How to Properly Use Nasal Sprays
One of the most common things I see is that patients aren’t properly instructed on the use of nasal sprays. Patients often don’t know what type of nasal sprays they are using, and who can blame them? There are nasal decongestants, nasal saline sprays, nasal saline rinses, and nasal steroids to name a few. All of them have confusing or difficult to pronounce names, and all are available over-the-counter - so they can’t hurt, right? Absolutely not. We’re going to briefly cover the basics of different types of nasal sprays before going over the proper way to use them.
Nasal decongestants (Afrin® or oxymetazoline, Vicks® Sinex also oxymetazoline, Neosynephrine or phenylephrine) are immediate relief nasal sprays. Almost immediately after spraying them, you notice relief in nasal congestion. These are best if only used for 2-3 days. If used for longer, a rebound effect occurs. The rebound effect results in worsening nasal congestion. More nasal decongestant is then needed to achieve the same amount of relief. This turns in to a never-ending cycle of worsening nasal symptoms. In fact, the medical term for this condition is rhinitis medicamentosa. This is much more common than you might realize. These medications typically should not be used regularly.
Nasal saline sprays (Simply Saline™, Equate®, Ocean Spray®) are nasal sprays made of isotonic saline. These nasal sprays are designed to help maintain nasal moisture and to remove contaminants from the nose. These are generally safe to use when following the package instructions, and these are frequently recommended to patients with nasal and sinus problems.
Nasal saline rinses (Sinus Rinse, Neti Pot, Navage®) are all versions of higher volume nasal rinses than nasal saline sprays. These vary in terms of the pressure at which the saline is delivered into the nose. Similar to nasal saline sprays, these rinses can help to maintain nasal moisture and and to remove contaminants from the nose. Many people with nasal and sinus problems such as allergies or sinusitis can benefit from the use of sinus rinses.
Nasal steroids can be considered the workhorses for treating allergies and sinusitis. Flonase or fluticasone, Rhinocort or budesonide, Nasacort or triamcinolone, and Nasonex or mometasone are some of the more commonly used nasal steroids. Some are available over the counter, but some require a prescription. These medications are not immediate relief medications. These medications work slowly over time and require 2-3 weeks of consistent usage prior to any benefit being seen. It is very important to stick with these medications even if you aren’t immediately noticing any benefit if they have been recommended to you. Most nasal steroids are similar in efficacy (meaning they generally all work about as well as each other). However, the formulations do differ. Because of this, patients may find 1 spray more tolerable than others. It may take trialing a few of these to determine which works best for you. But remember, the most important this is being consistent with these sprays so that over the long term - you can benefit from their effects. Nasal steroids are generally considered safe, but side effects do exist. Nasal steroids are delivered directly to the nose and can help avoid the need for oral steroids which are more likely to cause systemic side effects.
Now that you know the basic types of nasal sprays, let’s talk about how to use them properly. I frequently see patients who tell me that after they started using nasal sprays, they began having nosebleeds. While some of these medications can cause nosebleeds by drying out the nose, many times the cause of the nosebleeds is due to trauma to the nasal septum, especially in cases where there is a deviated nasal septum. When using nasal sprays, it is important not to aim towards the midline of the nose. Rather, you should be aiming toward the side. It can be helpful to use the opposite hand when spraying each side of the nose until you get the hang of it. For example, when spraying your left nasal cavity, you can use your right hand to help you aim the bottle gently toward your left eye when spraying in the nose. This helps avoid the nasal septum, and it helps the medications target both the inferior turbinate and the sinuses (which both are on the side of the nose and not in the middle).
In terms of nasal sinus rinse, I often recommend the NeilMed Sinus Rinse bottle. I think it does a good job of delivering the designated volume at an appropriate pressure to help it flow through the nasal and sinus cavity. This can be a little bit trickier than simply using nasal sprays, and I will try to post an instructional video on how to do this at some point in the future. But for now, a few tips. I generally recommend doing this over a sink or in the shower. My preferred technique is to gently lean forward so that my face is held slightly over the sink (don’t want to blow saline all over the bathroom floor). Take a deep breath in, so that you can slowly exhale through the nose while you gently apply pressure to the bottle sending the saline into one side of your nose. By exhaling through the nose, you will help the saline flow into one side, around the septum, and back out the opposite side. This can also help prevent the saline from going down your throat which can be unpleasant. I generally recommend using half the bottle for each side of your nose.
