NASAL SPRAY INSTRUCTIONS

FOR WET/AQUEOUS NASAL SPRAYS (medications) (see below for nasal saline washes)

  1. Remove the top plastic dust cap. The first time the spray is used, prime the spray by firmly pumping several times until a fine spray appears.
  2. Gently blow your nose to clear your nostrils if necessary.
  3. Look directly down at the floor in a sitting or standing position.
  4. Carefully insert the nasal applicator nozzle into one nostril, pointing the tip directly upward. The tip of the spray should be aimed towards the back of the head, and not directed at the side or middle of the nose.
  5. Spray one or two sprays into the first nostril. You may sniff lightly after each spray to prevent the spray from dripping out the front of the nose. Do not sniff too hard as you will then swallow the spray.
  6. Immediately after spraying into the nostril, tilt your head to the same side that you administered the nose spray. Your head should be perfectly sideways as if you had your ear on a table. This will allow the nose spray to soak into the side of the nose where swelling often occurs. The sinuses and the ear tube also open into the side of the nose.
  7. Keep your head tilted to the side for a minimum of 15 seconds, or up to 1 minute if your ears or sinuses are involved.
  8. Repeat the same procedure for the other nostril.

FOR YOUNG CHILDREN

A. Do not sniff after administering the nose spray.

B. After spraying into the nostril, immediately lie their head on a pillow for 30 seconds.

Ensure the pillow is the correct height so their head is lying truly flat on the same

side just sprayed into.

Note: most nasal sprays now used for allergic rhinitis-sinusitis contain a corticosteroid (anti-inflammatory). There is a theoretical risk that the nose spray can travel back up the tear duct into the eye. Corticosteroids in the eye can exacerbate glaucoma, cataract, and chronic viral infections in the cornea. A patient with any of these conditions who is using a topical nasal corticosteroid preparation, should have their eyes followed closely by their opthalmologist/optometrist.

Please look at the picture showing the anatomy of the nose (ANATOMY section). Note, that when using "standard" spray techniques the spray hits the front of the turbinates, drips to the floor of the nose, then goes into the throat and is swallowed. We are not treating the stomach! If you carefully follow the directions above the nose spray will soak into the true side of the nose and the sinus and ear (eustachian) tube openings. It is critical that your head is put truly sideways and kept there for 30 seconds. I often ask patients to lay their head flat (on the ear) on the kitchen table to ensure the spray goes where it is supposed to. Please look at the picture of the head turned sideways to see how the spray will drain into the true side of the nose and sinus and eustachian tube ostia (openings), reduce the inflammatory swelling and keep the sinus and eustachian ostia open.

 

NASAL SALINE WASHES

There are many commercial nasal saline preparations available. For very young children a nasal saline spray is appropriate and for all other individuals a nasal wash such as NetiPot TM (a gentle rinse technique) or Sinus Rinse TM (a more forceful flush technique particularly good for sinus problems) are appropriate. All of these preparations have a small amount of salt in the water solution. They cleanse the nose (of irritants such as smoke-dust and allergens), wash out excessive mucus, and help keep the sinus ostia open. These saline washes are completely safe as they contain no medication and do not significantly irritate the lining of the nose. These preparations are particularly useful if your nose is excessively dry, if the nose is carrying a large load of irritants or allergens, or if the nasal mucus is thick-tenacious. They are usually used twice-daily and can safely be used more frequently for acute nasal-sinus problems. I have some patients who find they can control all their nasal symptoms simply by using a saline nasal solution, but most allergy patients require an anti-inflammatory nasal spray. There have been studies done that show using a saline nasal solution followed by a nasal anti-inflammatory spray (the standard treatment for nasal allergy) can be more effective than either alone. A word of caution-the saline solution must be used prior to the nasal anti-inflammatory as the reverse would wash your medication away. I think it is very worthwhile for any individual with nasal allergy-sinus problems to try a nasal saline solution. These products come with specific instructions and can be obtained over-the-counter at most drugstores. You can make up your own saline solution with ordinary table salt and tap water ( tsp to tsp salt for 8 oz. water). If you have any difficulty with these solutions please contact me and I can give you a few pointers-tricks on how to use more effectively.

Dr. Bruce Sweet 2009