General Tips Sinuses

  • Always carry tissues with you
  • Dispose tissue and wipe surfaces when necessary.
  • Avoid crowded areas
  • Avoid smoky or heavily polluted irritant areas
  • Drink plenty of water (avoid coffee, tea, fizzy drinks, alcohol drinks) to prevent dehydration.
  • Drink plenty of warm drinks and fluids if appropriate.
    (Steam helps to unlock nose)
  • Keep your room well ventilated. Keep window open for air circulation
  • Nasal douching: sniffing a solution to help unblock one’s nose.
    • One teaspoon of salt and one teaspoon of sodium bicarbonate in a pint of water (that has been boiled and cooled to room temperature) to each nostril from a cupped handle allowing it to go down the back of your throat and spitting it out.
    • Not all the mixture should be used, four sniffs two to three times daily.
    • Do douching before if using nasal drops/sprays.

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How to use:

Nasal drops

  • To lie on their back with the head just off the bed and tilted so the chin is highest point of the head.
  • Patients should breathe normally through the mouth while instilling the prescribed number of drops into each nostril (see Image 2). Administration of drops while sitting or standing with the head tilted backwards causes more solution to pass down the back of the throat;
  • To hold this position for two minutes after drop instillation. This enables the steroid to reach the region where polyps arise and reduce inflammation where the sinuses open into the nasal cavity;
  • If multi-dose, manufacturers recommend that the dropper should be cleaned by wiping the nozzle with a clean tissue before replacing the cap.
  • It is important to understand that nasal sprays and drops are not always effective at reaching the sinuses, even post-surgery, and this has lead some rhinologists to advise combining nasal drops with saline irrigation.
  • It is the larger volume that improves penetration to the sinuses.
Image 2: Self-administration of nasal drops

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Using nose drops . Kernow Clinical Commissioning Group. 2021.

https://rms.kernowccg.nhs.uk/content/files/

Using%20nose%20drops%20and%20sprays.

pdf(accessed Oct 2021).

Fluticasone nasal spray and drops. NHS. 2020.
(accessed Oct 2021).
Merkus P, Ebbens F, Muller B, et al.
The ‘best method’ of topical nasal drug delivery: comparison of seven techniques.
Rhinology 2006;44:102–7.

 

Nasal irrigation

  • That if they are also using intranasal medication, this should be used after nasal irrigation. This is because the medication will have better distribution and efficacy;
  • To stand in front of a basin, tilt the head away from the bottle, and squirt the solution into each nostril, aiming the stream toward the back of the head, not the top (see Image 7). The solution may flow into one nostril and out the other (see Image 8);
  • To avoid breathing through the nose while preforming irrigation, as this can introduce water into the ear canal potentially leading to infection;
  • Sometimes a burning sensation in the nasal cavity occurs particularly if a non-buffered hyper or hypotonic irrigation solution is used; however, most patients seem to adapt to this.
  • Where possible, the use of pre-mixed irrigation solutions and sterile water should be used to reduce the risk of infection.

 

 

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Image 8: Avoid breathing through the nose while performing irrigation

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Principi N, Esposito S. Nasal Irrigation:

An Imprecisely Defined Medical Procedure.

IJERPH 2017;14:516. doi:10.3390/ijerph14050516

How to perform nasal irrigation. UpToDate. 2021.

https://www.uptodate.com/contents/image?

imageKey=ALLRG%2F71059&topicKey=

PC%2F83012&source=see_link

(accessed Oct 2021).

Nasal sprays

  • To keep the head upright, insert nozzle tip into one nostril keeping the other nostril open;
  • Hold the bottle with the index and middle finger at the top and the thumb at the bottom;
  • To use their right hand to spray the left nostril and vice versa, so that the spray is directed away from the septum (see Image 1). Holding the spray with the same hand as the nostril (e.g. right hand for right nostril) increases the risk of nasal irritation and bleeding since this directs the spray towards the nasal septum​[18]​;
  • That sprays should be administered while they slowly breathe in through their nose. After removing the nozzle, they should breathe out through the mouth;
  • To repeat for the other nostril before cleaning the nozzle and replacing the cap.

Other considerations

  • Overuse of some nasal sprays, such as decongestants, should be avoided as this can lead to rebound congestion (rhinitis medicomentosa), where tissue swelling worsens each time the nasal spray is stopped​[22]​. This creates a cycle of continued use.
Image 1: Self-administration of nasal spray

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Benninger MS, Hadley JA, Osguthorpe JD, et al. Techniques of Intranasal Steroid Use.
Otolaryngol Head Neck Surg 2004;130:5–24. doi:10.1016/j.otohns.2003.10.007
Menditto E, Costa E, Midão L, et al.
Adherence to treatment in allergic rhinitis using mobile technology.
The MASK   Study. Clin Exp Allergy 2019;49:442–60. doi:10.1111/cea.13333
Scadding GK, Kariyawasam HH, Scadding G, et al.
BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis
(Revised Edition 2017; First edition 2007).
Clin Exp Allergy 2017;47:856–89. doi:10.1111/cea.12953
By Wendy K Smith & Azhar M.Z. Hasham
The Pharmaceutical Journal, PJ, October 2021,
Vol 307, No 7954;307(7954)::DOI:10.1211/PJ.2021.1.105205