Topical nasal sprays for sinusitis are more effective if they reach the targeted tissue. Aqueous agents are affected by gravity and often wind up in the throat, especially if the head is tilted backward. I point out the location of the sinuses on a cross-section of the head and tell patients to let gravity be their friend. After spraying each nostril, patients should turn their head upside-down for 60 seconds. Kneeling on the floor or hanging the head and shoulders forward off a bed are the best positions. While the head is upside-down, tell patients to snort periodically to move the spray around.—LCDR STEVEN W. MOLL, DO, Chesapeake, Va. (143-12)
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