For children aged 6 years and older with eustachian tube dysfunction, apply a 12-hour nasal decongestant spray and have the child immediately assume a supine position to allow the medication to drip back to the eustachian tube opening (typically directly posterior to the nares).

If there is significant mucosal inflammation, follow with a nasal steroid using the same technique. The decongestant enhances the penetration of the steroid while simultaneously reducing the (already low) rate of systemic absorption, increasing the local effect. — Thomas Urschel, RPAC, Clarendon, N.Y. (167-6)

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