Ever notice the different nasal sprays out there? You’re probably using one or two of these. What once were obtained only by prescription
are now available over-the-counter (OTC).
There are also several prescriptions nasal sprays. Often when patients present for nasal
problems, I ask if they’ve been treated with any nasal sprays. Some have been but many times they don’t
recall the name or type of spray, simply stating, “ah you know, the stuff you
get from the store.”
Now there’s a lot of “stuff” out there to spray into your
nose, legal and illegal. So as docs, we
always like specifics. It kinda-sorta
helps.
First of all, let’s talk about proper application of a nasal
spray.
In order to avoid a long and wordy post and yawn-provoking,
not-so-fun boredom, we’ll break this topic into several bite-sized posts. We’ll eventually cover the mechanisms of
action and indications for the variety of nasal sprays in the future, but first
let’s go over proper use. Notice the
title picture above. You see how she’s
using the nasal spray? She’s using her RIGHT
hand to spray the LEFT side of her nose, pointing it slightly laterally to the
left side of her head. I usually
instruct patients to aim it to the outer corner of the opposite eye (the lateral
canthus). Vice versa for the right
side: use the left hand to spray the right side.
What gives? “The doc
is just trying to justify all his years of fancy education,” you’re probably saying
(out loud) to yourself. A spray is just a
spray as long as it gets up the nose.
There’s a rhyme and reason for this counter-intuitive
methodology, and it doesn’t require a fancy education to understand this. To explain the rationale, let’s cover a
little bit of nasal anatomy.
Figure 1 |
Let’s take a close-up view of the nose. Figure 2 is a cross-section of the nasal
passages inside your nose. Most of the
nasal volume is actually front and back (anterior to posterior, in medical
lingo) rather than straight up, as many people believe.
Notice the lateral structures on each side (towards the far
sides of the nasal passages). You’ll see
the turbinates. These structures,
particularly the inferior turbinates, have a pink mucosa covering a richly
vascular submucosa. This tissue provides
the sponginess to the tissues, allowing for humidification and warming the air
in the nose prior to its being received down the trachea and into the
lungs. Thus the mucosal secretes mucous
and fluid to provide moisture to the inhaled air. This also can be a source of problems. Also notice the middle meatus. This area underneath the middle turbinate
is the source of the ventilation and drainage of all of the sinuses except the
sphenoid sinus.
Thus, directing the spray to these lateral structures is
most optimal method of application: the spray is delivered to the most affected
mucosa and also to the middle meatus where most of the sinuses drain.
Notice the septum in the middle. This is the partition or wall the separates
the left and right sides of the nasal passages.
It has a thin lining of mucosa but is mostly bone and cartilage. It does not have the thick soft submucosa as
the turbinates and thus contributes little to congestion and secretion, so
delivery of a nasal spray to the septum is less critical. Given its thin mucosa, applying too much of a
spray to the septum can even be detrimental, causing bleeding and erosion of
the mucosa, sometimes leading to a septal perforation (hole in the
septum) which is undesirable. I’ve seen
patients create some doozies of septal perforations from improper nasals spray
use. Also, many times the septum is not
perfectly straight. This is called a septal
deviation, which can make the septum more prone to irritation from an improperly
used spray. So it’s even more important
to direct the nasal spray away from this structure.
Figure 3 is a side-view (sagittal view in medical
parlance) of the nasal passage. This
shows how the nasal spray should disperse into the nose. Each little circle in the drawing represents
a droplet of the nasal spray you’re using.
There are thousands of these little droplets entering your nose with one
application of the spray, so the illustration is an exaggeration of the droplet
size. And I wasn't about to draw thousands of tiny little droplets, since that would be ridiculously time consuming.
Figure 3 |
Remember: right hand sprays the left nostril, left hand sprays
the right. Aim towards the lateral
canthus. I’ve seen patients who’ve used nasal
sprays for a long time (even years) and when they’ve applied these instructions
(i.e., they listened to my advice), some of them are amazed the same nasal
spray they’ve been using forever-and-ever provides an even better result! So listen to your doc--for heavens-to-Betsy
you’ll find he/she is not so full of hot air after all.
We’ll talk about the different types of nasal sprays and their
indications. As for now…well, I’m a bit wiped
out, so I’m gonna take a nap.
©Randall S. Fong, M.D.
For more topics on medicine, health and the weirdness
of life in general, check out the rest of the blog site at randallfong.blogspot.com
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