is adequately cleaned after each use. 

Are Nasal Irrigations Always Effective?

Using nasal irrigation for chronic rhinosinusitis is an almost universal recommendation. They can be very effective at alleviating symptoms and helping your sinuses drain.

However, there is a wide variety of philosophies on how these nasal irrigations should be administered because there is an extensive array of sprays and neti pots from which to choose. More research must be done before enough evidence is gathered on what is the one most effective recommendation can be made.

That being said, the most recent recommendations from the International Consensus Statement on Allergy and Rhinology suggests that high volume nasal irritations as an adjunct to other various medical therapies were the best options.

Squeeze bottles tend to be most successful at irrigating the sinuses. These are considered the gold standard” for nasal irrigation. They include items such as the NeilMEd®, Sinugate® and the Navage®. 

Another issue to consider is the method of nasal irrigation and how it is delivered into the system. 

Following are a few interesting facts medical studies have uncovered.

  • Nasal irrigation doesn’t penetrate the sinuses as well in patients who have not undergone surgery.
  • The nose-to-ceiling position is the best one for rinsing the sphenoid sinuses. These are the sinuses that are located behind the nose and between the eyes.
  • Squeeze bottles seem to be more effective to irrigate the maxillary, frontal and sphenoid sinuses. 
  • There is no additional benefit to heating the nasal solution before delivering it.

Some Hygiene Tips

As mentioned earlier, keeping your irrigation system clean is vital for success and safety. If you don’t, you’ll create a hotbed of bacteria in your sinuses, which of course, will only make the situation worse.

We will provide the important information you need in order to help you maintain your nasal irrigation system. 

Remember to:

  • Clean your equipment every day with soap and water.
  • Every week, sterilize your equipment using Betadine or a solution of 100 parts water to one part bleach. Remember that the device has to air dry---and do so completely ---before you should use it again. 
  • Replace the system every three months to help avoid bacterial contamination.
  • Clean the rinse bottle by microwaving the system for 30-60 seconds. This has been shown to be very effective

The FDA also provides these additional recommendations:

  • When using your device, always wash and dry your hands.
  • Inspect your device before use to ensure it’s completely dry and clean.
  • Be sure to follow the manufacturer’s directions for use.
  • Wash the device between uses and dry the inside with a paper towel.

Dedication. Excellence. Compassion. These Are Our Principles at Raleigh Capital ENT

All of our physicians have graduated from some of the most highly regarded medical schools in the country. Their extensive pediatric and adult ENT training are from some of the leading programs in the United States, including Johns Hopkins University, the University of North Carolina, Duke University, the University of Virginia, Emory University, Ohio State University and the University of Pittsburgh and others.

This means you can rest assured that you’re not only working with a team of compassionate, seasoned professionals, but you will have access to the latest innovative treatments and procedures available. 

If you are having problems with your sinuses, or if nasal irrigation isn’t effective for you, please contact us so we can assist you.


Raleigh Capitol Ear, Nose, and Throat is the area's premier physician-owned ENT practice with seven convenient locations throughout Wake County. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us.


This article was reviewed by  Dr. Jeevan Ramakrishnan.


Centers for Disease Control. “Parasites.”

Food and Drug Administration. “Are Neti Pots Safe?” 

Succar, Eric F., MD, et. al. “Nasal Saline Irrigation: A Clinical Update.” 

International Forum of Allergy and Rhinology. Vol. 9, No. S1, May 2019