During an acute sinusitis attack, patients are often troubled by symptoms such as nasal congestion, purulent nasal discharge, and headaches, which can even affect sleep and daily activities in severe cases. When seeking relief, nasal irrigation and nasal sprays are two common choices, but their mechanisms of action and applicable scenarios differ.
Mechanism of Action: Physical Clearance vs. Drug Intervention
Nasal irrigation uses physiological saline or hypertonic saline to mechanically flush away purulent secretions, pathogens, and allergens from the nasal cavity and sinus openings. Its advantage lies in "physical battlefield cleaning"—for example, when using 250-500ml of physiological saline, the water flow can bypass the nasopharynx and drain from the other nostril, effectively diluting viscous secretions and improving sinus drainage. Furthermore, hypertonic saline (2%-3%) can reduce mucosal edema through osmotic pressure difference, but it needs to be used for a short period (≤7 days) to avoid damaging ciliary function.
Nasal sprays, on the other hand, act directly on the nasal mucosa through their drug components. For example:
Glucocorticoids (e.g., budesonide, mometasone furoate):Inhibit the release of inflammatory mediators, reduce mucosal edema, and decrease mucus secretion, suitable for long-term inflammation control;
Decongestants (e.g., oxymetazoline hydrochloride):Constrict nasal blood vessels, quickly relieve nasal congestion, but continuous use for more than 3-7 days may cause rebound congestion, leading to drug-induced rhinitis;
Hypertonic seawater spray:Moisturizes the nasal cavity through tiny droplets, dilutes secretions, and assists ciliary movement, suitable for children or those with limited access to the spray.
Efficacy Comparison: Adjunctive Relief vs. Targeted Treatment
Nasal irrigation is positioned as an "adjunctive measure." Its core function is to clean the nasal environment, creating conditions for drug absorption. For example, after irrigation in patients with acute sinusitis, the purulent plugs at the sinus openings are removed, allowing subsequent nasal sprays or oral antibiotics (e.g., amoxicillin-clavulanate potassium) to penetrate the lesion more efficiently. However, it should be noted that simple irrigation cannot kill pathogens; for patients with severe infections or severe headaches, combined antibiotic treatment is necessary.
Nasal sprays offer more targeted therapeutic effects:
Corticosteroids:Highly effective for allergic sinusitis, reducing the release of inflammatory mediators from the nasal mucosa and alleviating tissue edema. Continued use for several weeks is necessary to maintain efficacy.
Decongestants:Rapid onset of action (relieving nasal congestion within minutes), but effects only last for a few hours, suitable for short-term use during acute attacks.
Combination therapy:Clinically, a combination of nasal irrigation + nasal spray + oral antibiotics is commonly used. For example, patients first irrigate their nasal cavity in the morning to remove overnight pus, then use budesonide nasal spray to control inflammation. If nasal congestion is severe, oxymetazoline hydrochloride nasal spray can be added (for no more than 7 days).
Precautions for Use
Nasal Irrigation Contraindications and Techniques:
Contraindications: Caution is advised for patients with nasal bleeding, deviated nasal septum, or severe ear infections.
Techniques: When irrigating, lean forward at a 45° angle, with your head lower than your chin, so that the maxillary sinus openings are in a low position, using gravity to promote pus drainage. Children are advised to use a spray irrigator to avoid coughing.
Frequency: 2-3 times daily during the acute phase, once daily during the chronic phase, and extended to 4-8 weeks for postoperative patients.
Nasal Spray Usage Guidelines:
Dosage: 1-2 sprays per nostril daily for corticosteroids; no more than 2 times daily for decongestants.
Operation: Aim the nozzle at the lateral wall of the nasal cavity, avoiding direct spraying towards the nasal septum. Gently blow your nose after use to prevent medication from flowing into the pharynx.
Monitoring: Long-term use of corticosteroids requires regular nasal mucosal examinations. Children and pregnant women should have their dosage adjusted according to their doctor's instructions. Decongestants should be discontinued immediately and medical attention sought if used beyond their expiration date.
Scientific Choice
Treatment of acute sinusitis should be carried out in stages:
Acute exacerbation phase (first 3-7 days):Focus on symptom relief, which may involve a combination of hypertonic saline irrigation (twice daily) + decongestant nasal spray (short-term use) + oral antibiotics.
Inflammation control phase (after 7 days):Switch to normal saline irrigation (once daily) + corticosteroid nasal spray (for 2-4 weeks) to promote mucosal repair.
Special populations:Children should prioritize spray irrigators and hypertonic saline sprays. Pregnant women should avoid decongestants, and corticosteroids should be used strictly according to doctor's instructions.
Nasal irrigation and nasal sprays are not mutually exclusive but rather complementary "golden partners." Irrigation creates conditions for medication to take effect through physical cleaning, while nasal sprays precisely control inflammation through drug intervention. For patients with acute sinusitis, it is recommended to develop a personalized treatment plan under the guidance of a doctor: mild patients can use irrigation or nasal spray alone, while moderate to severe patients need to use a combination of medications and have regular follow-up visits to assess the effectiveness of the treatment.
