Chronic sinusitis is a common chronic inflammatory disease of the nose. Patients often experience persistent nasal congestion, purulent rhinorrhea, and headaches due to swelling of the nasal mucosa and accumulation of secretions. Nasal irrigation, as an important physical therapy tool, can significantly relieve symptoms and reduce the risk of recurrence by clearing nasal secretions, thinning mucus, and reducing exposure to allergens and pathogens. However, the frequency, timing, and specifics of nasal irrigation should be adjusted according to the severity of the condition and individual differences. Only scientific and standardized irrigation can achieve optimal results.
Select the timing and frequency of irrigation based on the severity of the condition
Acute exacerbation: 2-3 times daily for 1-2 weeks
When chronic sinusitis exacerbates due to infection, allergies, or environmental irritants (such as cold air or dust), nasal discharge increases significantly, and may be accompanied by yellow-green purulent rhinorrhea, facial tenderness, or a low-grade fever. During this period, it is recommended to perform nasal irrigation 2-3 times daily. The specific procedure can be referred to as follows:
After waking up in the morning: Clear secretions accumulated overnight and relieve morning nasal congestion;
One hour before bed: Avoid residual moisture in the nasal cavity after irrigation that may affect sleep;
When symptoms worsen: If the amount of nasal discharge increases suddenly after exposure to allergens, temporarily increase the frequency of nasal irrigation.
Research shows that after one week of continuous irrigation, over 80% of patients in the acute phase see a decrease in purulent discharge and improved sense of smell. At this point, under the guidance of a doctor, the frequency can be gradually reduced to once daily until symptoms are completely controlled.
Stable Remission Phase: Once daily for long-term maintenance
When symptoms have eased and nasal secretions have decreased, the frequency of irrigation can be adjusted to once daily to maintain nasal cleanliness and prevent recurrence. For example, patients with chronic sinusitis and allergic rhinitis should continue to rinse daily after the pollen season ends to reduce residual allergens. Patients with simple infectious sinusitis can continue rinsing for 2-3 weeks after symptoms disappear to consolidate the effect.
Special Cases: Adjust as Needed
Postoperative Patients: For the first week after endoscopic sinus surgery, irrigation is required 2-3 times daily due to the presence of blood crusts and secretions in the surgical cavity. Gradually reduce this frequency to once daily 2-4 weeks after surgery and continue for 3-6 months to promote mucosal repair.
Pediatric Patients: Due to the narrow nasal cavity, children under 3 years old are recommended to use a spray device once daily to prevent choking. School-age children can follow the adult protocol.
Elderly Patients: Those with hypertension or a history of epistaxis should follow their doctor's instructions for irrigation frequency and avoid vigorous irrigation that may cause blood pressure fluctuations.
Five Key Considerations for Scientific Irrigation
Temperature and Concentration: Isotonic saline near body temperature
Water temperature: Approximately 37°C is closest to the nasal mucosa, preventing cold-induced vasoconstriction and heat-induced damage. Preheat the irrigant in warm water in winter; avoid using ice water in summer. Concentration: 0.9% isotonic saline is the preferred choice. Hypertonic saline (2%-3%) may reduce swelling more quickly, but long-term use may damage the mucosal barrier. It is only recommended for acute use, no more than twice daily. After each rinse, rinse with isotonic saline.
Posture: Prevent backflow of fluid
Lean forward: When rinsing, tilt your head forward 30°-45° so that the irrigant flows into one nostril and out the other, avoiding pharyngeal drainage and stomach discomfort.
Mouth breathing: Keep your mouth slightly open and breathe slowly through your mouth during rinsing to prevent fluid pressure from causing earache or otitis media.
Irrigation pressure: Gentle is paramount
Pressure control: When using a neti pot, squeeze the bottle evenly to avoid sudden pressure that could cause fluid to rush into the sinuses or ear canal. Children should use a low-pressure spray device.
Time allocation: Rinse each nostril for approximately 10-15 seconds, alternating between the two sides. The total duration should not exceed 2 minutes to prevent overhydration of the mucosa.
Contraindications and Complication Prevention
Absolute Contraindications: Patients with acute epistaxis, severe septal deviation, or cerebrospinal fluid rhinorrhea should not use nasal irrigation.
Relative Contraindications: Patients with upper respiratory tract infections accompanied by fever or severe, uncontrolled hypertension should temporarily use nasal irrigation.
Complication Management: If ear pain, persistent epistaxis, or worsening headaches occur after nasal irrigation, discontinue use immediately and seek medical attention.
Adjunctive Measures: Improving Efficacy
Post-irrigation Medication: Administer nasal steroids (such as budesonide) 10 minutes after nasal irrigation to minimize dilution of the medication by secretions and increase local concentration.
Environmental Control: Avoid going outdoors for 30 minutes after nasal irrigation to prevent dust from re-contaminating the nasal cavity. In winter, use a humidifier to maintain indoor humidity at 40%-60%.
Nasal irrigation for chronic sinusitis should be individualized and phased: high-frequency irrigation for rapid symptom control during the acute phase, and low-frequency irrigation during remission to prevent recurrence. During the procedure, attention should be paid to details such as temperature, pressure, and posture. In addition, comprehensive treatments such as medication and immunomodulation should be combined. Patients should undergo regular follow-up visits (every 3-6 months) to assess mucosal recovery through nasal endoscopy or sinus CT scans, allowing for timely adjustments to treatment regimens. Scientifically standardized nasal irrigation not only improves quality of life but also serves as the cornerstone of long-term management of chronic sinusitis.
