Comparison of the distribution of intranasal steroid spray using different application techniques

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.