Acute sinusitis, a common otolaryngological disease, is characterized by nasal congestion, purulent nasal discharge, headache, and decreased sense of smell. In severe cases, it can even lead to intraorbital or intracranial complications. Its core pathology lies in acute purulent inflammation of the sinus mucosa, leading to mucosal edema, secretion retention, and bacterial biofilm formation. Nasal irrigation, as an adjunctive treatment, works synergistically through physical and biological mechanisms to alleviate symptoms and promote recovery.
Physical Clearance Mechanism
Patients with acute sinusitis often accumulate large amounts of purulent secretions in their nasal cavity, forming thick "crusts" that not only obstruct the sinus openings but also provide a breeding ground for bacteria. Nasal irrigation achieves physical clearance through the following methods:
Dilution and Flushing Effect
Using 0.9% isotonic saline or a special irrigation solution, the solution is delivered into the nasal cavity using the pressure of an irrigator, directly diluting the viscous secretions and reducing their adhesiveness. For example, in patients with sinusitis after surgery, rinsing can soften the crusts, making them easier to blow out or drain naturally. Studies show that rinsing 2-3 times daily can significantly reduce nasal secretions and relieve nasal congestion.
Disruption of Bacterial Biofilms
In patients with chronic sinusitis, a biofilm composed of bacteria and polysaccharide-protein complexes often forms in the nasal cavity. This biofilm has a dense structure and can resist antibiotic penetration. Rinsing mechanically disrupts the biofilm structure, exposing bacteria to the environment in which drugs act. For example, common pathogens such as Streptococcus pneumoniae and hemolytic streptococci are difficult to eliminate under the protection of the biofilm, and combining rinsing with antibiotic treatment can improve bactericidal efficiency.
Anti-inflammatory and Immune Modulation
The inflammatory response of acute sinusitis involves various cytokines and immune cells. Rinsing modulates the local immune environment through the following pathways:
Reducing the Concentration of Inflammatory Mediators
The rinsing solution can dilute inflammatory mediators such as histamine and leukotrienes in the nasal cavity, reducing their irritation to the mucosa. For example, in patients with allergic rhinitis, irrigation significantly reduces IgE antibody levels in the nasal mucosa, alleviating allergic reactions.
Promotes Mucosal Repair
Irrigation keeps the nasal mucosa moist, preventing ciliary damage caused by dryness. Isotonic saline has a similar osmotic pressure to the human body, maintaining normal mucosal cell morphology and promoting the recovery of ciliary beating frequency. Clinical observations have shown that patients who consistently irrigate after sinus surgery experience a reduction of more than 30% in mucosal epithelialization time.
Improves Ciliary Function
The nasal mucociliary transport system is the nasal cavity's "natural cleaner," and impaired function is a significant contributing factor to acute sinusitis. Irrigation improves ciliary activity in the following ways:
Removes Ciliary Coverage
Purulent secretions, dust, and other foreign matter can cover the ciliary surface, hindering their beating. Irrigation exposes the cilia, restoring a beating frequency of 10-15 times per minute. For example, in patients with chronic sinusitis, irrigation increases the mucociliary transport speed from 0.5 cm/min to over 2 cm/min.
Optimizing the Ciliary Motion Environment
The rinsing solution adjusts the nasal cavity pH to a slightly acidic level (pH 5.5-7.0), inhibiting bacterial growth while providing a suitable environment for ciliary movement. Furthermore, the moistened mucosal surface reduces friction between cilia, improving transport efficiency.
Enhancing Drug Penetration
Acute sinusitis often requires the combined use of nasal sprays containing corticosteroids and antibiotics. Rinsing can enhance drug efficacy:
Removing Drug Residue
Long-term use of nasal sprays may lead to drug deposition and crystal formation in the nasal cavity. Rinsing removes residual drugs, preventing local irritation and drug resistance.
Promoting Drug Distribution
After rinsing, the permeability of the nasal mucosa increases, allowing drugs to penetrate more easily into the deeper sinuses. For example, the symptom relief rate of mometasone furoate nasal spray combined with rinsing for allergic sinusitis is 40% higher than that of using the drug alone.
Scientific Irrigation
To ensure effective irrigation, please pay attention to the following points:
Temperature Control: The irrigation solution temperature should be close to body temperature (37-40℃) to avoid cold stimulation causing vasoconstriction or heat damage.
Pressure Adjustment: When using an electric nasal irrigator, control the pressure at 120-150 mmHg to avoid excessive pressure causing ear pain or coughing.
Posture: Tilt your head forward 30° and breathe through your mouth, allowing the solution to flow into one nostril and out through the opposite nostril or mouth.
Frequency and Course of Treatment: During the acute phase, 2-3 times daily; after symptom relief, reduce to once daily, continuing for 2-4 weeks.
Nasal irrigation, through four mechanisms—physical removal, anti-inflammatory repair, ciliary function restoration, and drug synergy—has become an important part of the comprehensive treatment of acute sinusitis. It is simple to operate and highly safe, especially suitable for children, the elderly, and postoperative patients. However, if complications such as severe headache, visual changes, or high fever occur, seek medical attention promptly to avoid delaying treatment.
