When seeing kids in the office with nasal viral respiratory infections,  I often casually  mention that the most suitable “medication” at the pharmacy happens to also be the least expensive, non-prescription,  and negligible  in terms of side effects.  Specifically, saline, salt water.  For infants there is saline spray and drops that can be followed by suction, and for older kids various other methods using different volumes of saline.  And for those oldand mature enough to accept it there is real nasal irritation, either from a squeeze bottle, or from that one of those Aladdin’s lamp/teapot shaped devices best known by the brand name Neti-Pot.  This sort of nasal irrigation, though a hard sell for even older children,  has offers real symptomatic benefit. Ever tried it?

And side effects?  Quite unusual and very mild: a little irritation or stinging, which is sometimes due to an incorrect salt concentration.  But very safe.

And now comes the report from the Louisiana Department of Health in mid-December of two adults who experienced some very, very  serious complications from Neti-Pot nasal irrigation:  fatal cases of meningitis and destructive brain effects  from the rare but serious ameoba,  Naegleria fowleri, an organism which causes necrosis in the brain, and is found in warm fresh bodies of water mostly in the southern states.   Almost all cases of niglaeria come from swimming in water harboring the parasite, which offers the opportunity for it to enter the nose and anatomically navigate to the brain.  And in these two particular Louisiana cases, contaminated tap water used for nasal irrigation, took same route of this devestating infection entering the fluid behind the brain.  Over the last decade there have been about thirty cases of fatal Naegleria, all but these two from swimming.  It does not result from simply drinking water which contains the ameoba.

An epidemiogist with the Louisiana state health department made a simple recommendation:  water used for  nasal irrigation should not be simple tap water, but either boiled or distilled.  And the general consensus even outside Louisiana seems to concur with this.  While this is rare infection, it is very simple to avoid that risk altogether by using one of these alternatives to right-from-the-tap.  

And where does leave us regarding the safety of the Neti-Pot and other means of  nasal saline irrigation?    Countless individuals have used the technique for many, many years, with an excellent safety record.  These two cases were tragic but quirky,  and geographically related.  They   present no  reason to avoid this form of treatment But the recommendation to use appropriate water as recommended–a very simple measue– just makes sense.  Now gettting kids to cooperate with the rest of the procedure  remains much more difficult.