Hidden Dangers of Neti Pots

Nasal rinsing 101

Those little teapotlike vessels with long spouts — otherwise known as neti pots — are used to funnel a saline or saltwater solution through the nasal passages as an antidote to a variety of sinus problems such as the common cold, sinusitis and allergies. They also help moisten dried-out sinuses in the winter. But they are meant to be used with sterile water and that’s where confusion sets in. ​What constitutes sterile? In short: not tap water.

According to the U.S. Food and Drug Administration, water straight from the faucet is safe to drink, but it’s not adequately filtered or treated to use as a sinus rinse.

“It may have pathogens and other substances in it that can be irritating and/or dangerous to put in the nose,” says Meha Fox, M.D., assistant professor of otolaryngology at Baylor College of Medicine in Houston.

So although tap water may be safe to swallow — thanks to stomach acids that kill such substances — that shouldn’t be confused with sterile.

And yet a study published in 2023 in Emerging Infectious Diseases suggests there is confusion. In a survey of 1,004 adults in the U.S., researchers found that even though most respondents said they know what constitutes sterile — and understand that tap water is not that — nearly two-thirds still responded that it is safe to use tap water with a nasal rinsing device like the neti pot.

About one-third believed, incorrectly, that tap water is free of bacteria and other microorganisms. 

In fact, tap water is safe to use for nasal rinsing only if you boil it for at least one minute — a minimum of three minutes if you live above 6,000 feet — let it cool to room temperature, the CDC advises. Then place it in a container with a lid and use it within 24 hours, suggests Schaffner, who added, “If you don’t want to boil water, buy distilled water or sterile water.”

Also important to keep in mind:

• If you have a weakened immune system, talk to your doctor first about the relative risks of using a neti pot.

• Use a saline rinse prepared with the mixture that came with your neti pot, or make it yourself. The American Academy of Allergy, Asthma & Immunology recommends the following recipe: Mix 3 teaspoons iodide-free salt and 1 teaspoon baking soda. Add 1 teaspoon of the mixture to 8 ounces (1 cup) of lukewarm sterile, distilled or boiled water for a single use. Store the remaining salt mixture in a small airtight container.

• Make sure the solution is at room temperature before using. Solutions that are too cold or too hot are hard to tolerate.

• Wash your neti pot after each use and be sure to dry the inside thoroughly with a paper towel or let it air dry between uses. “These devices can build up bacteria or mold, so they need to be cleaned regularly,” Fox says. “Some manufacturers recommend placing the device in the microwave for a short time.”

• Replace your neti pot regularly. “Most manufacturers recommend replacing the device every three months,” Fox says.

• Don’t overdo it. Let common sense be your guide. “You’re trying to soothe the membranes of your nose and sinuses and doing this too frequently — I have no idea what too frequently is — can irritate mucus membranes,” Schaffner says. One clue you may be overdoing it? Your nasal passages are “getting dried and cracked,” he adds. Another clue: Trouble hearing. “Nasal rinsing is a safe thing to do,” Fox says. But “the rinse fluid can get into the eustachian tube — the tube that connects the ear to the nose — and cause muffled hearing. The fluid usually clears up on its own. If you experience this, I recommend pausing on rinsing for a few days.”