Acute sinusitis is a common ENT disease, often caused by viral infection, bacterial infection, or allergic reaction, manifesting as nasal congestion, purulent nasal discharge, headache, and decreased sense of smell. Nasal irrigation, as an adjunctive treatment, can significantly relieve symptoms by clearing nasal secretions and pathogens. However, the question of whether or not to rinse the nasal cavity daily requires a comprehensive analysis based on scientific evidence and clinical practice.
The Necessity of Daily Nasal Irrigation for Patients with Acute Sinusitis
During an acute sinusitis attack, swelling of the sinus mucosa leads to retention of secretions, forming thick, purulent nasal discharge that blocks the nasal cavity and may even cause retrograde infection. Daily nasal irrigation at this time has the following benefits:
Clearing Pathogens and Allergens: Saline irrigation can physically remove bacteria, viruses, and allergens such as dust mites and pollen from the nasal cavity, reducing inflammatory stimulation. For example, in patients with concurrent allergic rhinitis, irrigation can reduce the accumulation of allergens in the nasal cavity and prevent lower respiratory tract allergic reactions.
Promotes sinus drainage: Flushing with water clears sinus openings blocked by purulent nasal discharge, restoring sinus ventilation. Studies show that rinsing 2-3 times daily can increase sinus secretion drainage efficiency by over 40%.
Relieves mucosal swelling: The rinsing solution moistens the nasal mucosa, reducing mucosal edema caused by dryness or inflammation, and improving nasal congestion symptoms.
Daily Nasal Irrigation Procedures and Precautions
Frequency and Course of Treatment
Acute Phase: It is recommended to irrigate 2-3 times daily for 5-10 minutes each time, for 1-2 weeks. For example, if there is a bacterial infection or a large amount of yellow purulent nasal discharge, the frequency can be increased to 3 times daily, gradually reducing the frequency after symptoms subside.
Remission Phase: If nasal secretions decrease, the frequency can be reduced to once daily or every other day until symptoms completely disappear. Patients with chronic sinusitis need to adhere to this regimen long-term, but there is no need to excessively prolong the course of treatment during the acute phase.
Key Operating Points
Equipment Selection: Use a dedicated nasal irrigator (such as an electric spray or squeeze-type) to avoid choking or aspiration. Children should be supervised by a parent to prevent fluid from entering the trachea.
Irrigation Solution Preparation: 0.9% isotonic saline solution is preferred, as its osmotic pressure matches that of the human body, reducing mucosal irritation. Hypertonic saline (e.g., 2%-3%) may worsen dryness, and hypotonic saline may cause tissue edema; both are not recommended for routine use.
Water Temperature Control: The water temperature should be close to body temperature (around 37°C). Cold water may cause nasal mucosal spasms, and hot water may scald the cilia. A temperature deviation exceeding 5°C may reduce the irrigation effect and even induce dizziness.
Position and Breathing: Tilt the head at a 45-degree angle during irrigation, allowing water to flow from one nostril to the other, avoiding entry into the Eustachian tube; breathe through the mouth to reduce ear pressure and decrease the risk of otitis media. Excessive head tilting back may cause fluid to enter the trachea.
Contraindications and Risks
For those with severe nasal congestion: If the nasal cavity is completely blocked, irrigation may worsen discomfort. A decongestant (such as naphazoline nasal drops) should be used first to relieve congestion before proceeding.
Special Populations: Hypertensive patients should use hypertonic saline with caution to avoid blood pressure fluctuations; post-nasal surgery patients should follow their doctor's instructions to adjust the irrigation plan to prevent intraoperative bleeding.
Complication Prevention: Avoid blowing your nose or bending over immediately after irrigation to prevent mucosal bleeding or fluid backflow into the sinuses. If ear fullness, stinging, or nasal bleeding occurs, stop immediately and seek medical attention.
Limitations of Nasal Irrigation
While nasal irrigation can relieve symptoms, it cannot replace drug treatment. Core treatment for acute sinusitis includes:
Antibiotics: For bacterial infections, amoxicillin-clavulanate potassium, cefuroxime axetil, etc., are required, with a course of treatment typically 7-14 days.
Corticosteroids: Nasal sprays (such as budesonide, mometasone furoate) can reduce mucosal swelling and promote sinus opening.
Mucolytics: Acetylcysteine granules can thin purulent nasal discharge, facilitating its drainage.
Physical therapy: Applying heat to the face, steam inhalation, or shortwave diathermy can help improve local circulation.
If symptoms persist for more than 10 days, or if high fever, severe headache, or vision changes occur, be alert for intraorbital or intracranial complications and seek immediate medical attention.
Daily nasal irrigation is safe and necessary for patients with acute sinusitis, but it must be strictly followed according to protocol, controlling the frequency and course of treatment, and combined with medication. Irrigation is not only a means of symptom relief but also an important step in promoting sinus function recovery. With proper management, most patients can see significant improvement within 1-2 weeks, but those with chronic sinusitis or anatomical abnormalities require long-term follow-up, and surgical intervention may be considered if necessary.
