A few weeks ago there was a news story about a woman who died from using tap water in her neti pot. Basically, she was infected by a brain-eating amoeba. So the CDC now recommends using sterile water to rinse your sinuses.
I occasionally use a NeilMed sinus rinse thingie. I could use distilled water in it, but it’s much easier to just use warm tap water. Assuming I rinse my sinuses something like 20 times a year, how much risk am I incurring to by using tap water? Is it like the chance of dying from a fall on the stairs or like dying from an earthquake?
I am on city water, sourced from Lake Michigan. I would think that might matter.
Also, if I am at some level of risk from brain-eating amoebas by using treated Lake Michigan water in my sin, how much risk are people at who swim in Lake Michigan?
It happens sometimes. But I would think that a good rule of thumb is that whenever an injury/death from a common activity makes national/international news, then it is a pretty rare injury.
"DO NOT USE TAP WATER UNLESS STERILIZED BY BOILING
For your safety, do not use tap water, faucet water, or non-chlorinated or non-ultra (.2 micron) filtered well water for dissolving the mixture UNLESS it has been previously boiled for five minutes or more as boiling sterilizes the water. Before using the product, make sure the boiled water has been cooled down. You can store boiled water in a clean container for up to seven days in the refrigerator. Other choices are distilled, micro-filtered (through 0.2 micron), commercially bottled or, as mentioned earlier, previously boiled water cooled to lukewarm or body temperature."
I use distilled water in my CPAP machine. A gallon of distilled water is less than a dollar.
Personally, not only would I use distilled water for a neti pot, but I would also bring it to a rolling boil for 5 minutes to sterilize it (and then allow it to cool, of course).
While the risk of infection may be indeed be relatively low, it needs to be compared to the fraction of the population who use neti pots (which I’d guess is fairly low), much less 20 times per year (which I’d guess would be even lower).
As a civil engineer, I will tell you that tap water is perfectly safe to drink, but it is certainly not sterile.
I use tap water in mine, but I always boil it and let it cool to just above body temperature before I use it.
My BFF has had a lot of sinus issues, and his ENT specialize told him NOT to use one, because it could push the infection farther back into his sinus cavities. However, for people who just have occasional problems, it should be OK.
Well, my question wasn’t “how do I minimize my chances of dying from brain-eating amoeba in my sinus rinse?” but rather “if I decide not to go through that rigmarole, what’s my statistical risk?”
You can check up on how your water treatment is done. If it involves chlorine, you should be fine because the chlorination kills the amoeba (in theory.)
Plus, Lake Michigan is relatively cold water. The amoeba usually dwells in water in warmer regions, such as Texas and Florida.
On top of that, it’s winter these days, which only makes the water even colder and less amoeba-hospitable.
That being said, it’s still not a smart gamble to take either way.
What you appear to be asking are, “What are the odds that I will be infected by Naegleria fowleri?” The specific odds may face are unquantifiable because there isn’t sufficient data on infections for the specific population of nasal rinse uses, it is unknown how well treated your tap water is or the prevalence of N. fowleri in your environment, and your personal susceptibility to infection, which is suspected to vary from person to person.
However, “risk” is never assessed just a single percentage or ratio of odds, because inherent in risk assessment is the potential severity of occurrence. There are different ways to assess and plot risk but most look something like this chart in which some product of likelihood and severity/criticality are combined to assess the degree of significance of the risk, and the to find the best way of reducing risk. In this case, regardless of the likelihood, the criticality of infection is severe because of the consequences. (Infection will result in severe brain damage and likely death, and infection by N. fowleri is resistant to medical treatment even if the infection is properly diagnosed before the onset of neurological damage). Hence, unless it was possible to quantify the probability as being so low that you could use tap water 20 times per year times your remaining expected lifespan with a likelihood per use that would not exceed whatever roll of the dice you would find acceptable to avoid the “inconvenience” of using distilled water, it doesn’t make sense to accept any level of risk.
As an example, if there is a 0.01% chance of infection per use, and you use tap water in your nasal irrigator 20 times a year for the next fifty years (1000 incidences), you would have a ~1:10 chance of being infected. Given the unknowns, it makes little sense to risk infection compared to spending a few dollars per year to purchase distilled water. And as robby notes, municipal water services treat water to remove the pathogens that would cause infection from ingestion but do not sterilize it, nor would it be possible to make the entire path from treatment to water supply network to the plumbing in your house sterile.
How likely? Not very. The otolaryngology and Infectious disease experts all report that the risk is ‘extremely low’ and that it’s a ‘rare’ complication. And that generally the risk is more for the elderly or immunocompromised. But the available data is just not good enough to to really give precise numbers.
I’ve been using a neti pot for over a decade, using well water that has not been found to contain amoebic organisms; I don’t plan to change my practice based on the slight risk. But I have patients who choose to use saline or distilled water, or ultra-filtered water, to reduce their risk even further. That’s not unreasonable. Just know that it won’t reduce the risk to zero. But it definitely makes it safer.
We do riskier things every day, like driving a car. That’s far more likely to result in injury or death than using tap water for a sinus rinse. But we choose to improve our odds when driving by wearing seat belts and taking other precautions.
Stranger’s 0.01% chance per use is, in my mind, far too high. I suspect the actual lifetime risk to be well lower than 0.01%, else we’d be seeing a LOT more brain abscesses clinically than we do. The academic papers cited in Snopes’ article on the topic provide enough statistical info for me to make such a WAG.
Not necessarily, because the trials aren’t independent. A large part of the probability of getting infected is the question of whether your local water source contains the amoebas in the first place, and that’s not likely to change with repeated uses.
Water as it comes from a treatment plant is almost always safe for anything, but that does not mean that water that comes out of your faucet is equally safe. Water can be contaminated in the distribution system. That is why the CDC recommends boiling for 1 minute at sea level and for 3 min above 6500 feet. That is a generous amount of overkill because amoebae are not robust creatures, they are all likely to die well before the water temperature gets anywhere near boiling. And once boiled, the water will be safe for nasal irrigation forever if kept in a closed container. Amoebae are not floating around in the air in your kitchen.
Am I to understand that your practice is no longer confined to… umm…confined patients*? If so, Good on ya!
*It strikes me as implausible that incarcerated persons tend to have the option of choosing distilled water in their neti pots. Should I be mistaken, I will happily accept correction.
I treat many patients in prison who are at different security levels. The folks in minimums have more options than those in maximums.
I’m completely ruined for private practice now, I tell patients exactly what I think they need to know; complete and unvarnished truth about their situation. Fortunately I don’t have to face patient satisfaction surveys. Though most of my patients do seem to appreciate this direct approach.
Also, since the official recommendation is to use distilled water, distilled water can be provided on request if the patient has a legit prescription for the neti pot.
Just like we use distilled water for our patients with CPAP machines.
I read the linked news story and related reports on google search. I did not find how the doctors established that the Neti was culprit as opposed to tap water/spray getting in her nose during a shower or bath. Is there any information available on this ?
