Nasal inflammatory diseases encompass a spectrum of conditions, including acute and chronic rhinitis, acute and chronic sinusitis, and specific subtypes such as allergic rhinitis and drug-induced rhinitis. Epidemiological data suggest that the prevalence of these conditions varies significantly, with rhinitis affecting 10% to 40% and sinusitis affecting 5% to 15% of the population across different regions (1, 2). These diseases are frequently associated with symptoms such as nasal obstruction, rhinorrhea, and cephalalgia, which profoundly impact patients' quality of life.

Nasal irrigation is a critical adjunctive therapy for nasal inflammatory diseases. Both the EPOS2020 and Rhinitis 2020 guidelines recommend its use in the management of various forms of rhinitis and sinusitis in adults and children (1, 2). Similarly, the 2018 Chinese guideline for chronic sinusitis endorses nasal saline irrigation as an adjunctive treatment for chronic and refractory sinusitis across all age groups (3). As a safe and feasible intervention, nasal irrigation is widely utilized both pre- and post-operatively in endoscopic sinus surgery. It functions by eliminating nasal and sinus secretions, crusts, antigens, biofilms, and inflammatory mediators, thereby enhancing mucociliary clearance and significantly alleviating nasal symptoms. These effects collectively contribute to improved patient quality of life (4, 5).

Despite extensive guidelines and consensuses underscoring the importance of nasal irrigation in managing nasal inflammatory diseases, healthcare professionals often regard it as a simplistic intervention, delegating its execution entirely to patients. Currently, there is a lack of standardized nursing protocols for nasal irrigation, and minimal effort is devoted to educating patients about its principles, procedural techniques, and precautions. As a result, it remains uncertain whether patients perform nasal irrigation correctly, possess confidence in the treatment, or implement it effectively. To date, few studies have explored the knowledge, attitudes, and practice of patients with sinonasal inflammatory diseases regarding nasal irrigation, despite the close relationship between these factors and the therapeutic efficacy of the intervention (6). The evidence suggests that when patients receive adequate education about nasal irrigation, their attitudes toward the treatment improve, leading to more thorough implementation and, consequently, better clinical outcomes (7).

Currently, there is no consensus regarding key parameters of nasal irrigation, including solute, solvent, volume, pressure, frequency, posture, and device selection. Nevertheless, several studies have reviewed and summarized the existing evidence on nasal irrigation techniques (4, 8). Building on these reviews, this study aims to develop a self-designed questionnaire to assess the knowledge, attitudes, and practice of nasal irrigation among patients with nasal inflammatory diseases. By evaluating the current implementation of nasal irrigation in this patient population, the study seeks to optimize patient education and clinical management, ultimately enhancing therapeutic outcomes for nasal inflammatory diseases.

This study is a cross-sectional investigation involving patients diagnosed with nasal inflammatory diseases, including acute(˂12 weeks) and chronic(≥12 weeks) rhinosinusitis(inflammation of the nose and/or paranasal sinuses) (1). Participants were recruited from the Department of Otolaryngology at Mianyang Central Hospital between March 15, 2025 and May 31, 2025. During their hospital stay or follow-up visits post-discharge, patients completed an anonymous, paper-based questionnaire. The study was reviewed and approved by the Ethics Committee of Mianyang Central Hospital (No. S20250337-01). All procedures in this study were conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Prior to participation, written informed consent was obtained from all participants.

This study employed a cross-sectional survey to analyze the knowledge, attitudes, and practice of nasal irrigation among patients with rhinosinusitis admitted to a tertiary hospital. This study aimed to explore the awareness and practice of nasal irrigation from the perspective of patients with rhinosinusitis, a topic that, to our knowledge, has not been previously investigated on the basis of a review of the literature.

With respect to knowledge about nasal irrigation, patients demonstrated a relatively good understanding of whether solutes can be freely added to the nasal irrigation solution and the recommended treatment duration. However, significant knowledge gaps have been identified in several areas, including the optimal concentration and temperature of the irrigation solution, the target populations and indications for nasal irrigation, the distinctions between manual and electric irrigation devices, and the differences between nasal irrigation and nasal sprays.

