The People's Perspective on Medicine

Why Sterile Water Is Best to Flush Sinuses

You can use a saline solution made with salt and sterile water to wash out your nasal passages and clear your sinuses during allergy season.

Have you ever heard of a neti pot? This tool from the Ayurvedic medical tradition looks a lot like Aladdin’s lamp. But you don’t rub it to make a genie appear. Instead, you fill it with tepid saline solution and use it to pour water in one nostril. (Bend over a washbowl or basin, as it will come out the other nostril.) This helps to clear dust, pollen and other gunk from the nasal passages and can be a powerful aid against allergy symptoms. Do you need to use sterile water to make the saline solution? Our reader is not the only one to insist that this is important.

Use Sterile Water in Your Neti Pot:

Q. Please warn people who use a neti pot or other method to flush their sinuses that they should make the saline solution only with sterile water, never tap water. There have been a couple of documented deaths from primary amoebic encephalitis in the past decade from people using a municipal water supply for neti flushes. The problem was an unknown contamination of the water supply.

A. A renowned allergist, Dr. David Peden, agrees that tap water is inappropriate for home-made saline to flush the sinuses. He prefers sterile water or, even better, a commercially prepared saline solution. You could rinse your nasal passages and sinuses once or twice a day during allergy season to ease congestion, but using the neti pot more often isn’t helpful.

The neti pot is not the only technology that can be use to wash away nasal congestion. We’ve heard from several readers who prefer NeilMed or a similar method to flush the sinuses. One person sent this story.

Spritzing Saline to Save the Sinuses:

Q. You recently had a letter from someone with frequent sinus infections. For many years, I too struggled with sinus infections every few months. I’d feel bad and usually have bad breath.

To deal with them, I went to a doctor who would prescribe antibiotics and strong decongestants. Then four years ago, I read in the Mayo Clinic newsletter about using saline solution for clearing out mucus. So every morning after my shower and every evening before bed, I tilt my head back and squirt saline solution in each nostril and “snort” it up into my sinuses. I then blow my nose.

Doing this twice daily prevents mucus buildup that invites bacterial growth. This solution is cheap and natural. The saline spray costs about $3 and lasts a week.

Occasionally during allergy season I still have to take an OTC decongestant, but I have not been to the doctor for this problem in 4 years. This has made life so much better.

Saline Nasal Spray or Neti Pot?

A. Using saline nasal spray as you do is a variant of the ancient Indian practice of using a neti pot with saline solution to rinse the nasal passages and sinuses. Researchers at the University of Wisconsin (Madison) have found that many patients with chronic sinus problems report dramatic improvement when they start using saline solution regularly (Annals of Family Medicine, Jul-Aug. 2006). 

With a range of devices available, patients have significant choice about how to wash out their nasal passages. Gradually, doctors who treat allergies and sinus problems are coming to the conclusion that this practice can be helpful (International Journal of Immunopathology and Pharmacology, Mar-Dec. 2018). Irrigation devices can easily become contaminated (American Journal of Rhinology & Allergy, May-June 2012). As a result, you should wash your neti pot or other device after use and be sure to use sterile water when you make the saline solution.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Rabago D et al, "Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study." Annals of Family Medicine, Jul-Aug. 2006. DOI: 10.1370/afm.552
  • Casale M et al, "Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update." International Journal of Immunopathology and Pharmacology, Mar-Dec. 2018. DOI: 10.1177/2058738418802676
  • Psaltis AJ et al, "Contamination of sinus irrigation devices: a review of the evidence and clinical relevance." American Journal of Rhinology & Allergy, May-June 2012. DOI: 10.2500/ajra.2012.26.3747
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There is a low-pressure aerosol saline spray designed specifically for flushing out sinus cavities. I’ve used it for years while in the shower. Convenient! Easy to use. No mixing!

I have always used boiled tap water for my Neti Pot and have never had a problem with infections.

What about filtered water from a Berkey water filter

How long do you have to boil the water for it to be sterile?

Is distilled water considered sterile and safe to use without boiling it?

Yes.

Distilled water should be ok, I hope, as I’ve been using it for years….

