Saline nasal irrigation means rinsing your nose and sinuses with salt water. People may do this with a neti pot (a device that comes from the Ayurvedic tradition) or with other devices, such as bottles, sprays, pumps, or nebulizers. Saline nasal irrigation may be used for sinus congestion, allergies, or colds.

There’s limited evidence that saline nasal irrigation can help relieve cold symptoms. Studies of this technique have been too small to allow researchers to reach definite conclusions.

Saline nasal irrigation used to be considered safe, with only minor side effects such as nasal discomfort or irritation. However, in 2011, a severe disease caused by an amoeba (a type of microorganism) was linked to nasal irrigation with tap water. The U.S. Food and Drug Administration (FDA) has warned that tap water that is not filtered, treated, or processed in specific ways is not safe for use in nasal rinsing devices and has explained how to use and clean these devices safely.

Little teapots with long spouts have become a fixture in many homes to flush out clogged nasal passages and help people breathe easier.

Along with other nasal irrigation devices, these devices — commonly called neti pots — use a saline, or saltwater, solution to treat congested sinuses, colds and allergies. They’re also used to moisten nasal passages exposed to dry indoor air. But be careful. Improper use of these neti pots and other nasal irrigation devices can increase your risk of infection.

Nasal irrigation devices — which include neti pots, bulb syringes, squeeze bottles, and battery-operated pulsed water devices — are usually safe and effective products when used and cleaned properly, says Eric A. Mann, M.D., Ph.D., a doctor at the FDA.

Tap water isn’t safe for use as a nasal rinse because it’s not adequately filtered or treated. Some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections. They can even be fatal in some rare cases, according to the Centers for Disease Control and Prevention (CDC).

“There are various ways to deliver saline to the nose. Nasal spray bottles deliver a fine mist and might be useful for moisturizing dry nasal passages. But irrigation devices are better at flushing the nose and clearing out mucus, allergens and bacteria,” Mann says.

Information included with the irrigation device might give more specific instructions about its use and care. These devices all work in basically the same way:

• Leaning over a sink, tilt your head sideways with your forehead and chin roughly level to avoid liquid flowing into your 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 your nostrils. Then repeat the procedure, tilting your head sideways, on the other side.

Sinus rinsing can remove dust, pollen and other debris, as well as help to loosen thick mucus. It can also help relieve nasal symptoms of sinus infections, allergies, colds and flu. Plain water can irritate your nose. The saline allows the water to pass through delicate nasal membranes with little or no burning or irritation.

And if your immune system isn’t working properly, consult your health care provider before using any nasal irrigation systems.

To use and care for your device:

• Wash and dry your hands.
• Check that the device is clean and completely dry.
• Prepare the saline rinse, either with the prepared mixture supplied with the device, or one you make yourself.
• Follow the manufacturer’s directions for use.
• Wash the device, and dry the inside with a paper towel or let it air dry between uses.

Talk with a health care provider or pharmacist if the instructions on your device do not clearly state how to use it or if you have any questions.

• Distilled or sterile water, which you can buy in stores. The 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 for use within 24 hours.
• Water passed through a filter designed to trap potentially infectious organisms.

Use safe water to protect yourself from a deadly brain infection.

Many tiny germs live in warm water.Naegleria fowleri is a water-loving ameba (very small germ) that is often found around the world in ponds, lakes, and rivers. It also can hide in pipes connected to tap water.

Naegleria is so small, even water that looks, smells, and tastes clean can have the amebae swimming in it. Nasal rinsing with unsafe water can lead to infection.

Infections from Naegleria are deadly and rare.

When water contaminated with Naegleria is sniffed up the nose, the ameba can travel to the brain. This causes the disease primary amebic meningoencephalitis (PAM), which destroys brain tissue and usually results in death.

• Infections are deadly: Of 154 people known to be infected in the United States from 1962—2021, only four people have survived.
  • Most Naegleria infections are due to swimming in warm lakes or rivers.
• Infections are rare:
  • There has only been one reported Naegleria infection associated with ritual nasal rinsing in the U.S.
    • More infections linked to ritual nasal rinsing have been reported globally.
  • Two additional infections have been linked to using neti pots or similar devices to rinse sinuses with salt solutions made from contaminated tap water.

You cannot get infected from drinking contaminated water. You can only get PAM when contaminated water goes up into your nose.

Use Safe Water to Protect Yourself

You can lower your risk of becoming infected with Naegleria during ritual nasal rinsing by using treated water. It is safest to use boiled, distilled, sterile, or filtered water. If that is not possible, you can disinfect the water using chlorine.

Water Treatment Options for Nasal Rinsing

• Use water that has been previously boiled for 1 minute and left to cool. At elevations above 6,500 feet, boil for 3 minutes.
• Use water with a label specifying that it is distilled or sterile water.
• If boiled, distilled, or sterile water are not available use a water filter designed to remove harmful germs.
  • Choose a filter that is labeled as “NSF 53” or “NSF 58.” Filter labels that read “absolute pore size of 1 micron or smaller” are also effective.
  • Carefully read and follow the manufacturer’s instructions for the water filter you are using.
• If you are unable to use boiled, sterile, distilled or filtered water, you can use chlorine bleach to treat the water. Learn how to use bleach to disinfect your water.

