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Vincent Cumberworth BSc FRCS Consultant Ear,
Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872
3861
Information is supplied only upon the condition that the viewer
will make their own determination as to the suitability of the
information for its purposes prior to use. There will be no
responsibility for information that is misused or misinterpreted and
the information should not be used as a substitute for consultation
with a health care professional. It is not possible to answer
questions regarding individual cases or to enter into individual
correspondence.
HOW TO INSTIL NASAL DROPS
The ostio-meatal complex lies between the middle and inferior
turbinates ie. the middle meatus and includes the ostium of the
maxillary sinus. This area drains by ciliary activity, the maxillary
sinus, the anterior ethmoids and the frontal sinus. These three
paranasal sinuses are most commonly affected by disease. Swelling of
the mucosa in this area, whether due to allergy, infection or other
factors, will result in blockage and obstruction, preventing
aeration and drainage. Nasal polyps, which are prolapsed swollen
mucosa, also arise predominantly from the anterior ethmoids and
protrude down through the middle meatus to obstruct the nose.
Topical medication, decongestants or steroids, must reach the
ostium-meatal complex in order to be effective. Patients prescribed
nose drops will invariably instil these while standing or sitting
with the head back resulting in the drops passing immediately along
the floor of the nose to the post-nasal space and then swallowed.
Nasal sprays may be more effective but if there is obstruction of
the ostio-meatal complex, the most effective method of application
is to instil nose drops in the head down and forwards position to
allow these to run into the middle meatus and the anterior ethmoids.
Patients may lie down on a bed with the head forwards or kneel with
the head between their knees (the “Mecca” position) but most will
find it easier to instil drops lying on their back with their head
well extended, applying 2 drops to each nostril. The patient is then
instructed to turn over immediately into the prone position with
their head well forwards and downwards and remain in this position
for two minutes. This can be repeated twice daily. There has been
criticism that it is difficult to judge the number of drops used,
particularly with the present plastic squeeze bottles, which are
provided. This can be overcome to some extent by keeping the
medication in the refrigerator as the cost drops entering the nose
are more easily perceived. Alternatively, while lying supine with
the head back, the drops can be instilled by an assistant.
Betamethasone drops used in this way can be extremely effective in
the management of rhinosinusiitis and nasal polyposis. Short-term
use of decongestants may be similarly applied for the management of
upper respiratory tract infections.
© Vincent Cumberworth 2005
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