Acute sinusitis is an acute purulent inflammation of the nasal mucosa, often accompanied by symptoms such as nasal congestion, purulent nasal discharge, headache, and decreased sense of smell. In clinical treatment, nasal irrigation is used as an adjunct method to improve the nasal environment through physical flushing and osmotic pressure. However, the choice between hypertonic saline and normal saline requires comprehensive judgment based on the stage of the disease, individual differences, and procedural guidelines.
Normal Saline: Gentle and cleansing, suitable for daily care and basic treatment during the acute phase
Core Mechanism of Action
Normal saline (0.9% sodium chloride solution) has the same osmotic pressure as human body fluids, and will not cause dehydration or edema of the mucosa during rinsing. It removes purulent secretions, allergens, and pathogens from the nasal cavity through physical flushing, while moisturizing dry mucosa, reducing erosion and pain. For example, patients often have residual crusts in their nasal cavity after sinusitis surgery; normal saline irrigation can soften and remove these crusts, promoting mucosal healing.
Advantages of Use in the Acute Phase
During an acute sinusitis attack, a large amount of purulent secretions accumulate in the nasal cavity, and repeated nose blowing may aggravate mucosal damage. Rinsing with physiological saline can gently remove secretions and avoid secondary damage to the mucosa. Studies show that rinsing with physiological saline 2-3 times daily can significantly reduce the amount of nasal secretions and relieve nasal congestion symptoms, making it especially suitable for children, the elderly, and postoperative patients.
Safety and Applicable Population
Physiological saline has low irritation and almost no contraindications, making it suitable for long-term use. For children, a spray device is recommended to avoid choking; caution is needed for those with severe nasal mucosal erosion and bleeding, but physiological saline is still safer than hypertonic saline. Furthermore, physiological saline can be used in combination with nasal sprays of hormones, antibiotics, etc., to enhance the therapeutic effect.
Hypertonic Saline: Rapid Swelling Reduction, Suitable for Short-Term Use During the Acute Inflammatory Phase
Osmotic Pressure-Driven Swelling Reduction Mechanism
Hypertonic saline (usually a 2%-3% sodium chloride solution) absorbs water from edematous mucosal tissue through osmotic pressure difference, rapidly relieving nasal congestion symptoms. Its effect of diluting viscous secretions is stronger, promoting the drainage of purulent secretions. For example, after rinsing with 3% hypertonic saline, the time for improvement in nasal ventilation in sinusitis patients is 30% shorter than that of normal saline.
Short-term effects during acute phase
During an acute sinusitis attack, hypertonic saline can shorten the course of the disease and reduce the duration of symptoms. A clinical study showed that rinsing with 3% hypertonic saline three times daily, combined with antibiotic treatment, shortened the average headache relief time by 2 days. However, it should be noted that hypertonic saline should not be used for a long time, as long-term use may damage ciliary function and worsen mucosal damage.
Risks and contraindications
Hypertonic saline is highly irritating, and some patients may experience nasal burning or dryness of the mucosa. If ear fullness or ear pain occurs after rinsing, it should be stopped immediately and Eustachian tube dysfunction should be investigated. In addition, hypertonic saline is contraindicated within 24 hours after nasal surgery, in patients with severe epistaxis, or in patients with skull base fractures; when used by diabetic patients, the concentration should be reduced to below 2% to avoid mucosal burns.
Scientific Selection
Basic Treatment in the Acute Phase: Saline Solution is the First Choice
For patients with mild to moderate acute sinusitis, saline solution is the preferred irrigation solution. Its gentle cleansing effect meets daily care needs and creates favorable conditions for subsequent drug treatment (such as antibiotics and nasal corticosteroids). For example, patients who irrigate with saline solution twice daily in conjunction with oral amoxicillin-clavulanate potassium experience a significant improvement in symptom relief.
Adjunctive Treatment in the Acute Inflammatory Phase: Short-Term Use of Hypertonic Saline
If the patient has severe nasal congestion and thick purulent nasal discharge, 3% hypertonic saline solution can be used for a short period (3-5 days) under the guidance of a doctor. For example, in patients with acute sinusitis accompanied by fever, hypertonic saline irrigation can promote the drainage of purulent secretions and assist antibiotics in controlling infection. However, the concentration and frequency must be strictly controlled to avoid long-term use.
Special Populations and Complication Management
Children and the Elderly: Saline solution is the preferred choice. Children should use a spray device, and the elderly should pay attention to the control of irrigation pressure.
Postoperative Patients: Irrigation should begin 24 hours after surgery, initially using saline solution, and then adjusted according to recovery progress. For individuals with concurrent allergies: Rinsing with physiological saline can simultaneously remove allergens, and can be combined with antihistamines (such as loratadine) to control allergic reactions.
Operating Procedures and Precautions
Temperature Control: The rinsing solution temperature should be close to body temperature (35-37℃) to avoid cold stimulation causing vasoconstriction or heat damage.
Positioning: When rinsing, lean forward at a 45-degree angle and tilt your head slightly to one side, allowing the saline solution to enter from one nostril and flow out from the other, avoiding choking or ear discomfort.
Frequency and Course of Treatment: Physiological saline 1-2 times daily, up to 3 times during the acute phase; hypertonic saline should not be used more than 2 times daily, and continuous use should not exceed 5 days.
Equipment Selection: Adults can use a squeeze-type nasal irrigation pot; children are advised to choose a nebulizer; electric nasal irrigators offer more stable pressure and are suitable for long-term use.
Nasal irrigation for acute sinusitis requires a treatment plan tailored to the stage of the condition and individual differences. Physiological saline is the first choice for basic treatment due to its gentle cleansing and high safety profile, while hypertonic saline can provide rapid symptom relief during short-term use in the acute inflammatory phase. Regardless of the type of rinsing solution chosen, it is essential to strictly adhere to the operating procedures to avoid complications caused by excessive rinsing or improper concentration. If symptoms persist for more than 10 days or if fever, headache, or other symptoms worsen, seek medical attention promptly and consider antibiotic treatment or endoscopic nasal surgery if necessary.
