The sinuses, as a collective term for the air-filled bony cavities surrounding the nasal cavity, play important roles in regulating nasal pressure and humidifying air. However, when a foreign object enters the sinus, patients often experience symptoms such as nasal congestion, runny nose, local pain, and even fever. In severe cases, it can lead to complications such as sinusitis and intracranial infection. Therefore, whether nasal irrigation, as a non-invasive treatment, can be used to remove foreign objects from the sinuses becomes a key concern for patients.
Principles and Scope of Application of Nasal Irrigation
Nasal irrigation involves injecting saline or a medicated solution into the nasal cavity under specific pressure, using the water flow to flush out secretions, allergens, and pathogens. Its core mechanisms are:
Physical flushing:The water flow loosens and removes viscous secretions adhering to the sinus openings;
Mucosal repair:Saline solution has the same osmotic pressure as the human body, reducing mucosal edema and promoting ciliary movement;
Drug delivery:When used in conjunction with antibiotics or hormones, it can locally suppress the inflammatory response.
Applicable Scenarios:
Small foreign objects (such as dust or pollen) lodged near the sinus openings;
Cleansing of residual secretions after foreign object removal;
Adjunctive treatment for acute sinusitis caused by foreign object irritation.
Contraindications:
Sharp foreign objects (such as glass shards or metal nails) embedded deep in the sinuses;
Plant-based foreign objects (such as beans or seeds) may swell due to water absorption, potentially worsening the lodging;
Concurrent with severe epistaxis, skull base fracture, or acute otitis media.
Key Points of Sinus Irrigation Procedure
Preoperative Assessment: Determining the Nature and Location of the Foreign Object
Use nasal endoscopy or sinus CT scan to confirm the size, shape, and depth of the foreign object. For example, a plastic toy accidentally inserted by a child may be located in the inferior nasal meatus, while metal dust from occupational exposure often deposits in the ethmoid sinus. If the foreign object has penetrated the sinus bone wall and entered the cranial cavity, irrigation is strictly prohibited.
Irrigation Solution Selection and Preparation
Basic Formula: 0.9% physiological saline (isotonic solution). Avoid using tap water or hypertonic saline (may irritate the mucous membranes).
Drug Enhancement: In cases of concurrent infection, gentamicin (80,000 units/250ml) or budesonide (1mg/250ml) can be added.
Temperature Control: Approximately 37℃ is ideal. Excessive heat may burn the mucous membranes, while excessive cold may cause vasospasm.
Procedure and Patient Position
Anterior Nasal Irrigation Method:
The patient should be seated with their head tilted forward at 45° and breathing through their mouth.
Insert the irrigator nozzle into one nostril and slowly squeeze the bottle to allow the water to flow along the nasal cavity wall and out through the opposite nostril or mouth.
Avoid swallowing or speaking during the irrigation process to prevent aspiration of the liquid into the trachea.
Sinus Negative Pressure Replacement Method (Requires Specialized Equipment):
The patient lies supine with their head tilted back so that their nostrils are vertically upward.
The doctor inserts an olive-shaped tube into one nostril, while using a suction device on the other nostril to create negative pressure. By intermittently pressing the balloon, the medication is forced into the sinus to replace purulent secretions.
Note: This method requires strict control of the suction pressure (≤20 kPa) to avoid damaging the mucosa.
Post-Irrigation Observation and Complication Management
Effectiveness Evaluation
Success Criteria: Relief of nasal congestion and runny nose after irrigation; nasal endoscopy showing patent sinus openings.
Failure Criteria: No foreign body is found in the irrigation fluid, but the patient continues to experience headache and fever; be alert for foreign body residue or infection spread.
Complication Prevention
Nosebleed: Bleeding may occur if the irrigation pressure is too high or the mucosa is fragile. The procedure should be stopped immediately and a cold compress applied locally.
Ear Pain: Irrigation fluid entering the middle ear may cause otitis media; the patient's head position should be adjusted or another method should be used.
Infection Worsening: Patients with weakened immune systems, such as those with diabetes, require enhanced anti-infection treatment after irrigation.
Recommendations for Special Cases
Foreign Bodies in Children's Sinuses
Children are prone to foreign body impaction due to narrow nasal cavities and poor cooperation. Recommendations: Prioritize endoscopic removal using a suction device or forceps; Irrigation should only be used as a postoperative adjunct, avoiding forced manipulation that could displace the foreign body.
Occupational Foreign Bodies in Sinuses
For example, cement dust inhaled by construction workers. Recommendations:
Pre-irrigation with an oral mucolytic agent (e.g., enteric-coated eucalyptol capsules) to dilute secretions;
Post-irrigation with nasal corticosteroids (e.g., mometasone furoate) to reduce inflammation.
Residual or Recurrent Foreign Bodies
If symptoms do not improve after irrigation, consider:
Incomplete removal of the foreign body, requiring a second endoscopic surgery;
Abnormal sinus anatomy (e.g., deviated septum) causing poor drainage, requiring simultaneous correction.
Nasal irrigation can be used as an adjunct to the management of sinus foreign bodies, but its effectiveness is highly dependent on the nature and location of the foreign body and the individual patient's condition. For small, superficial foreign bodies, proper irrigation can significantly improve symptoms; however, for sharp, deep foreign bodies or those complicated by severe infection, prompt medical attention is necessary for complete removal via nasal endoscopy or surgery. Patients should never attempt to irrigate themselves blindly, as this may worsen the injury or delay treatment.
