Nasal irrigation is a common method for relieving nasal congestion and clearing the nasal cavity, and is widely used as an adjunctive treatment for rhinitis, sinusitis, and allergic diseases. However, it is not always appropriate—improper use can worsen the condition or even lead to serious complications.
Acute Nasal Injury or Surgical Trauma
Active Epistaxis
When the nasal cavity is actively bleeding (e.g., fresh blood dripping after frequent nose blowing or persistent discharge of bloody discharge), the pressure from nasal irrigation can dislodge newly formed blood crusts, leading to increased bleeding or recurrent bleeding.
Clinical Case: A patient with allergic rhinitis developed erosion of the nasal septum in the Li's region due to frequent nose blowing. After self-irrigation, she experienced severe bleeding and required emergency anterior nasal packing to stop the bleeding.
Recommendation: Avoid nasal irrigation for 48 hours after the nosebleed stops. Allow the mucosa to heal (usually 3-5 days) before gradually resuming nasal bleeding.
Early Postoperative Nasal Surgery
For one to two weeks after septal correction surgery, polypectomy, or other procedures, the nasal cavity must be maintained stable with expandable sponges or absorbable materials. Irrigation may disrupt their support, leading to bleeding or delayed healing.
Special Circumstances: After functional endoscopic sinus surgery (FESS), your doctor may prescribe specialized irrigation solutions (such as those containing antibiotics or steroids), but the prescribed duration, pressure, and frequency of irrigation must be strictly adhered to.
After Nasal and Facial Trauma
Before healing, injuries such as nasal bone fractures and skull base fractures can cause irrigation fluid to enter the skull through the damaged ethmoid plate (the weakest part of the skull base), potentially leading to life-threatening complications such as meningitis and brain abscesses.
Warning Signs: If you experience "panda eyes" (periorbital congestion), cerebrospinal fluid rhinorrhea (clear watery discharge), or loss of smell after trauma, seek medical attention immediately and avoid irrigation.
Contraindications for Specific Illnesses
Acute Upper Respiratory Tract Infection with High Fever
When a fever (temperature > 38.5°C) occurs, the nasal mucosa is highly congested and edematous. Irrigation may exacerbate mucosal damage and even induce otitis media (especially in children whose Eustachian tubes are short and flat, where pressure changes can easily lead to fluid backflow).
Alternative: Use saline spray (such as sea salt spray) instead of irrigation to reduce mucosal irritation.
Acute Attack of Severe Allergic Rhinitis
When a patient experiences severe sneezing, clear runny nose, itchy eyes, or an asthma attack, the nasal cavity is hypersensitive. Irrigation may trigger a combined irritation of the "irrigant-allergen" reaction, exacerbating symptoms.
Scientific Basis: Research shows that during pollen season, when allergen concentrations exceed 50 grains/m³, the number of sneezes within one hour of irrigation may increase by 30%.
Nasal Tumors or Suspected Malignancies
Undiagnosed nasal tumors (such as nasopharyngeal carcinoma and nasal hemangioma) may rupture, bleed, or metastasize due to irrigation pressure. Symptoms such as unilateral progressive nasal obstruction and bloody discharge should be of particular concern.
Treatment Principle: First, perform a nasal endoscopy and biopsy to determine the pathological nature, then have a physician assess whether irrigation is suitable.
Coagulation Disorders or Long-Term Anticoagulant Therapy
For patients with hemophilia, thrombocytopenia, or those taking anticoagulants such as aspirin or warfarin, even minor trauma to the nasal mucosa can cause uncontrolled bleeding, significantly increasing the risk of irrigation.
Risk Factors: The incidence of epistaxis in patients on long-term anticoagulant therapy is 5-8 times higher than in the general population, and the risk of major bleeding after irrigation is increased by 40%.
High-Risk Scenarios Related to Operation
Improper Irrigation Solution Temperature or Concentration
Too low a temperature (<20°C): Stimulates vasoconstriction of the nasal mucosa, triggering reflex headaches;
Too high a temperature (>40°C): Denatures mucosal proteins, impairing ciliary motility;
Too high a concentration (e.g., excessive salt content when preparing homemade saline): Causes an osmotic imbalance in the mucosa, exacerbating edema.
Correct Standard: Irrigation solution temperature should be close to body temperature (32-35°C), with a concentration of 0.9% (isotonic) or 2.3% (hypertonic, requiring doctor's guidance).
Improper Irrigation Pressure Control
Excessive pressure: May flush secretions into the sinuses or middle ear, causing sinusitis or secretory otitis media;
Too low a pressure: Ineffectively removes viscous secretions, reducing irrigation effectiveness.
Operational Tips: Use a moderate pressure when using a manual squeeze bottle (not causing ear pain). Choose an electric irrigator with adjustable pressure.
Improper irrigation posture
Tilt your head back: This can cause the irrigant to flow into the pharynx, causing coughing or even aspiration.
Insufficient forward leaning: This prevents gravity from helping secretions drain, increasing the risk of sinus reflux.
Standard posture: Sit or stand, lean forward 45 degrees, head slightly tilted to one side, and breathe through your mouth to avoid holding your breath.
Cautionary Use in Special Populations
Infants and Preschoolers
Anatomical Characteristics: Children have narrow nasal cavities and short, flat Eustachian tubes, making irrigating more likely to cause otitis media.
Poor Cooperation: Struggling can cause irrigant to enter the airway, leading to aspiration pneumonia.
Recommendation: Nasal irrigation is prohibited for children under 3 years old. Children aged 3-6 should use a dedicated pediatric irrigator (such as a spray) under a doctor's supervision.
Pregnant Women
Hormonal Changes: During pregnancy, the nasal mucosa is congested and sensitive, and irrigating may induce nosebleeds.
Drug Risks: Using medicated irrigants (such as antibiotics or hormones) may affect fetal development. Management Principles: Avoid nasal irrigation during early pregnancy (first trimester). Use during mid- to late pregnancy requires a thorough assessment of the pros and cons.
Patients with Severe Cardiovascular Disease
Blood Pressure Fluctuations: Holding your breath or straining during nasal irrigation can cause a sudden increase in blood pressure, increasing the risk of cerebral hemorrhage.
Postural Hypotension: Frequent changes in body position can induce dizziness or even falls.
Indication Screening: Nasal irrigation is contraindicated in patients with systolic blood pressure >180 mmHg or diastolic blood pressure >110 mmHg.
The "Contraindications" list for nasal irrigation is not intended to restrict its use, but rather to help users develop a risk awareness—enjoying its cleansing and anti-inflammatory benefits while avoiding potentially hazardous situations. If you have concerns about your condition, follow the "Three Questions" guideline:
Is the condition acute?
Are there any structural abnormalities in the nasal cavity?
Is the procedure performed correctly?
If there is uncertainty, consult an otolaryngologist promptly. Nasal endoscopy, allergen testing, and other procedures can be used to identify contraindications and develop a personalized treatment plan.