Is purchased distilled water the same as “sterile” water? If not, what exactly IS “sterile” water? If using boiled water, is there a length of time it should be boiled or just reaching the boiling point – or what? More specifics and details please. I have been doing nasal irrigation for years, since having had a terrible sinus infection years ago. It has helped tremendously. However, after reading about those horrific incidents of people using tap water and getting bacterial infections (deaths, as I recall), I stopped using tap water and thus effectively stopped nasal irrigation. Allergies are bad this year and I bought some distilled water to use – but now I am uncertain. So: more specifics and details please.
And thank you.

Distilled water is sterile and you can feel confident using it.

My 20 year old son had a severe sinus infection. He visited the emergency room where he was given antibiotics. After 2 more days of pain, it was detected that the infection traveled to his brain. He was using distilled water. He was in the ICU for 5 days, and it wasn’t clear if he would survive. It was suggested by several doctors that the sinus rinse he was using probably helped push the infection into his brain.

The ENT, infectious disease dr, and surgeon all agreed that the rinse should never be used.

I have used a neti pot for many years. I currently am using purchased distilled water to which I add salt, baking soda and glycerin. Is this an adequate equivalent of sterile water? I make up a gallon and store in the refrigerator – before using I pop my pot into the micro wave for warming.

Distilled water is sterile.

Does purified or distilled water count as “sterile water?”

Yes.

Would distilled water be ok to use in the Neti pot ?

Is distilled water OK to use for saline nasal rinse? The instructions for my NeilMed state “distilled water” should be used. Is there a difference between distilled and sterile? And if, so, is it a medically significant one? Thanks.

Distilled water is sterile.

I regularly use the neti pot for sinus and allergy. I would never dream of using any kind of water without boiling it first and putting neti pot itself in boiling water. Cannot imagine anyone using water directly from tap, but using boiling water from my tap is also what makes it affordable to do on a regular basis.

In addition to boiling the water before adding the salt, I steep the water with thyme for its natural antibacterial effect. “Nettypotting “ with this solution twice a day when I start feeling congested works wonders!

Can distilled water be used for sinus flushes? Is it considered sterile?

Will boiling the water first kill the amoeba’s?

Yes.

Yes, sinus irrigation with the saline solution does work. I’ve been doing it for over two years to treat an overactive sinus condition, and I have had zero infections in my nose and sinus, and not even one head cold or flu. I use the commercial Neilmed squeeze bottle and prepared salt packets, and they have worked fine. The company has a world-wide market going for its sinus irrigation products, and they are very reliable and well made. Most drug stores carry a full line of these and similar products. You can devise your own homemade version, or use a little (watering can style) ceramic netipot, but you must use only distilled water, (or highly filtered water) which is pure H20 without any contaminants. The salts are a necessary additive — for some reason, even pure H20 with salts in the sinus will let you know instantly that you’ve made a big mistake — it causes immediate pain as soon as the water hits the nasal interior. If you’ve ever forgotten to add the salts, I guarantee you’ll remember it well and never try it again! The salts are a specific combination of non-iodized salt and backing soda. Having running sinuses for two years (not caused by any allergy) is an ordeal, but flushing the sinus daily at least eliminates infections. There is a new procedure just now coming into use by specially trained ENT physicians which involves freezing (and killing) the nerve at the back of the sinus, using a small probe that is cooled to MINUS 85 degrees (!). I had it done several weeks ago and have noticed a definite improvement in my condition. The doctor says a few more weeks recovery is needed for a final conclusion as to effectiveness, but most patients have noticed a clear improvement. The procedure is called Clarifix and is worth checking into to see if it could help your condition. You may have to shop around a bit to find an ENT who is qualified in this new procedure.

I adopted daily use of Neil Med nasal rinse after listening to a lecture by a pediatrician about 10years ago. Childhood nasal infections and ear infections dropped dramatically in those children who adopted the daily practice. Because the eustacean tubes are nearly horizontal in children they tend to accumulate fluids which lead to infections. Using a home made nasal formula for myself, one based on a well known commercial saline formula (7 parts sea salt to 5 parts baking soda) I have seen the virtual elimination of troublesome hay fever allergic symptoms. Perhaps I should use sterile water but since my domestic water is free of chlorine I find this mixture comfortable and effective.

Is boiling tap water for 3-4 minutes and then cooling sufficient for sterilization? I’ve been doing this for several years.

I’ve been using a neti pot for years, using tap water that I boil and allow to cool. No problems.

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