Nasal irrigation is a common treatment for relieving symptoms of rhinitis, allergies, or colds. Its simplicity and immediate effectiveness have made it a staple in many home medicine cabinets. However, some users experience a brief feeling of dizziness after nasal irrigation—blacking out, feeling unsteady, and even nausea. This reaction leads many to worry, asking, "Is there something wrong with the procedure?" or "Is my body unsuitable for nasal irrigation?" In reality, dizziness after nasal irrigation is not necessarily abnormal, but its cause, duration, and severity need to be determined based on individual circumstances.
Physiological Mechanism
Nasal Mucosal Irritation Triggers Vascular Reflex
During nasal irrigation, saline (or a specialized irrigation solution) flows into the nasal cavity, directly stimulating the trigeminal nerve endings on the nasal mucosa. The trigeminal nerve is the primary pathway for facial sensation, and its branches have neural connections to the carotid sinus, a key structure in blood pressure regulation. If the irrigating fluid is too cold (e.g., more than 3°C below body temperature) or too concentrated (e.g., over 3%), it may trigger the nasocardiac reflex, causing a temporary slowing of the heart rate and vasodilation, leading to insufficient blood supply to the brain and causing vertigo.
Ear pressure imbalance interferes with vestibular function
The nasal cavity and middle ear are connected by the Eustachian tube. Improper posture during irrigating (e.g., tilting the head too far back) may allow some fluid to enter the middle ear through the Eustachian tube, altering the pressure in the middle ear. The vestibular apparatus (located in the inner ear and responsible for balance) is extremely sensitive to pressure changes. Fluctuations in middle ear pressure can directly interfere with its signal transmission, leading to "otogenic vertigo." This vertigo is often accompanied by tinnitus or a feeling of fullness in the ears, lasting from seconds to minutes.
Chain reactions of blood pressure fluctuations
Some people (especially the elderly or those with poor blood pressure regulation) may experience postural hypotension during irrigating due to stress or changes in body position (e.g., suddenly moving from a sitting position to a standing position). After saline solution flows into the nasal cavity, some blood may temporarily pool in the head, further exacerbating insufficient blood supply to the brain. Studies show that approximately 15% of rhinitis patients experience mild dizziness during the first irrigation, 60% of which is related to blood pressure fluctuations.
Operational Factors
Uncontrolled Irrigation Solution Temperature and Concentration
Too Low a Temperature: Using unheated saline solution (such as refrigerated saline solution at 4°C) in winter can stimulate vasoconstriction in the nasal mucosa, leading to local ischemia. Experiments have shown that for every 1°C decrease in the temperature of the irrigating solution, the incidence of dizziness increases by 8%.
Too High a Concentration: If the concentration of homemade saline solution exceeds 3% (0.9% for isotonic saline), it can disrupt the osmotic balance of the nasal mucosa, causing cellular edema and indirectly stimulating nerve reflexes.
Recommendation: Use warm water around 37°C (close to body temperature) to prepare the irrigating solution, and strictly follow the proportions in the instructions.
Improper Irrigation Posture
Tilt the head back too far: When irrigating with the head tilted back, the solution can easily flow into the Eustachian tube, increasing pressure in the middle ear. The correct posture is to lean forward and lower your head, allowing the rinse solution to flow out of the other nostril, reducing the risk of aspiration.
Excessive pressure in unilateral irrigation: Squeezing the bottle forcefully may cause the liquid to flow too quickly, irritating the choanae nerve. We recommend a "gentle squeeze, slow release" technique, limiting each nasal irrigation time to 10-15 seconds.
Excessive irrigation frequency
Frequent irrigation (e.g., more than twice daily) can over-clean the nasal mucosa, disrupting the surface mucus layer, leading to dryness and increased sensitivity. In this case, even mild irritation can trigger a strong nerve reflex. Clinical advice: Reduce the frequency to once a day during symptom relief, and 3-4 times a week for maintenance.
What symptoms of vertigo should be considered?
Accompanying symptoms suggest a serious problem
If vertigo persists for more than 10 minutes or is accompanied by the following symptoms, seek medical attention immediately:
Severe headache: May indicate increased intracranial pressure or cerebrovascular accident;
Blurred/double vision: May be related to insufficient blood flow to the brain or nerve damage;
Confusion/coma: Rare but may be a precursor to an allergic reaction (e.g., contaminated irrigant) or cardiac syncope.
Contraindications for Special Populations
Patients with severe cardiovascular disease: Such as coronary artery disease or arrhythmias; the blood pressure fluctuations caused by irrigating may trigger angina pectoris;
Patients with ear diseases: Such as otitis media or a perforated eardrum; irrigating fluid entering the middle ear may aggravate the infection;
Children and the elderly: The former have shorter Eustachian tubes, while the latter have poorer blood pressure regulation; both require adjustment of the irrigating regimen under the guidance of a doctor.
How to Reduce Dizziness
Pre-Irrigation Preparation
Environmental Adjustment: Choose a warm, draft-free environment to avoid vasoconstriction caused by cold.
Postural Training: Before your first irrigation session, practice the "leaning forward and bowing your head" position to ensure your head is stable during irrigation.
Emotional Relaxation: Take deep breaths to relieve tension and avoid anxiety exacerbating reflex hypotension.
During Irrigation
Temperature Monitoring: Test the irrigation solution temperature with the inside of your wrist to ensure it is not cold.
Pressure Adjustment: Maintain even pressure when squeezing the bottle, avoiding sudden bursts.
Alternating Sides: Irrigate the side with the most severe symptoms first, then switch to the other side to minimize the duration of unilateral stimulation.
Post-Irrigation Observation
Rise Slowly: Sit quietly for 2 minutes after irrigation, then gradually stand up to avoid postural hypotension.
Recording Responses: If dizziness occurs after each irrigation session, record the time of onset, duration, and accompanying symptoms for your doctor's evaluation.
Prompt Adjustments: If dizziness occurs frequently, try reducing the frequency of irrigation, adjusting the concentration, or switching to a spray-type irrigation device.
Brief dizziness after nasal irrigation is often a physiological reflex or the result of improper operation, and can be significantly improved by adjusting the temperature, posture, and frequency. It serves more as a warning signal, reminding the user to pay attention to the details of the irrigation or their own health status. However, if the dizziness persists, worsens, or is accompanied by dangerous symptoms, it is necessary to stop the irrigation immediately and seek medical attention. After all, any care method should be based on safety.
