Acute and chronic sinusitis are two common types of nasal mucosal inflammation. Although both present with nasal congestion and runny nose as core symptoms, their duration, pathological characteristics, and treatment goals differ significantly. Nasal irrigation, as an adjunctive treatment, requires adjustments to the operational details based on the disease type to achieve precise intervention.
Irrigation Frequency
Acute sinusitis, due to its short course and severe inflammatory response, produces predominantly mucopurulent nasal secretions that easily block the sinus openings, leading to poor drainage. In this case, high-frequency irrigation (2-3 times daily) is necessary to quickly remove purulent secretions, reduce bacterial colonization, and relieve nasal congestion and headache. For example, patients can irrigate once each in the morning, before bed, and in the afternoon, increasing the frequency, especially when the amount of purulent nasal discharge is high.
Chronic sinusitis, due to its prolonged course, impairs the ciliary function of the nasal mucosa, resulting in yellowish-green, viscous secretions that easily form crusts. In this case, the irrigation frequency should be reduced to 1-2 times daily to avoid over-stimulating the mucosa. If a patient has undergone endoscopic sinus surgery, the irrigation frequency may need to be extended to 4-8 weeks post-surgery, twice daily, to promote epithelialization of the surgical cavity and reduce polypoid changes.
Patient Positioning
For patients with acute sinusitis, due to swelling of the sinus openings, a "forward-tilting head-down position" should be adopted during irrigation. This involves tilting the body forward at a 45° angle, with the head lower than the chin, so that the maxillary sinus openings are in a low position, utilizing gravity to promote drainage of pus from the sinuses. For example, the patient can stand in front of a sink, tilting their head forward during irrigation to allow the irrigation fluid to flow out from the opposite nasal cavity or mouth, preventing backflow into the Eustachian tube.
For patients with chronic sinusitis, due to mucosal fibrosis and narrowing of the sinus openings, a "lateral tilting position" is required for precise irrigation. The specific procedure is as follows: The patient should be seated or standing, tilting their head 30°-40° towards the irrigation side, placing the olive-shaped tip of the irrigator on the outer side of the nasal cavity, allowing the water to flow in an arc along the nasal passage, fully contacting the sinus openings. For example, when rinsing the right nasal cavity, tilt your head to the right, with the tip of your nose pointing outwards, allowing the rinsing solution to penetrate deeper into the ethmoid and maxillary sinuses.
Irrigation Solution Preparation
For acute sinusitis, 0.9% isotonic saline solution is the primary choice. Its osmotic pressure is similar to that of body fluids, gently removing secretions and avoiding irritation of the swollen mucosa. If nasal congestion is severe, 2%-3% hypertonic saline solution can be used for a short period to reduce mucosal edema through osmotic pressure difference, but continuous use should not exceed 7 days to prevent damage to ciliary function.
For chronic sinusitis, the choice of rinsing solution is more flexible. Postoperative patients can use saline solution containing gentamicin (500mL saline + 1 ampoule of gentamicin), which has both cleansing and anti-inflammatory effects. Patients with dry rhinitis can choose a moisturizing rinsing solution containing hyaluronic acid to enhance the mucosal barrier function. For children or those with limited access to the device, a spray rinsing device is recommended, as its atomized particles can directly reach the sinus openings, reducing irritation.
Operating Techniques
When rinsing for acute sinusitis, the principle of "gentle and slow" should be followed. When using the irrigator, apply moderate pressure to avoid excessive pressure that could cause the irrigating solution to enter the Eustachian tube and cause otitis media. Breathe through your mouth during irrigation; do not swallow or speak to prevent choking. If you experience a feeling of fullness or pressure in your ear during irrigation, stop immediately and adjust your position.
For chronic sinusitis, irrigation requires enhanced deep cleaning. When using an electric irrigator, adjust to pulse mode to use water flow to agitate and remove viscous secretions. Sinus balloon irrigation should be performed by a professional in a medical institution. The irrigating solution is injected after the balloon dilates the sinus ostia to directly remove deep lesions in the maxillary and ethmoid sinuses. After irrigation, gently blow your nose to avoid excessive force that could cause nosebleeds.
Nasal irrigation is a crucial part of sinusitis management, but its effectiveness depends on precise control of the procedure. Acute sinusitis requires high-frequency, gentle irrigation to quickly relieve symptoms, while chronic sinusitis requires low-frequency, deep cleaning to maintain mucosal function. Patients should choose an appropriate irrigation method under the guidance of a doctor and have their nasal mucosa checked regularly to avoid over-irrigation that could damage ciliary function. Scientific nasal irrigation can significantly improve nasal ventilation, reduce the risk of recurrence, and enhance quality of life.
