Position-Guided Nasopharyngeal Irrigation for Post-Radiotherapy Ulcer Care in Nasopharyngeal Carcinoma

To describe and standardize a position-guided nasopharyngeal irrigation protocol for post-radiotherapy nasopharyngeal ulceration (RINU) in patients with nasopharyngeal carcinoma (NPC), a prospective comparative clinical setting was used among 184 patients diagnosed with RINU between January and March 2025. Participants were randomly assigned to receive either routine manual irrigation (n = 92) or irrigation using an improved position-guided device (n = 92). The protocol incorporates an anatomically guided, double-lumen catheter with a direction-controlled tip, an adjustable outer sheath, and a low-pressure manual pump system operating at 50-100 mmHg, enabling controlled saline delivery with simultaneous drainage. Core procedural elements include catheter positioning relative to the nasopharyngeal vault, regulation of irrigation pressure and flow, sequencing of irrigation cycles, and management of continuous outflow to minimize fluid retention. The protocol was applied in a clinical setting with evaluations performed at baseline, 1 month, and 2 month using standardized endoscopic grading of mucosal injury, assessment of secretion viscosity, bacterial culture testing, pain measured by the visual analog scale (VAS), and comfort assessed by the General Comfort Questionnaire (GCQ). Baseline demographic and clinical characteristics were comparable between groups. During follow-up, differences were observed between groups in mucosal healing status, secretion characteristics, microbiological findings, and patient-reported symptom measures, with statistically significant between-group differences across endpoints (all p < 0.05). Endoscopic examinations documented granulation and epithelialization patterns over time, and no severe adverse events were observed during protocol application. This protocol describes a reproducible, standardized framework for position-guided nasopharyngeal irrigation in the post-radiotherapy management of RINU.