How to use a saline rinse or neti pot safely

The rule that matters most is the water. Use distilled or sterile water, or tap water you've boiled and cooled, and never water straight from the tap. Then lean over a sink, pour the salt solution into your upper nostril so it drains out of the lower one, and wash and dry the device after each use.

Why can't you use tap water?

The FDA says tap water isn't safe for nasal rinsing because it isn't adequately filtered or treated. Some tap water contains low levels of organisms, including amebas, that may be safe to swallow because stomach acid kills them. In your nose, the FDA says, they can cause potentially serious infections.

The CDC puts it plainly. Although rare, people have died from rinsing their sinuses with tap water containing the amebas Naegleria fowleri and Acanthamoeba.

A 2024 CDC report described 10 people in the United States who developed invasive Acanthamoeba infections after nasal rinsing. All 10 had weakened immune systems, and 3 of them died. At least 4 had used tap water for rinsing. One more used sterile water but then soaked the device in tap water.

These infections are rare. But the fix is simple and cheap, so there's no reason to take the chance. If your immune system isn't working properly, the FDA advises checking with your healthcare provider before using any nasal rinse.

Which water is safe for a nasal rinse?

The FDA lists three options:

• Distilled or sterile water, which you can buy in stores. The label will say "distilled" or "sterile".
• Tap water boiled for 3 to 5 minutes, then cooled until lukewarm. Previously boiled water can be stored in a clean, closed container and used within 24 hours.
• Water passed through a filter designed to trap potentially infectious organisms.

The CDC's own guidance is a rolling boil for 1 minute, or 3 minutes at elevations above 6,500 feet. If you boil water, following the FDA's longer time covers both. The AAAAI recommends bottled sterile distilled water over boiling your own at home.

Which device should you use?

The FDA groups neti pots, bulb syringes, squeeze bottles and battery-powered pulsed water devices together as nasal irrigation devices. It says they're usually safe and effective when used and cleaned properly, and that they all work in basically the same way.

Pick whichever you find easiest to handle. Whatever you choose, the FDA suggests making sure it suits the age of the person using it, and reading the instructions that come with it.

Saline sprays are a different thing. An FDA doctor explains that spray bottles deliver a fine mist that can be useful for moisturizing dry nasal passages, but irrigation devices are better at flushing the nose and clearing out mucus, allergens and bacteria.

How do you mix the solution?

If your rinse kit came with salt packets, follow its directions. If you're making your own, the AAAAI recipe is:

• Mix 3 teaspoons of pickling or canning salt with 1 teaspoon of baking soda, and store it in a small airtight container. The salt should contain no iodide, anti-caking agents or preservatives, which can irritate the lining of the nose.
• Add 1 teaspoon of that mixture to 8 ounces (1 cup) of lukewarm sterile distilled water.

If it burns or stings, use less of the dry mix. The AAAAI says the solution can be kept in the refrigerator for up to 3 days, but it's best to mix a fresh batch each time.

The salt isn't optional. The FDA notes that plain water can irritate the nose, while saline lets the water pass through the delicate nasal lining with little or no burning.

How do you use a neti pot or squeeze bottle?

The FDA describes it this way. Lean over a sink and tilt your head sideways, keeping your forehead and chin roughly level so the liquid doesn't run into your mouth. Put the spout into your upper nostril and let the solution drain out through the lower one. Breathe through your mouth while you do it. Then turn your head and repeat on the other side.

The AAAAI's version, for a bulb syringe or squeeze bottle, adds some useful detail:

1. Lean over the sink, or do it in the shower, and turn your head to one side.
2. Gently squeeze about 4 ounces of solution into the upper nostril while breathing normally through your mouth. Within a few seconds it should run out of the other side.
3. Turn your head the other way and repeat.
4. Blow your nose very gently afterward, so solution doesn't get pushed toward your ears.

The AAAAI adds a few cautions. Don't use a sinus rinse if your nose is severely blocked, try not to get solution in your ears, and stop if you get pain, nosebleeds or other problems.

What if it doesn't feel right?

The first few rinses can feel odd. The AAAAI says the process may take a little getting used to. Most problems have a simple fix:

• If it stings or burns, make a weaker solution with less of the dry mix, and check that your salt has no iodide or additives.
• If it runs down your throat, tip your forehead and chin back toward level, as the FDA describes.
• If water ends up in your ears or they feel full, adjust your head angle and blow more gently.
• If nothing comes out of the other side, your nose may be too blocked to rinse right now. The AAAAI says not to rinse a severely blocked nose.

If you get pain, nosebleeds, fever or headaches, stop and check with a doctor.

When should you rinse?

There's no single right time to rinse, but two habits make sense. If you use a medicated nasal spray, rinse first. The AAAAI says you can carry on with your prescribed nasal medicines after a rinse and may notice they work better, and the Sleep Foundation notes doctors sometimes suggest rinsing before other nasal medicines for that reason.

If congestion is keeping you awake, rinsing in the evening clears some of the mucus before you lie down. The Sleep Foundation says a rinse can flush out congestion-causing mucus, moisturize the nasal passages and reduce irritants. Our guide to sleeping with a stuffy nose covers what else can help at night, and if your nose is often blocked at bedtime, it's worth reading about why your nose gets stuffy at night.

How do you keep the device clean?

The FDA says to wash the device and dry the inside with a paper towel, or let it air dry, between uses. Keep in mind the case above where the water was sterile but the device was soaked in tap water. Whatever touches the inside of your nose counts, not only what's in the solution.

The Sleep Foundation adds that people should be diligent about cleaning their equipment to avoid introducing bacteria into the nose.

Does rinsing actually help?

The research is modest in size but mostly points in a helpful direction.

For allergies, a 2018 Cochrane review pooled 14 studies with 747 children and adults. Saline rinsing may reduce how bad people rated their allergic rhinitis, compared with no rinsing, for up to three months, with no reported side effects. The quality of the evidence was low, and the studies were small, but the authors described saline as a possible cheap, safe and acceptable option alongside steroid sprays and antihistamines that deserves better research.

For chronic sinus problems, a 2016 Cochrane review found some benefit from a daily, large-volume (150 ml) salty rinse compared with placebo. The evidence was low quality at three months and very low at six months. In that trial, 23% of people in the saline group had side effects, including nosebleeds. In a separate trial, people using a low-volume saline mist had worse symptoms than people using a steroid spray.

For colds, a 2015 Cochrane review concluded that rinsing possibly helps symptoms, but the trials were small and at high risk of bias. The only side effect reported was minor nasal discomfort or irritation in a minority of people.

For people with allergies, see why allergies get worse at night for bedroom changes that pair well with rinsing.

When should you stop and see a doctor?

The FDA advises seeing a healthcare provider if your symptoms aren't relieved or get worse after rinsing, or if you have a fever, nosebleeds or headaches. For children, it says rinsing can be used if a pediatrician recommends it, and that very young children might not tolerate it.

The CDC says to get medical care right away if you develop a headache, fever, confusion or vomiting after rinsing your sinuses.

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.