Release: May 12, 2000
Contact: Kenneth Satterfield, 407-238-4161 (as of 5/12/2000)
Applying Steroids to Nasal Passages Proves Effective in Reducing Symptoms Associated with Secondary Sinusitis
Orlando, FL -- Intranasal steroid sprays have been used effectively for the treatment of chronic rhinosinusitis for over 20 years. Their action relies upon the inhibition of a number of nasal responses including basophil migration and mucosal sensitivity to histamine. By inhibiting the migration of inflammatory cells, the release of inflammatory mediators is decreased. This results in a reduction of nasal mucosal inflammation, which may reduce symptoms such as sneezing, rhinorrhea, nasal congestion, and secondary sinusitis due to ostial obstruction.
A new prospective study examined patients who regularly use a topical nasal steroid spray to determine the medication on the nasal mucosa. Participants in the study were given a sample bottle of an aqueous steroid nasal spray that had been colored with a non-toxic food dye, and were instructed to use the spray in their usual manner. Bilateral anterior rhinoscopy and fiberoptic nasal endoscopy were performed after application of the spray to determine its location on the nasal mucosa The intranasal examination was repeated after 15 minutes to allow for redistribution of the medication by mucociliary transport. Findings were recorded after each examination and are discussed along with potential clinical implications.
The authors of the study, "Effective Application of Nasal Steroid Spray in Common Practice," are Richard A. Lebowitz, MD, Suzanne K. Doud Galli, MD., PhD, and Renato Giacchi, MD, all from the Department of Otolaryngology, New York University, New York City, NY. Their findings were presented before the American Rhinologic Society, meeting May 15-16, in Orlando, FL.
Methodology: Fifteen who regularly use an aqueous nasal steroid spray were recruited into this prospective study. Patients with nasal polyps or a history of prior nasal or sinus surgery were excluded.
The study population consisted of 11 females and four males patients with a mean age of 42.7 years (range 35-62 years). Patients were asked the length of time they had been using a nasal steroid spray, and whether they are right or left handed. A standard non-aerosol metered dose pump containing 10g (40 metered doses) of an aqueous steroid spray was dyed with 0.1 cc of blue vegetable coloring.. After priming the spray bottle, patients were asked to introduce two sprays of the dyed medication into each nostril in their usual manner. Immediately after using the spray, patients underwent bilateral anterior rhinoscopy and fiberoptic nasal endoscopy to determine the location of the spray on the nasal mucosa. The intranasal examination was repeated after 15 minutes to allow for redistribution by mucociliary transport. After each examination, the location of the dyed spray on the nasal mucosa at the following anatomic sites was recorded: nasal vestibule; anterior tip of the inferior turbinate; caudal, mid and posterior nasal septum, middle turbinate, middle meatus, nasal floor and nasopharynx. The amount of medication visible at each site was recorded by researchers as none or small to moderate.
Results: Key findings of the study are:
* All 15 patients had medication visible on a nasal examination immediately after application of the medication and upon reexamination after 15 minutes. There was no difference in the pattern of spray application between the right and left sides. Three (20 percent) patients were left hand dominant, and 12 (80 percent) were right-handed; six patients (40 percent) switched hands when using the spray on either side. The average length of time that patients had been using a steroid nasal spray was greater than nine months. However, a number of patients stated that they use the spray periodically making an accurate determination of use difficult.
* In all patients, the nasal vestibule was the site of maximal application of steroid spray
(average 1.6, on the scale from 0 to 2). The anterior tip of the inferior turbinate and the anterior nasal septum were the mucosal surfaces with the greatest amount of visible medication following application (average 1.4, and 1.2 respectively). The other sites, in decreasing order of quantity of visible medication, were the nasal floor (average 1.0), mid nasal septum (average 0.8), and middle turbinate (average 0.6).
* In no case was there visible spray in the middle meatus or the nasopharynx immediately following its application. Active redistribution of the medication by mucociliary transport resulted in a 50 percent reduction in the average score at all sites except the nasal vestibule at 15 minutes after application. The highest concentration of medication at the time of reexamination was in the nasopharynx (average 1.4), where initially none was visible.
Conclusions: Several definite patterns were observed. There is equivalent distribution of the nasal spray in both nostrils regardless of which hand was used, and which is the patient's dominant hand. Most of the medication is applied anteriorly to the vestibule, anterior septum, and anterior tip of the inferior turbinate. There is active redistribution of the medication by mucociliary transport, consistent with the known patterns of mucociliary clearance. Direct or secondary application of the medication to the middle meatus does not occur. Further studies will help to determine the effects of factors such as surgery, and polyps on the distribution and efficacy of topical nasal steroid spray.
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