Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Amebic Meningoencephalitis and Neti Pots

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Neti pots are devices used to irrigate the sinuses with saline solution or other liquid for cleansing purposes. They rely upon gravity and head positioning to facilitate flow of the liquid into one nostril, which is sometimes allowed to drain out the same side, and sometimes (with the aid of head positioning) induced to drain out the other nostril. This is not the same as inhaling heated water vapor (steam) or using a bulb or other nasal irrigating device. 

Nasal irrigation is sometimes employed to treat or prevent sinus conditions, such as allergic sinusitis or chronic sinusitis. I have seen a few people employ nasal irrigation on a sporadic basis to moisten their nasal passages at high altitude (to combat the effects of cold, dry air) and to break up mucous accumulation associated with upper respiratory infection, particularly when it becomes obstructive and annoying.

There have been reports, including recently, of amebic meningoencephalitis caused by the ameba Naegleria fowleri transmitted in water contained in neti pots. This water was tap water, which may support the ameba. Amebic meningoencephalitis is most commonly associated with exposure to inadequately chlorinated swimming pools. The typical story is of a young person who jumps feet first into the pool and drives water up into the nose and sinuses, followed by the infection. 

Using a neti pot is the intentional equivalent of allowing water to enter the sinuses. Therefore, water used in neti pots should be thoroughly disinfected by prior boiling or a disinfection/sterilization technique that assures the removal of amebic life forms. Tap water should not be assumed to be safe for use in neti pots, even if it is assumed safe for drinking. It appears in the literature that 47 degrees C is a minimum temperature to which water should be heated prior to considering it safe for use in a neti pot.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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