The optimal concentration of nasal irrigation solution remains a subject of debate, posing significant challenges for patients seeking effective management. Previous studies have employed saline solutions of varying concentrations, with some utilizing sodium lactate Ringer's solution. Both hypertonic and isotonic saline solutions are commonly used in clinical practice, as supported by the literature. While hypertonic saline may offer advantages in relieving symptom and enhancing ciliary motility, no significant differences have been observed in imaging outcomes or olfactory improvement. Consequently, the most effective concentration for nasal irrigation remains undetermined (9–12). Further complicating this issue is the availability of hypertonic solutions with varying concentrations on the market, raising questions about the need for a standardized hypertonic concentration (13). Patients, particularly elderly patients, often lack sufficient knowledge regarding the appropriate concentration of nasal irrigation solutions. This has led to the misconception that any saline solution is suitable for nasal irrigation. In clinical practice, we have observed instances where patients prepare homemade saline solutions using table salt, which may result in inconsistent concentrations and potentially compromise nasal function.

The temperature of the irrigation solution is a critical factor in ensuring patient comfort and safety. To minimize nasal mucosal irritation or bleeding, solutions close to body temperature are recommended (14). While some studies suggest that premade irrigation solutions can be refrigerated for up to 12 days without an increased risk of cross-contamination (15), evidence regarding the optimal expiration date for nasal irrigation solutions remains limited, and no consensus has been established. Given the potential for bacterial growth, it is advisable to use prepared nasal irrigation solutions promptly. Some studies recommend that solutions be used within 24 h to maintain hygiene and reduce the risk of contamination (9, 14).

Manual (e.g., squeeze bottles or bulb syringes) and electric (e.g., powered irrigation) devices, despite differing in their power mechanisms, are both classified as high-flow, high-pressure systems. These devices facilitate thorough nasal cavity cleansing, making them particularly suitable for patients with chronic sinusitis who present with significant nasal secretions and crusts (9, 16). Recent advancements in nasal irrigation devices have focused on enhancing irrigation efficacy, yet all of these advancements remain grounded in the high-flow, high-pressure principle (17). In contrast, nasal sprays operate as low-volume, high-pressure devices, primarily designed for daily nasal moisturization. They are less effective at removing nasal secretions, crusts, and inflammatory mediators and are incapable of achieving the deep cleansing and sinus penetration provided by nasal irrigation systems. Consequently, nasal sprays are fundamentally distinct from nasal irrigation devices in both function and clinical application (18). The distinctions between manual and electric irrigation devices, as well as between nasal irrigation and nasal sprays, are critical for patients when selecting appropriate nasal care products. For example, relying solely on nasal sprays for post sinusitis surgical care is insufficient.

The survey data in the present study underscore the need for enhanced patient education regarding nasal irrigation, particularly concerning the solution concentration, temperature, and shelf-life. Additionally, tailored guidance should be provided to patients on the basis of their specific disease conditions to ensure optimal adjuvant treatment outcomes. Nasal irrigation is a safe and versatile intervention suitable for a broad range of demographics, including infants, children, and pregnant women (19, 20). By communicating with patients about the safety and applicability of nasal irrigation across these populations, clinicians can bolster patient confidence, improve treatment compliance, and enhance therapeutic efficacy.

This study revealed that patient age and reading frequency significantly influence patients' understanding of nasal irrigation practice. Age has a broad impact, affecting knowledge across multiple domains, including solute composition, solution temperature, irrigation frequency, treatment duration, target populations, and distinctions between electric and manual irrigation devices, as well as between nasal irrigation and nasal sprays. Patients aged 50 years and above demonstrated significantly lower correct-answer rates on some topics, likely attributable to age-related declines in cognitive and comprehension abilities, as well as limited access to knowledge and information sources. Furthermore, patients with higher reading frequencies exhibited better comprehension of key aspects of nasal irrigation, such as the optimal irrigation frequency and appropriate clinical indications. These findings underscore the need for targeted educational interventions, particularly for elderly patients and those with less reading engagement. To enhance accessibility and engagement, educational materials should incorporate visual aids, such as illustrations or videos, and minimize text-heavy content, thereby making the information more intuitive and easier to understand.

This study revealed that patients exhibit a high level of confidence in the safety of nasal irrigation, with 88.7% recognizing it as a safe intervention. Additionally, the majority of patients (92.6%) acknowledged its importance in the management of rhinosinusitis, and 79.0% believed that it contributed to their recovery. However, only 58.4% expressed confidence in its efficacy as a standalone treatment for rhinosinusitis. This discrepancy may reflect patient perceptions that, while nasal irrigation is a valuable adjunct to rhinosinusitis treatment, it is insufficient as a sole therapeutic modality.

