Chronic rhinitis is a common ENT disease, characterized by nasal congestion, runny nose, and decreased sense of smell. Its pathological basis is chronic inflammation of the nasal mucosa and ciliary dysfunction. Nasal irrigation mechanically removes pathogens, dilutes inflammatory mediators, and restores mucosal moistness. However, the frequency of nasal irrigation should be determined based on the severity of the disease, the mucosal repair cycle, and patient tolerance.
Pathological Basis and Mechanism of Nasal Irrigation
Mucosal damage in chronic rhinitis presents a vicious cycle of "inflammation-repair-reinjury":
- Mucosal barrier disruption: Long-term inflammation leads to goblet cell hyperplasia and abnormal mucus secretion, resulting in the accumulation of viscous secretions;
- Ciliary dyskinesia: Cilia collapse and decreased beat frequency prevent the effective removal of pathogens and allergens;
- Microcirculatory impairment: Mucosal congestion and edema exacerbate nasal congestion and create a hypoxic environment, further inhibiting ciliary function.
- Nasal irrigation breaks the cycle through the following mechanisms:
- Physical removal: Using 0.9% saline as a carrier, it flushes away viscous secretions, pathogens, and inflammatory cells;
- Osmotic pressure regulation: An isotonic solution maintains osmotic pressure balance in mucosal cells, preventing hypertonic or hypotonic stimulation that exacerbates edema;
- Ciliary activation: After irrigation, mucosal moisturization is improved, and ciliary beat frequency can return to 70%-80% of normal levels.
Key data: Studies have shown that patients with chronic rhinitis who consistently irrigate their nasal cavity twice daily experience significant reductions in mucociliary transit time and nasal congestion scores after three months.
Frequency of irrigation according to severity of disease
Mild chronic rhinitis: Once daily to maintain mucosal homeostasis
- Symptoms: Intermittent nasal congestion (relieved during the day), small amounts of clear or sticky rhinorrhea, and no loss of smell or headache.
- Pathological stage: The mucosa is in a compensatory phase, with partially preserved ciliary function and inflammation limited to the surface layer.
- Goal of irrigation: Clear secretions accumulated overnight and prevent worsening of nasal congestion in the morning. Recommended
- Procedures:
- Time: Within 30 minutes after waking up in the morning, when mucosal secretion activity is reduced and irrigation is more effective;
- Solution: 0.9% normal saline to avoid mucosal drying caused by hypertonic solutions;
- Device: Manual nasal irrigation bulb or simple spray bottle with moderate water pressure;
- Combination Therapy: Use a nasal glucocorticoid spray after irrigation to enhance the anti-inflammatory effect.
- Clinical Evidence: Follow-up shows that in mild patients who irrigate once daily, the proportion of nasal mucosal thickness returning to normal after 6 months is significantly higher than in the non-irrigation group.
Moderate Chronic Rhinitis: Use twice daily to interrupt the progression of inflammation
- Symptoms: Persistent nasal obstruction (requiring mouth breathing), mucopurulent nasal discharge, occasional loss of smell, and possible postnasal drip.
- Pathological Stage: Chronic mucosal inflammation worsens, with partial loss of cilia and an increased risk of ostiomeatal complex obstruction.
- Goals of Irrigation: Dilute mucopurulent secretions, reduce pathogen load, and prevent sinusitis complications.
- Recommended Procedures:
- Time: Rinse once in the morning and once before bedtime. Nighttime rinsing can reduce secretions that flow back into the throat during sleep.
- Solution: 0.9% saline combined with nasal glucocorticoid nebulizer (doctor's guidance required) to reduce secretion production through local anti-inflammatory treatment.
- Device: Electric spray nasal irrigator, which uses pulsed water flow to more thoroughly clear sinus secretions.
- Combination Therapy: Oral mucus draining agents are taken after rinsing to promote mucus drainage.
- Key Study: A randomized controlled trial demonstrated that twice-daily rinsing, combined with medication, significantly reduced the incidence of sinusitis and shortened the time it took for olfaction to recover in moderate patients.
Severe Chronic Rhinitis: Rinse three times daily during flare-ups. Acute Management
- Symptoms: Severe nasal congestion (requiring vasoconstrictor therapy), purulent nasal discharge, persistent anosmia, and possible concurrent headaches or facial tenderness.
- Pathological Stage: Extensive mucosal fibrosis, extensive ciliary loss, and complete obstruction of the ostiomeatal complex, making secondary bacterial infection more likely.
- Irrigation goals: Rapidly clear purulent secretions, reduce local inflammatory cytokine concentrations, and facilitate drug penetration.
- Recommended procedures:
- Time: Rinse once in the morning, one hour after meals, and before bed. Rinse after meals to prevent food debris from accumulating in the nasal cavity.
- Solution: During acute infection, use 0.9% saline combined with antibiotic nasal drops (prescription required). Irrigation delivers antibiotics directly to the lesion.
- Device: A medical vacuum suction device (hospital-use) or a home electric nasal irrigator (powerful mode) uses negative pressure to simultaneously aspirate secretions and irrigate.
- Combination therapy: After irrigating, administer a nasal corticosteroid spray and oral antibiotics (the course of treatment must be as directed by your doctor).
- Emergency treatment: If nosebleeds occur during irrigating, pause the procedure and administer a lubricating mucosal medication. If bloody discharge or persistent headaches occur, seek medical attention immediately to rule out a tumor.
Frequency adjustments for special scenarios
Pediatric patients
The nasal mucosa of children is delicate, so the volume of each irrigated session must be strictly controlled, not exceeding twice daily. It is recommended to use a pediatric nasal irrigation tip, which delivers low-pressure instillation to avoid coughing and ear discomfort.
Studies have shown that children with chronic rhinitis who irrigate once daily, combined with antihistamines, experience significant reductions in symptom scores and no complications from otitis media.
Pregnant Patients
Hormonal changes during pregnancy can easily trigger nasal congestion. Irrigation can relieve nasal congestion without medication side effects. It is recommended to irrigate once or twice daily using 0.9% saline solution, avoiding medication-containing or hypertonic solutions.
Safety Tip: If nosebleeds or earache occur after irrigating, discontinue use immediately and consult a doctor.
Postoperative Patients
Patients undergoing septal correction or sinus surgery should irrigate three times daily for the first week to remove blood clots and secretions. After one week, increase to twice daily for two weeks. After two weeks, adjust the frequency based on follow-up examination results.
Key Points: Lean forward and breathe through your mouth when irrigating to avoid excessive pressure that may cause wound dehiscence.
Nasal irrigation for chronic rhinitis should adhere to the principles of "tiered management, specialized equipment, and adaptive use." The basic frequency is once daily for mild cases, twice daily for moderate cases, and three times daily during severe episodes. This frequency should be adjusted dynamically based on specific scenarios, such as children, pregnant women, and those undergoing surgery. Through scientific time management and the use of specialized equipment, nasal irrigation can become a core method for chronic rhinitis patients to control symptoms, prevent complications, and improve their quality of life, helping them achieve the health goal of "breathing freely."
