First came the FDA warnings about neti pots and brain-eating amoebas. Now doctors say neti pots and other gadgets that rinse the nasal passages could be behind a growing number of chronic sinus infections tied to tough-to-treat mycobacteria.
Many people swear by neti pots, which look a bit like space-age teapots. They're an ancient and drug-free method for rinsing away congestion from colds and allergies, and recently they've experienced a resurgence because of celebrity endorsements and media reports.
The trouble starts when the pots are filled with tap water, which can harbor microorganisms. These microorganisms don’t normally cause infections in the body, but washing them deep into the sinuses may give them a chance to start growing in places they normally couldn’t reach.
In a new study, which is published in Emerging Infectious Diseases, allergy doctors in New York reviewed 10 years of patient records to find people diagnosed with chronic sinus infections. They were looking for patients who also tested positive for rare mycobacteria, which are related to the germs that cause tuberculosis.
Thirty-three people, about 1% of all the patients in the practice who had bacteria cultured from their sinuses, turned up positive for mycobacteria.
Mycobacteria in the Sinuses
“You don’t really expect to see these bacteria in the sinuses,” says Jeffrey Suh, MD, an ear, nose, and throat doctor at Ronald Reagan UCLA Medical Center in Los Angeles. “These atypical mycobacteria are in the environment. They’re in the soil. They’re in the water, but not necessarily in the nose. They’re not the common players you see in these chronic infections.”
Suh has also investigated mycobacteria in sinus infections, but he was not involved in the current research. He points out that just finding the mycobacteria, as rare as it seems to be, doesn’t mean that they are actually causing a person’s symptoms.
“Just because you have bacterium that grows from your sinuses, it might not be doing anything,” he says. The study's researchers agree, and say more research is needed to understand the role of mycobacteria in sinus infections.
These mycobacteria tend to be a problem for people with medical conditions like HIV that lower their immune function. Surprisingly, only about a third of those patients identified in the new study had an immunity problem that might have put them at greater risk for infection.
Nearly all (91%) had sinus problems severe enough that they'd had surgery to relieve their symptoms, which included headaches, congestion, runny nose, and loss of smell or taste.
But the biggest common link between the patients with mycobacteria was nasal washing -- 31 out of the 33 said they were using some kind of device to rinse their nasal passages, and 26 of those patients said they used tap water to do it.
That made the researchers curious about whether their home taps might be tainted with the same germs found in their sinuses.
Researchers got permission to take samples from eight of the patients' homes. They took hot and cold water samples and swabbed the insides of taps and showerheads.
Five out of the eight tested positive for at least one strain of non-TB mycobacteria. DNA fingerprinting revealed that half of the homes tested had exactly the same strain that was found in the resident’s sinuses.
“There was one patient who was irrigating with filtered water from a Brita filter. It was actually growing in a Brita filter,” says researcher Wellington S. Tichenor, MD, the New York City allergist who treated the patients and investigated their infections.
To be fair, Tichenor says, Brita filters are great for reducing chemicals like chlorine and some metals but they don’t claim to keep bacteria out of drinking water.
Washing Nasal Passages Safely
In order to stay safe, the FDA recommends using distilled or sterile water. Alternatively, the agency says people who want to rinse their sinuses can boil tap water for three to five minutes and then let it cool. Previously boiled water can be stored in a clean container for use within 24 hours.
Filtered water can also be used, according to the FDA, as long as it’s been passed through a specialized filter with a pore size of 1 micron or smaller.
“The best thing is to use sterile water, which is what I use for my nose,” Tichenor tells WebMD. But there’s a catch. Sterile water can be a bit tough to get. It requires a doctor’s prescription. Or people can pick up sterile water rinses for contact lenses. Those solutions come in small bottles, though. And Tichenor says that getting enough to rinse your nose can quickly become costly.
How quickly can a neti pot or other nasal washing device become contaminated? Tichenor cites research that shows 25% will pick up germs after one week, while 100% become contaminated after a month.
“What it means is that you need to change it on a regular basis,” he says. Cleaning isn’t enough since the neck of the pot is often hard to scrub.
SOURCES: Tichenor, W. Emerging Infectious Diseases. Sept. 12, 2012.News release, Emerging Infectious Diseases.Wellington S. Tichenor, MD, The Center for Allergy, Asthma, and Sinusitis, New York.Jeffrey Suh, MD, otolaryngologist, Ronald Regan UCLA Medical Center, Los Angeles.
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