Nasal irrigation is widely adopted among patients with nasal inflammatory diseases, with a utilization rate of 80.4%. This high adoption rate is largely driven by recommendations from healthcare providers during hospitalization or follow-up visits. Furthermore, the majority of these patients in the present study have undergone surgical interventions, which contributes to their high compliance with nasal irrigation practice. Overall, nasal irrigation is considered easy to perform, as 94.1% of patients reported being able to complete the procedure independently. Although 28.6% of patients experienced discomfort during nasal irrigation, 94.6% found it tolerable. Notably, only 28.4% of patients discontinued irrigation after experiencing discomfort, whereas approximately two-thirds (69.6%) chose to continue or delay the procedure. These findings underscore the high safety and tolerability of nasal irrigation as a therapeutic intervention. Age-related differences were also observed. A greater proportion of patients under 50 years of age reported that nasal irrigation alleviated their discomfort. In contrast, patients aged 50 years and above were more likely to continue irrigation despite discomfort, potentially reflecting their greater resilience, which may be attributed to more challenging life experiences.

In this study, patients primarily obtained information about nasal irrigation from hospitals, with a relatively low proportion relying on the internet, literature or acquaintances. Similarly, hospitals were the main resource for resolving irrigation-related issues, highlighting the central role of healthcare providers in patient education regarding nasal irrigation in Southwest China. Evidence-based nursing programs have been shown to improve the efficacy of nasal irrigation in chronic sinusitis patients following functional endoscopic sinus surgery, leading to significant improvements in symptoms, CT scores, nasal endoscopy scores, and overall quality of life (21). These findings underscore the importance of providing patients with scientifically validated, evidence-based clinical guidance on nasal irrigation practice.

Younger patients and those with higher educational levels demonstrated greater independence in accessing information, often utilizing the internet or books rather than relying solely on hospitals. For this demographic, educational outreach should extend beyond hospital settings to include traditional media (e.g., books, newspapers, television, radio) and new media platforms (e.g., social media, self-published content) to broaden the reach of nasal irrigation knowledge. In contrast, older patients and those educated less may benefit more from concise, easily accessible educational materials available through hospital platforms, such as posters and instructional videos. Tailoring educational strategies to address the specific needs and preferences of different patient groups can enhance the effectiveness of nasal irrigation practice and improve clinical outcomes.

This study has several limitations. First, as a pilot study designed to identify key areas for subsequent clinical work and public education, the sample size was relatively small. Future studies should aim to include a more diverse population, encompassing individuals of varying ages and educational backgrounds. The current study included a limited representation of children and highly educated individuals, potentially omitting some critical issues. For pediatric populations, a more tailored questionnaire—such as one assessing children's resistance to nasal irrigation, which is completed by parents—could be developed to design more acceptable nasal irrigation protocols (22). Additionally, this study was conducted at a tertiary hospital in Southwest China. While tertiary hospitals serve a large and diverse patient population, regional disparities exist between Southwest China and coastal areas. Variations in educational levels and access to information between these regions could influence patient knowledge and practice related to nasal irrigation. Therefore, caution should be exercised when extrapolating these results to other settings. To address these limitations, future research should involve large-scale, multicenter surveys across diverse geographic regions. Furthermore, the differences between age groups observed in this study resulted from an exploratory subgroup analysis. The rationale for this dichotomization requires further validation in prospective studies. Such efforts would enhance the robustness and applicability of the findings, providing a more comprehensive understanding of nasal irrigation practice and their implications for patient care.

This study evaluated the attitudes, knowledge, and practice of nasal irrigation among patients with nasal inflammatory diseases who were undergoing or had undergone inpatient treatment at a tertiary hospital. The findings revealed that patients held a highly positive attitude toward the safety and efficacy of nasal irrigation. The practice rate of nasal irrigation was high, with most patients able to perform the procedure independently. Hospitals and healthcare providers were the primary sources of information for patients regarding nasal irrigation.

However, patients demonstrated a low level of knowledge about key aspects of nasal irrigation, including the solution concentration, temperature, shelf life, target populations, clinical indications, and differences between irrigation devices. Patient age, educational level, and reading frequency significantly influence patient knowledge, attitudes, practice, and information acquisition related to nasal irrigation.

These findings highlight the need for more comprehensive, accessible, and diverse educational initiatives and clinical guidance to improve patients' understanding of nasal irrigation. By enhancing science popularization efforts, patients with nasal inflammatory diseases can achieve better treatment outcomes and optimize the therapeutic benefits of nasal irrigation.