Nasal Douching Protocol After Septoplasty
Nasal douching with saline irrigation should be started after septoplasty as it significantly improves healing, reduces crusting, and accelerates symptom relief compared to no irrigation. 1, 2
Recommended Protocol
Timing
- Begin nasal saline irrigation 24-48 hours after removal of nasal packing (if used) or immediately after surgery (if no packing)
- Continue for at least 2-3 months postoperatively
Method
- Nasal douching technique is superior to sprays or nebulization for distributing irrigation solution to the maxillary sinus and frontal recess 1
- Use 250ml of isotonic saline solution twice daily 1
- Perform with head tilted forward over a sink or in shower
Solution Type
- Isotonic saline is more effective and better tolerated than hypertonic saline 1
- Commercial preparations or homemade solutions (1 teaspoon salt + pinch of baking soda in 500ml boiled water) are both acceptable
Evidence-Based Benefits
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 demonstrates that:
- Regular nasal douching results in significantly better nasal symptoms at 3,6,9, and 12 months post-surgery 1
- Isotonic solutions show better outcomes than hypertonic solutions for postoperative care 1
Research shows that patients using saline douching after septoplasty experience:
- 58% reduction in disease severity by day 7 (vs. 25% in controls) 2
- 84% reduction in disease severity by day 14 (vs. 51% in controls) 2
- 87% reduction in nasal obstruction by day 14 (vs. 48% in controls) 2
- 88% reduction in nasal discharge and crusting by day 14 (vs. minimal improvement in controls) 2
Important Considerations
Nasal Packing
- Modern evidence does not support routine nasal packing after septoplasty 3, 4
- If packing is used, it should be removed within 24-48 hours before beginning irrigation
- Trans-septal suturing is a valid alternative to nasal packing with fewer complications 5, 6
Patient Instructions
- Avoid forceful nose blowing for at least 1 week after surgery 1
- Avoid flying, diving, forceful sneezing, or playing wind instruments for at least 6 weeks 1
- Use gentle pressure when irrigating to avoid complications
Complications to Monitor
- Retained secretions in the nasal cavity can vary from thin white to yellowish/greenish discharge 1
- Watch for signs of infection or septal hematoma during follow-up visits
Follow-Up Care
- Regular endoscopic evaluation is recommended during the healing period
- Continue intranasal corticosteroids along with saline irrigation to maintain improvement 7
- Culture-directed antibiotics may be needed if infection develops 7
By following this protocol, patients can expect faster healing, reduced crusting, improved nasal patency, and better overall outcomes after septoplasty surgery.