Nasal Sprays: Proper Technique…Again


You meet a lot of interesting people in a medical practice.  Once in a while you’ll come across someone who utterly defies the rules of logic and common sense.  I’ve written previously about (Nasal Sprays—Proper Technique.   Indeed, there are right and wrong ways to use a nasal spray, contrary to conventional wisdom, and I’ve advised countless patients on the proper method.   I believed the instructions were simple enough, but Heavens-to-Betsy there arises that rare breed who entirely miss the boat.

To reiterate the technique: your right hand sprays the left nostril, the left hand sprays the right.  Aim towards the lateral canthus our outer part of the eye.  The goal is to apply the spray to the intended target--the lateral side of the nose containing the natural openings into the paranasal sinuses and the turbinates, structures designed to increase the surface area of the mucosa (the moist, pink lining tissue).  I’ve seen a few patients who’d apply the spray right onto the nasal septum (the midline partition of the nose; for more on the nasal septum click here), causing septal ulcerations or a perforation (a hole) through it.  This only leads to a host of other problems.

The natural tendency is to use the dominant hand to spray each side of the nose (Figure 1).  For instance, a right-handed person would naturally use their right hand to spray both sides of the nose.  However, when the spray is delivered to the right side, it’s often angled incorrectly towards the septum.  When the right hand sprays the left side, it is delivered correctly.  Using the same hand in essence works optimally for only one side of the nose.  The opposite holds true for left-handers.

Figure 1

I found myself re-explaining the use of a nasal spray when one gentleman came in for follow up.  He said the spray was barely working.  I asked about the opposite-hands-thing and he confirmed this.  He demonstrated the technique.  He used his left hand to apply the spray to his right nose correctly as discussed before, but alas!  He unnaturally contorted his wrist, bending his hand another 90 degrees to angle the nozzle towards the center of his face to apply the spray right onto the nasal septum!  The drawing in the title picture captures this.

“Oh no!” I freaked out.  Did I bungle the instructions so badly to misguide this poor guy?

I thought my usual verbal, visual and written instructions were clear, but obviously I erred in my thinking.  I re-demonstrated again the proper use, the same way I’ve done for countless others ad infinitum.  A light-bulb must’ve illuminated above his head, like a cartoon bubble, for his face expressed an “aha!” moment of enlightenment.

“Oh, I get it doc!”  He laughed.  On a subsequent follow-up, he expressed the spray worked wonderfully.

(Sigh)  So here is the message again, demonstrated with a nifty picture:

They say a picture’s worth a 1,000 words, so please don’t screw this up and give yourself an irritating septal ulceration or nasty perforation.  Say, I’ll write a future post on nasal septal perforations.  See you then!

©Randall S. Fong, M.D.

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