Sinonasal Distribution of Nasal Drops and Spray according to Head Positions

Roh, Hwan Jung; Kim, Tae Won; Lee, Jeong Hoon; Lee, Hyun Sun; Goh, Eui Kyung; Wang, Soo Geun

Abstract

BACKGROUND AND OBJECTIVES
This study was designed to compare sinonasal distribution of topical nasal drops and spray according to head positions and to suggest optimal head position for effective topical delivery. SUBJECTS AND METHODS: The study group included five healthy subjects (normal group) and five patients who had got endoscopic sinus surgery (ESS group). A visual assessment of the intranasal distribution of nasal drops and spray was made using Fluorescein Blue Filter System after instillation of TobraDex(R) drops and Nasonex(R) dyed with 0.2% fluorescein. Each group took five kinds of head position for nasal drops and two for nasal spray. RESULTS: Drops instilled with head back position were found along the nasal floor, and drops with Mecca position and vertex to ground position were found in the olfactory cleft in both groups. Drops instilled in Mygind position and Ragan position were found in the middle meatus and head of the middle turbinate in the normal group, and in the middle meatus, ethmoidectomized cavity, and maxillary sinus in the ESS group. The head neutral position showed effective distribution to the septum, lateral nasal wall, and middle turbinate in the normal group, and in the ethmoidectomized cavity in the ESS group, compared to the head forward position which distributed the drops lower depending portion. CONCLUSION: These results suggest that, for the effective delivery of nasal drops, Mecca position and vertex to ground position are recommended to the olfactory cleft, and Mygind position and Ragan position are proposed to the middle meatal region in non-surgery patients and ethmoidectomized cavity and maxillary sinus in post-ESS patients. Head neutral position is recommendable for effective delivery of nasal spray compared to head forward position regardless of ESS.