Sinus irrigation is a common adjunctive treatment in ENT departments. It uses saline or specialized irrigation solutions to remove nasal secretions, allergens, and pathogens. It is particularly suitable for patients with chronic sinusitis and allergic rhinitis. However, many people experience fluid flowing down the throat during the procedure, which can even cause choking or anxiety. Is this normal? What are the factors involved?
Physiological Structure
The human upper respiratory tract is composed of the nasal cavity, pharynx, and larynx. The posterior end of the nasal cavity directly connects to the oral cavity through the nasopharynx. If irrigation fluid enters the nasal cavity and fails to exit through the anterior nares, it may flow down the nasopharynx into the oral cavity due to gravity or pressure. This phenomenon is anatomically normal and is particularly prone to the following:
Improper irrigation posture: tilting the head too far back or upright can alter the direction of fluid flow;
Excessive irrigation pressure: Some patients, seeking a "thorough clean," increase the water flow rate, exceeding the normal capacity of the nasal cavity;
Nasal structural abnormalities: Such as a deviated septum or enlarged turbinates, can obstruct one nasal cavity, forcing fluid out the opposite or posterior side.
A typical case: A patient with chronic sinusitis, suffering from chronic nasal congestion, habitually tilted her head back while irrigation. This resulted in fluid flowing into her throat with every attempt. After a doctor's guidance, she adjusted her posture to a 45-degree forward tilt, and the problem improved significantly.
Operational Factors
The effectiveness of sinus irrigation is closely related to proper operation. The following common misconceptions can lead to fluid flowing into the throat:
Choosing the wrong irrigator:
There are three types of irrigators on the market: squeeze bottle, electric pulse, and spray. Squeeze bottle irrigators require manual pressure control, which can cause fluid to flow backward if applied too hard. Electric irrigators, if not set to low, can also cause choking and coughing. Beginners are advised to prioritize electric irrigators with adjustable pressure.
Irrigation Solution Temperature and Concentration:
The temperature of normal saline should be close to body temperature (around 37°C). Excessive cooling can stimulate contraction of the nasal mucosa, while excessive heat can cause swelling, both of which affect the drainage pathway. Regarding concentration, 0.9% isotonic saline is most suitable. Hypertonic saline (2%-3%) can reduce edema but may increase the risk of fluid retention.
Single Irrigation Volume:
The recommended irrigation volume for adults is 200-300ml per session. Excessive volume can lead to saturation of the nasal cavity, forcing fluid to overflow from the posterior end. For children, due to their smaller nasal cavity volume, the single irrigation volume should be halved.
Pathological Factors
Although fluid flow into the throat is generally a physiological phenomenon, the following situations require prompt medical attention:
Persistent Coughing:
If severe coughing occurs after each irrigation, even vomiting, this may indicate a space-occupying lesion (such as nasopharyngeal carcinoma) or severe structural abnormality in the nasopharynx, requiring investigation with nasal endoscopy or CT. Unusual odor or color of the fluid:
Normal irrigation fluid is colorless and transparent. If the discharged fluid is yellow, green, or has a foul odor, it may indicate a sinus infection or pus accumulation, requiring bacterial culture and treatment adjustments.
Associated Symptoms:
If ear pain or hearing loss occurs while the fluid is flowing into the throat, excessive irrigation pressure may lead to a retrograde middle ear infection (such as secretory otitis media). Immediately stop irrigation and seek medical attention.
Coping Strategies
To reduce the discomfort of fluid flowing into the throat, the following measures can be taken:
Optimizing Posture:
When irrigating, lean forward with the head slightly below heart level to allow the fluid to flow out of the anterior nares. Parents can help stabilize the head of children.
Stage-Based Irrigation:
Irrigate the nasal cavity with the least severe symptoms first, then switch to the opposite side after the fluid has drained. This avoids pressure imbalances caused by irrigating both sides simultaneously.
Assistive Tools:
Use an irrigator with a one-way valve to prevent backflow of fluid; or wear a nose clip to temporarily block the opposite nasal cavity and guide the fluid out in one direction. Postoperative Patient Precautions:
For the first month after endoscopic sinus surgery, irrigation pressure should be reduced to avoid avulsing scabs. Patients with nasal packing should temporarily suspend irrigation.
In most cases, sinus irrigation fluid flowing into the throat is a result of a combination of physiology and technique. This can be significantly improved by adjusting posture, controlling pressure, and choosing appropriate tools. However, if it is accompanied by unusual symptoms or persists frequently despite proper procedure, prompt investigation for pathological factors is necessary. Scientific knowledge and standardized procedures are key to ensuring the safety and effectiveness of sinus irrigation.
