Experts Warn About Fatal Brain Infections from Using Tap Water in Sinus Rinses–Here's What To Know
TikTok is right: Using tap water for sinus rinses is not a good idea.
Cold and flu (and RSV, COVID) season was a doozy this year. As spring begins, it may seem like you and any applicable germ buckets—er, children—are coughing and sneezing less.
Not to rain on your parade, but here comes allergy season.
Since there's no cure for common colds and allergies (come on, science), sinus rinses can be a lifesaver for symptom management. A quick explainer for the uninformed:
"Saline rinses, also known as nasal irrigation, douching, washing or lavage, is the process whereby liquid, usually in the form of isotonic or hypertonic saline, is flushed through a squeeze bottle, pump or gravity-based device to wash mucus and allergens from the nasal passage and detach any crust from [the] nasal mucosa to provide relief from nasal obstruction, sneezing, itching and/or runny nose," says Dr. Elise Perlman MD, FAAP, who works in the division of pediatric emergency medicine for Northwell Health's Cohen Children's Medical Center of New York.
TL;DR: It rinses snot and crust from your nose. In many other situations, "rinse" involves tap water. But TikTokers are sounding the alarm about tap water and sinus rinses.
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“Please don’t use tap water to rinse your nose…besides parasitic infections that sometimes contaminate tap water, there are…lots of different types of bacteria that can cause not only sinus infections but also lung and respiratory tract infections," says Dr. Jia-Yia Liu, who goes by @healthyimmunedoc on TikTok.
Dr. Liu adds that this bacteria can get into the bloodstream.
It sounds scary. Is it that bad? Parade got a pair of doctors on the line to discuss tap water and sinus rinses.
Related: Here’s What It Means If You Have Yellow Snot—and How To Treat It at Home
Is Rinsing Your Sinuses With Neti Pots Safe?
Good news: You don't have to throw the baby out with the tap water.
"Rinsing sinuses with Neti Pot is safe," says Dr. Ali Alhassani, MD, the head of clinical at Summer Health. "They can help to alleviate symptoms from a cold, allergies or sinus infections by flushing the nasal passages and clearing them of mucus, allergens or other irritants."
Dr. Alhassani adds that nasal rinses are safe for children so long as a parent is there to monitor and help.
Is It OK To Use Tap Water for a Sinus Rinse?
Nope. Dr. Alhassani and Dr. Perlman agree: People should not use water straight from the tap for sinus rinses.
"Tap water should only be used if it has been sterilized or boiled prior to preparing the solution," Dr. Alhassani says. "However, bottled or distilled water are great alternatives as it reduces the risk of using contaminated water."
What Happens If You Use Tap Water for a Sinus Rinse?
Dr. Perlman warns that regular tap water may contain a contaminant called Naegleria fowleri, a brain-eating amoeba. This amoeba is challenging to see.
"While the water may appear clear and clean, if amoebae are present during nasal irrigation, it can travel to the brain where it can cause a life-threatening infection of the brain," Dr. Perlman says.
Therefore, Dr. Perlman advises against using tap water for nasal irrigation.
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How Common Are Naegleria Fowleri Infections in the United States?
According to the CDC, "Naegleria fowleri infections are rare. In the United States, between zero and five cases were diagnosed annually from 2012 to 2021. During this period, a total of 31 infections were reported in the United States."
However, as rare as the infections are, they do happen. Unfortunately, in Feb. 2023, a man in Florida died after being infected with the brain-eating amoeba, "possibly as a result of sinus rinse practices utilizing tap water," according to the Florida Department of Health.
Can I Use Bottled Water for a Sinus Rinse?
Yes, you likely can—but read the label.
"Bottled water can be used for saline irrigation as long as the label specifies that is 'distilled' or 'sterile' water," says Dr. Perlman. "Otherwise, it should not be used and runs the same risk as using tap water which is the potential for transmission of a life-threatening infection of the brain."
Related: 7 Myths About Fevers Doctors Wish People Would Stop Believing
What Types of Water Are Safe To Use?
According to Dr. Perlman, it's best to stick to sterile water or saline for nasal irrigation. You can find them at most pharmacies.
Otherwise, tap water can be used with appropriate preparation.
"Boiled water should be boiled for approximately one minute and cooled before use," Dr. Perlman says. "Bottled water can be used if it specifies that it is distilled or sterile water. There are also pre-made packets for purchase and recipes available to make your own saline rinse at home, suggested by several organizations, which include iodide-free salt, baking soda and distilled water."
How To Use Nasal Irrigation Devices
Dr. Alhassani offers this advice for using nasal irrigation devices, particularly with children:
Clean your hands.
Warm the solution slightly. "You can do this by pouring the saline solution into a clean bowl and microwaving it briefly," says Dr. Alhassani. "This will make it easier to tolerate."
Load the solution into the delivery device, such as a bulge syringe or Neti Pot.
Bend your child over the sink or shower, and squirt the solution into each side of their nose. Dr. Alhassani advises parents to aim for the back of the head, not the top of the head.
Wait and watch. "The solution should flow into one nostril and out the other, but it’s OK if some is swallowed," says Dr. Alhassani.
Have your child blow their nose.
Repeat steps five and six.
Clean instruments thoroughly.
"Continue the rinse once or twice per day while you are having congestion symptoms," Dr. Alhassani says.
Related: Essential Oils: Yay or Nay for Lungs?
Can You Use Nasal Irrigation Devices on Children?
Yes, but Dr. Perlman cautions that parents should always consult their pediatrician first.
"Nasal irrigation itself may not be the right solution for your child depending on their underlying condition or context in which it is being used," Dr. Perlman says.
And Dr. Alhassani notes that parents should always monitor their children (or do nasal irrigation for them).
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Sources
Dr. Elise Perlman MD, FAAP, works in the division of pediatric emergency medicine for Northwell Health's Cohen Children's Medical Center of New York
Dr. Ali Alhassani, MD head of clinical at Summer Health
Centers for Disease Control and Prevention. (2022, October 18). General information. Centers for Disease Control and Prevention. Retrieved March 21, 2023, from https://www.cdc.gov/parasites/naegleria/general.html#anchor_55634
