A Prospective Randomized Blinded Cross-Over Trial Using Nasal Drops in Patients with Nasal Polyposis: An Evaluation of Effectiveness and Comfort Level of Two Head Positions

Abstract

The aim of this study was to compare the efficacy and the degree of discomfort caused by the Mygind's (supine and head extended) position and the lying on the side head down (LSHD) position used for instilling nasal drops. We performed a prospective randomized blinded cross-over trial. Twenty-three patients with nasal polyps were recruited and were given Betnesol nasal drops for 6 weeks after assessing their peak nasal inspiratory flow rate and grading the polyps. The assessor was blinded to the position used by the patient that was selected randomly. The patients were reviewed after 6 weeks when both their flow rates and their polyp grades were reassessed. They were given a visual analog chart to record the ease by which drops could be instilled and any discomfort caused by the position. After a 2-week washout period the patients were treated for another 6 weeks with the same drops using the other head position. Twenty-one patients completed the study. The LSHD and Mygind's positions were equally effective in controlling the nasal polypi. Mygind's position was easier to instill drops in the nose although LSHD position caused less discomfort for the patient. The nasal peak inspiratory flow increased linearly as the polyp size decreased. In 86 and 90% of the patients the nasal obstruction and nasal discharge, respectively, were well controlled. The drops were efficacious in both head positions. The LSHD position caused the least discomfort, although patients found Mygind's position easier to instill drops. Steroid nasal drops are an effective way to manage patients with nasal polyposis.