Comparison of the distribution of intranasal steroid spray using different application techniques.
Optimizing the intranasal distribution of nasal steroid spray (NS) is important in managing patients with allergic rhinitis (AR). Using a 3-dimensional computational model of the human nose, we found that inspiratory airflow improved particle distribution by 86%. We hence designed a study to determine if the intranasal distribution of NS is improved by (1) simultaneous gentle inspiration or (2) nasal decongestion.



Twenty patients with AR were recruited. Colored triamcinolone nasal spray Nasacort®, was applied to 1 side of the nasal cavity with simultaneous gentle inspiration (technique1) and the other side with no inhalation (technique 2). Flexible nasoendoscopy with video documentation was performed immediately after each application. The same procedures were repeated 30 minutes after nasal decongestion. The nasal cavity was divided into 10 different regions and presence of the colored medication in each region was given 1 point.



Prior to decongestion, the mean total score was significantly higher using technique 1 (4.61 ± 0.25) compared to technique 2 (3.80 ± 0.24), (p = 0.03). Following decongestion, the mean total score for techniques 1 and 2 was (5.20 ± 0.40) and (4.30 ± 0.32), respectively. The differences in total score for both techniques before and after decongestant were not significant.



The presence of inspiratory airflow, using the gentle inspiration technique, improves the intranasal distribution of NS in patients with AR. The use of correct technique is more important than nasal decongestion in the distribution of nasal spray particles.
Department of Otolaryngology-Head and Neck Surgery, National University Hospital System (NUHS), Singapore. sok_yan_tay@nuhs.edu.sg.
Sok Yan
SY
Tay
Department of Otolaryngology-Head and Neck Surgery, National University Hospital System (NUHS), Singapore.
Siew Shuen
SS
Chao
Department of Otolaryngology-Head and Neck Surgery, National University Hospital System (NUHS), Singapore.
Kim Thye Thong
KT
Mark
Department of Otolaryngology-Head and Neck Surgery, National University Hospital System (NUHS), Singapore.
De Yun
Y
Wang
D000281:Administration, Intranasal / Q000379:methods*; D000328:Adult; D000336:Aerosols; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004338:Drug Combinations; D004724:Endoscopy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D014663:Nasal Decongestants / Q000627:therapeutic use; D010656:Phenylephrine / Q000627:therapeutic use; D065631:Rhinitis, Allergic / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D016037:Single-Blind Method; D014221:Triamcinolone / Q000008:administration & dosage* / Q000627:therapeutic use; D020535:Video-Assisted Surgery; D055815:Young Adult
D000336:Aerosols; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D014663:Nasal Decongestants; C546419:phenylephrine, lidocaine drug combination; D010656:Phenylephrine; D014221:Triamcinolone; D008012:Lidocaine
CFD; allergic rhinitis; computational fluid dynamics; nasal airflow dynamics; rhinosinusitis; steroid therapy