Nasal irrigation is a common method for relieving nasal congestion and cleansing the nasal cavity. The physical flushing of saline or specialized solutions effectively removes allergens, secretions, and pathogens, improving nasal symptoms. However, this procedure is not suitable for all people and in all situations. Ignoring contraindications and blindly using irrigation can cause mucosal damage, spread the infection, and even be life-threatening.
Acute Nasal Infection
When the nasal cavity is in an acute infection (such as bacterial sinusitis or vestibulitis), the mucosa becomes congested and edematous, weakening the local defenses. Irrigating during this period may flush pathogens deeper into the nasal cavity, causing the infection to spread.
Typical manifestations:
Increased purulent discharge (yellow-green, viscous)
Local pain or tenderness (such as soreness in the sinus area)
Systemic symptoms such as fever and headache
Risks: Irrigation pressure may propel pus into the cranial cavity (as in sphenoid sinusitis), causing intracranial infection; or it may flow back through the Eustachian tube into the middle ear, triggering otitis media. Recommendation: Antibiotics should be used as the priority treatment during acute infection. Nasal irrigation should be continued only after the discharge clears and symptoms subside.
Active Nosebleeding
Nosebleeding (epistaxis) is an absolute contraindication for nasal irrigation. During irrigation, the pressure of the water flow may dislodge damaged mucosa or dislodge blood clots, causing further bleeding or even severe bleeding.
Common Causes:
Dry rhinitis (increased mucosal fragility)
Hypertension (increased vascular pressure)
Hematologic disorders (such as thrombocytopenia)
Interventions:
Minor bleeding: Sit with your head down and apply pressure to the nostrils with your thumbs for 5-10 minutes while applying a cold compress to the forehead.
Persistent bleeding: Seek medical attention immediately and stop bleeding with endoscopic electrocoagulation or packing.
Avoid nasal irrigation for 3 days after bleeding stops, allowing the mucosa to fully heal.
Early Postoperative Nasal Surgery
After procedures such as septal correction and polypectomy, wounds may form in the nasal cavity or packing (such as expandable sponges) may be placed. Irrigation at this time may:
Dislodge the packing, causing bleeding or hematoma formation
Contaminate the wound surface, increasing the risk of infection
Damage the newly formed mucosa, delaying healing
Timeframe:
Simple packing: 48-72 hours after surgery (after packing removal)
Complex surgery (such as skull base surgery): Follow your doctor's instructions, usually waiting 2-4 weeks
Alternative: Use saline spray to moisten the nasal cavity in the early postoperative period to relieve dryness and discomfort.
Severe Cardiovascular Disease
During nasal irrigation, some patients may experience sneezing, coughing, or vasoconstriction due to the stimulation, leading to a sudden increase in blood pressure or heart rate. This risk is significantly increased in the following individuals:
Uncontrolled hypertension (systolic blood pressure >180 mmHg)
Severe coronary artery disease (such as unstable angina)
Cerebrovascular disease (such as those recovering from a cerebral hemorrhage)
Mechanism: Irrigation stimulates branches of the trigeminal nerve, which, through reflex stimulation, induces sympathetic nervous system activation, leading to a cardiovascular stress response.
Recommendation: For such patients, assess blood pressure stability before irrigating. Maintain a seated position during the procedure, avoid sudden changes in position, and minimize the duration of each irrigation.
Children and People with Cognitive Impairments
Children (especially those under 6 years old) and people with cognitive impairments may aspirate or choke on the irrigant due to poor cooperation, leading to the following risks:
Aspiration: The irrigant enters the trachea, causing aspiration pneumonia (especially if accompanied by Mycoplasma pneumoniae infection).
Coughing: Violent coughing can cause a sudden increase in nasal pressure, potentially causing ear pain (due to abnormally open Eustachian tubes).
Device Damage: Children may insert the irrigator tip deep into their nasal cavity out of curiosity, potentially damaging the mucosa.
Safety Tips:
Children should use a designated pediatric irrigator (such as a sprayer) under parental supervision.
People with cognitive impairments should avoid using the irrigator themselves and seek assistance from medical staff if necessary.
Keep your head tilted forward during irrigating, avoiding tilting your head back.
Special Physiological Conditions
While the following conditions are not absolute contraindications, careful evaluation or adjustment of irrigation protocols is warranted:
Pregnancy:
Avoid using irrigation solutions containing medications (e.g., hormones, antibiotics).
Prefer normal saline and control irrigation pressure.
Severe coagulation disorders:
e.g., hemophilia, long-term anticoagulant therapy (warfarin, aspirin).
Check coagulation parameters (e.g., INR) before irrigation and discontinue anticoagulants if necessary.
Nasal Structural Abnormalities:
e.g., severely deviated septum, stenotic nares.
A customized irrigation tip or a spray irrigation may be necessary.
Make informed decisions, prioritize safety
Contraindications to nasal irrigation involve multiple considerations, including infection control, wound healing, and cardiovascular safety. Before the procedure, perform a self-assessment using the following three questions:
Do you have an acute nasal infection or bleeding?
Is the patient recovering from surgery or experiencing a serious medical condition?
Is the patient cooperative?
If any contraindications exist, prioritize treatment of the underlying condition and resuming irrigation when conditions permit. Consult an otolaryngologist for any uncertainties. Do not overlook potential risks in the pursuit of short-term results. The core of health care lies in "moderation", and only scientific decision-making can truly protect nasal health.
