Patients with acute sinusitis often experience persistent nasal congestion, purulent discharge, and facial tenderness due to increased nasal secretions and swelling of the mucous membranes. In severe cases, they may even cause systemic symptoms such as headache and fever. As an auxiliary treatment, nasal irrigation can significantly relieve symptoms by clearing nasal secretions and reducing mucosal edema. However, the concentration of physiological saline directly affects the flushing effect and safety - improper concentration may cause earache, mucosal damage and other complications. This article will systematically analyze the scientific ratio and operating points of physiological saline during acute sinusitis irrigation.
Basis for selection of physiological saline concentration
The preferred 0.9% isotonic saline for daily maintenance:
The 0.9% sodium chloride solution has the same osmotic pressure as human body fluids. It will not destroy the electrolyte balance of the nasal mucosa during flushing and is suitable for daily maintenance of acute sinusitis. Its mild moistening effect can dilute purulent secretions, promote ciliary movement, and reduce pathogen adhesion. For example, a 32-year-old patient with acute sinusitis used 0.9% saline rinse twice a day. After 3 days, the nasal congestion score dropped from 7 points to 3 points, and the amount of purulent discharge was reduced by 60%.
2%-3% hypertonic saline is a powerful tool for reducing swelling in the acute phase:
Hypertonic saline quickly absorbs mucosal edema fluid through osmotic pressure difference, shortening the course of the acute phase. Studies have shown that patients with acute sinusitis who use 3% saline for irrigation have a 40% reduction in nasal mucosal swelling subsidence time compared with the isotonic saline group. However, it should be noted that hypertonic saline should not be used continuously for more than 7 days, otherwise it may damage ciliary function and increase the viscosity of secretions.
Concentration taboos
Salt water with a concentration lower than 0.9% will aggravate mucosal edema and cause "rebound nasal congestion"; salt water with a concentration higher than 3% may directly damage the nasal mucosa and even induce epistaxis. A patient once experienced nasal mucosal erosion after irrigating with 5% saline prepared by himself, and the irrigation needed to be suspended and growth factor gel was used topically to repair it.
Preparation specifications of physiological saline
Material selection
Iodine-free medical sodium chloride (to avoid iodine irritation of mucous membranes) and sterile distilled water (to prevent impurities from causing infection) must be used. Edible salt contains iodine and anti-caking agents, and mineral water contains minerals and cannot be used for preparation. For example, a patient developed nasal tingling and increased secretions after mistakenly rinsing with saline prepared from iodized salt. After examination, he was diagnosed with an iodine allergic reaction.
Preparation method
0.9% saline: add 0.9g medical sodium chloride per 100ml of distilled water (or 4.5g per 500ml).
3% saline: add 3g medical sodium chloride per 100ml of distilled water.
It is necessary to use an electronic scale for weighing (error ≤ 0.1g) and avoid using measuring spoons for estimation. Preparation containers need to be sterilized by high temperature and high pressure or use disposable sterile containers. Wipe the countertop with 75% alcohol before operation.
Save and use
After preparation, the solution should be sealed and stored in a 4°C refrigerator. It should be discarded if not used within 24 hours. If the solution appears turbid, flocculent or has an odor, it must be discarded immediately. A patient was infected with Pseudomonas aeruginosa after rinsing with homemade saline solution that had been stored for 3 days, resulting in aggravation of sinusitis.
Optimization strategy for flushing operations
Temperature control
The temperature of the salt water needs to be maintained at 35-37°C (close to body temperature) to avoid excessive cold irritating the Eustachian tube and causing earache, and excessive heat damaging the mucosa. The prepared salt water can be heated in warm water, or a constant-temperature rinser can be used. Research shows that the incidence of earache in the 37°C saline rinse group is 75% lower than that in the 25°C group.
Posture adjustment
In a sitting or standing position, tilt the head forward 30° to allow the irrigation fluid to flow out of the contralateral nasal cavity and reduce the risk of entering the Eustachian tube. Avoid tilting your head to flush, otherwise fluid may flow back through the nasopharynx and into the middle ear. A patient once developed acute otitis media after raising his head for irrigation and required puncture and drainage treatment.
Stress management
When using a squeeze nasal irrigator, the force should be such that the water flow is linear rather than jet-like to avoid excessive pressure impacting the tympanic membrane. Children or those with abnormal Eustachian tube function can choose a spray irrigator, whose pressure is easier to control.
Response plan for special scenarios
Pediatric patients
Children's nasal mucosa is more delicate, so it is recommended to use 0.9% saline, and the single flushing volume should not exceed 100ml (usually 200-300ml for adults). For example, after 5-year-old children were rinsed with 50ml of 0.9% saline, the incidence of earache was reduced by 60% compared with the adult group.
Postoperative patients
Patients after nasal surgery need to use sterile saline prepared by the hospital to avoid contaminating the wound with self-prepared saline. A patient with sinusitis developed a wound infection after using homemade saline water for irrigation, and his hospital stay was extended by 10 days.
People with allergies
Those who are allergic to pollen and dust mites can add 0.05% fluticasone propionate to physiological saline (doctor's guidance is required), and flushing at the same time can remove allergens and reduce mucosal inflammation. Studies have shown that patients with allergic sinusitis who receive combined flushing have a 50% shorter symptom control time than the medication alone group.
The long-term value of scientific flushing
Standardized use of saline rinses can not only relieve acute symptoms, but also reduce the recurrence rate of sinusitis. Long-term follow-up shows that patients with chronic sinusitis who insist on daily irrigation reduce the number of acute attacks per year from 4.2 to 1.8, and their quality of life scores increase by 40%. In addition, flushing can reduce the use of antibiotics and reduce the risk of drug resistance - data from a community hospital show that the antibiotic usage rate of patients in the flushing group dropped by 65% compared with the control group.
Normal saline irrigation for acute sinusitis is a treatment in which "the details determine success or failure". From the precise selection of concentration to the aseptic operation of preparation, from the strict control of temperature to the standardized adjustment of posture, every link is related to efficacy and safety. Patients need to develop a personalized plan under the guidance of a doctor to avoid the "empiricism" trap. Only scientific flushing can achieve the treatment goal of "flush once, stay comfortable for a day; persist for one month, stay away from recurrence".