Talk to your doctor if you have concerns.

Naegleria symptoms may be mild at first and include headache, fever, nausea, or vomiting. Later symptoms may include stiff neck, confusion, seizures, and hallucinations. The disease generally causes death within about 5 days after symptoms start.

To make your water safe for sinus rinsing and ritual nasal rinsing, it is safest to use boiled, sterile, or filtered water. If that is not possible, disinfect the water using chlorine; the cloudiness of the water can affect the ability to disinfect the water.

1. Boiled or distilled (preferred)

• Boil: Use water that has been previously boiled for 1 minute and left to cool.
  • At elevations above 6,500 feet, boil for 3 minutes.
• Buy: Use water with a label specifying that it contains distilled or sterile water.

2. Filter (if boiled, sterile, or distilled water not available)

Filter: Use a filter designed to remove common germs.

• The label should read “NSF 53” or “NSF 58” or contain the words “cyst removal” or “cyst reduction”. If these words are present it means the filter can remove Naegleria. See more information about reading filter labels.
• Filter labels that read “absolute pore size of 1 micron or smaller” are also effective at removing Naegleria.
• Some manufacturers of nasal rinsing devices recommend using 0.2 micron absolute pore size filters that will also remove many types of bacteria; these would also remove Naegleria. Follow the manufacturer recommendations if 0.2 micron absolute filters are recommended.

3. Disinfect (if no boiled or distilled water and no filter available)

Disinfect: Learn how to disinfect your water to make it is safe from Naegleria.

If you are unable to use 1) boiled or 2) sterile/distilled or 3) filtered water, you can use chlorine bleach to treat the water using the following instructions. If the water being treated is cloudy or murky (turbid), those particles may protect Naegleria from being killed by the chlorine. Because of that, we recommend filtering cloudy water first to remove particles and then using a double dose of chlorine disinfectant. The protocol below for disinfection with bleach is intended only to be used for nasal rinsing and not to be used for routine or emergency drinking water disinfection. We have added an extra amount of bleach to this protocol for an additional safety factor that is higher than that used for treating drinking water.

If the water is clear:

• Obtain a medicine dropper and add the number of drops shown in the table below of unscented liquid household chlorine bleach for the amount (one gallon or one quart/liter) of clear water to be disinfected. Use the % sodium hypochlorite shown on the label (either 4 to 5.9% or 6 to 8.25%).
  • Stir the mixture well.
  • Let it stand for 30 minutes or longer before you use it.
  • Store the disinfected water in clean, sanitized, covered containers.

If the water is cloudy, murky, colored, or very cold:

• Filter water through a clean cloth, paper towel, or coffee filter

OR

• Allow any sediment to settle to the bottom of your container, then carefully pour the clear water from the top into a clean container with as little disturbance of the sediment layer as possible.

THEN

• Obtain a medicine dropper and add the number of drops of unscented liquid household chlorine bleach shown in the table below for the amount (1 gallon or 1 quart/liter) of clear water to be disinfected. Use the % sodium hypochlorite shown on the label (either 4 to 5.9% or 6 to 8.25%).
• Stir the mixture well.
• Let it stand for 30 minutes or longer before you use it.
• Store the disinfected water in clean, sanitized, covered containers.

Make sure the device fits the age of the person using it. Some children are diagnosed with nasal allergies as early as age 2 and could use nasal rinsing devices at that time, if a pediatrician recommends it. But very young children might not tolerate the procedure.

Whether for a child or adult, talk to your health care provider to determine whether nasal rinsing will be safe or effective for your condition. If symptoms are not relieved or worsen after nasal rinsing, then return to your health care provider, especially if you have fever, nosebleeds or headaches while using the nasal rinse.

There is some evidence to suggest that saline nasal irrigation may modestly improve some seasonal allergy symptoms.

What Does the Research Show?

The available data on efficacy of saline nasal irrigation for seasonal allergy symptoms consist of several randomized controlled trials in both adults and children, as well as a systematic review and meta-analysis.

• A 2012 systematic review and meta-analysis of 10 studies found that saline nasal irrigation administered regularly over a period of up to 7 weeks was observed to have a beneficial effect on nasal symptoms, reduction in medicine consumption, acceleration of mucociliary clearance time, and quality of life in adults and children with allergic rhinitis.
• A 2012 review of nasal saline irrigation in the management of sinonasal disease found that nasal saline irrigation appears to demonstrate some modest clinical benefits.

Safety

• Nasal irrigation is generally safe; however, neti pots and other rinsing devices must be used and cleaned properly.
• Most important is the source of water that is used with nasal rinsing devices. According to the U.S. Food and Drug Administration, tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse. Some tap water contains low levels of bacteria and protozoa, including amoebas, which can stay alive in nasal passages and cause potentially serious or fatal infections.
• Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.