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.

Instillation of Nasal Drops

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.

The ostio-meatal complex lies between the middle and inferior turbinates, in 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 consist of 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 often 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 being 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 “over” 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 cold 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.