My otorhinolaryngologist (hereafter "doc") prescribed Flonase spray. He explained that it should reduce my nasal congestion and retard the growth of polyps. I followed his advice and used this product, but I never noticed any benefit from it. Then a correspondent told me that his doc told him that there is a problem with the delivery system (a hand-actuated pump spray, hereafter "spray") for Flonase -- the active ingredient (fluticasone propionate, a steroid) is not delivered far enough up the nose to be effective against the sort of inflammation and polyps that he and I have. I assume that this product is effective for the sorts of nasal allergies that many people have (so called "hay fever"), because it sells well. I now use Nasacort, which I find more effective than Flonase.
Several correspondents have noted that the hand-pump sprays work better for them if they apply them after getting into a head-down position, better to allow gravity to bring the spray to where it is needed. One approach is to lie on the bed on one's back with the head hanging over the side of the bed and instill the steroid solution. Another approach is to get on your knees on the floor, spray your nostrils, and then assume the Mecca position (head down). For more details on this method of administering nasal steroids, please see Dr. Robert McGinnis' letter in the American Family Physician, 1997, Administering Topical Steroids in Sinusitis with Head Inverted, 56(5), 1301-1302. Elsewhere Dr. McGinnis explained how to do this with Flonase -- carefully open the bottle, being sure not to break it -- you don't want slivers of glass in the fluid. He suggested using a pair of wire cutters repeatedly to crease the metal collar until it releases. He then transfers the fluid into a different container and uses a TB or insulin syringe (without the needle) to administer the medicine as drops. This seems likes a technique that should approximate that provided by using Flixonase Nasules. Of course, you need to know what dose to use. Dr. McGinnis suggested doing a search (National Library of Medicine; Grateful Med; Medline) of the literature for the latest information on steroid drop treatment of nasal polyps and sinusitis (most of which will likely come from outside of the US) and then consulting with your personal physician. Dr. McGinnis does not have a doctor-patient relationship with me or with you (and I don't have one with you either), so anybody who wishes to use the head-inverted method of administering steroids is doing so at his or her own risk -- that is, Dr. McGinnis is assuming no personal liability (nor am I) in explaining how he has used this method. In these litigious days, physicians have to watch out for themselves!
Dr. McGinnis reported that he was currently treating himself with 0.4 ml of Flonase in each nostril at bedtime. By his calculations that is 200 mcg per nostril, which is twice the amount recommended in the literature that comes with Flonase nasal spray. Dr. McGinnis also suggested that the product within Flixonase nasules may well be more concentrated than is that in Flonase nasal spray.
Dr. McGinnis also suggested that interested persons see if they can get the Flixonase nasule drops from outside the country and avoid any potential problems that could occur from modifying/adapting Flonase Nasal Spray for use as drops. Such problems could include getting bits of metal, glass, plastic or other material into the medication and then into your nose, getting infections from re-using syringes and container without sterilizing them, and so on. I really wish the Flixonase nasules were available in the US. I'm too cheap to buy medicines that my insurance provider won't pay for.
Karagama, Lancaster, Karkanevatos, and Sullivan (Delivery of Nasal Drops to the Middle Meatus: Which is the Best Head Position, Rhinology, 2001, 39, 226-229) researched effectiveness of four different head positions. They found that the Mygind (head dangling back) and the Ragan (lie on side, head turned towards opposite shoulder, no pillow, instill into lower nostril) positions were more effective at delivering the medication to the middle meatus than were the Mecca (kneeling, vertex touching the floor) and the Head Back (sit or stand, tilt head back)positions. These positions are illustrated in their article. Since sinusitis and nasal polyposis most often involve the maxillary and the anterior ethmoid sinuses, it is thought that medication will be most effective if it is delivered to the ostiometal complex through which these sinuses drain. The ostiometal complex opens into the middle meatus (see Anatomy of the Sinuses and Sinus and Nasal Anatomy). With the Mecca position no medication was delivered to the middle meatus -- rather it pooled in the roof of the nose -- but the authors also suggested that placing the medication in the roof of the nose may be exactly what is desired when the intranasal steroid is intended to treat anosmia/hyposmia or nasal polyps in the roof of the nose.
Kayarkar, Clifton, and Woolford (An evaluation of the best head position for instillation of steroid nose drops, Clin Otolaryngol. 2002, 27, 18-21) found the Lying Head Back (LHB) position (very similar to the Mygind position described by Karagama et al.) best for delivering drops to the middle meatus. Check the figures in their article, available online, and linked above. It is the LHB position that I employ, largely because I find it convenient and comfortable. Thanks to Dr. McGinnis for pointing me to this article.
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This page most recently revised on 4-May-2021.