“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #165

Allergy season! Everything necessary combat congestion.

Many of us recommend various nasal sprays to our patients, especially during cold/flu “season” or during spring or fall allergy flares.  But most of us don’t take the extra time to teach patients how to get the sprayed fluid into the eustachian tube, where much of the congestion accumulates.  

The fluid accumulation in the eustachian tube can create pressure within the ear, resulting in pain and discomfort.  Prescribing or recommending nasal sprays is quite effective, but only if the patient understands gravity’s impact on the sprayed fluid.  

Since the nasal spray is dispensed UPward into the nares, gravity’s impact is pulling it, letting it flow, or falling back down the throat, missing the eustachian tube and most sinus cavities altogether.  

I typically recommend a bedtime dose of all nasal sprays, whether it is a prescription or an OTC, or even if it’s just plain ol’ saline.  Using a bedtime spray helps minimize the falling spray down the throat, uses gravity to your advantage, & helps get the medicine delivered to the sinuses & tubes.  

The initial step is teaching patients to do everything to prepare for bed first, sit on the side of the bed, and then spray into nares per instructions.  Tell them to lay flat immediately after spraying, turning their head to one side for one minute and then the other side for one minute.  Doing this step helps maximize fluid delivery directly into the congested areas of sinuses and tubes.  Once the 2 minutes is expired, they can get comfortable and go to sleep; do NOT get up afterward.  

Creating a macro with these instructions spelled out for your patient’s visit summary is also quite helpful and time-saving since you can hand it to the patient or provide it via your portal system for future reference.

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