What are the recommendations for patient education regarding nasal sores?

Patient Education for Nasal Sores

Patients with nasal sores should be educated to use proper nasal spray technique—specifically holding the spray in the opposite hand from the nostril being treated and aiming away from the nasal septum—as incorrect technique is the primary preventable cause of nasal irritation, epistaxis, and in rare cases septal perforation. 1

Critical Technique Instructions to Prevent Nasal Sores

Proper Nasal Spray Administration

• Use the contralateral hand technique: Hold the spray bottle in the opposite hand from the nostril being sprayed (right hand for left nostril, left hand for right nostril) to naturally angle the spray away from the septum 1
• Ipsilateral spray technique (same hand as nostril) results in four times higher incidence of epistaxis and three times higher rate of discontinuation compared to contralateral technique 1
• Keep the head upright during administration—not tilted back 1
• Breathe in gently or slowly during spraying 1
• Do not close the opposite nostril, as this pushes the septum toward the spray 1

Pre-Spray Preparation

• Blow the nose before using the spray to clear secretions 1
• If using nasal saline irrigation, perform it before applying medicated sprays to avoid rinsing out the medication 1
• Prime the bottle before first use and shake before each application to ensure proper drug suspension 1

Understanding Medication Effects and Expectations

Timing of Symptom Relief

• Intranasal corticosteroids have a delayed onset of action (approximately 12 hours) with maximal efficacy reached over days to weeks 1
• Patients must use intranasal corticosteroids regularly—not on an as-needed basis—to maintain symptom control 1
• This delayed effect should be explained to prevent premature discontinuation due to perceived ineffectiveness 1

Common Side Effects and When to Worry

• Mild nasal irritation, dryness, or occasional minor bleeding can occur but often resolves with proper technique 1
• Headache or sinus pain occurs in approximately 4-8% of users of gel-based nasal sprays 2
• Seek immediate medical attention for severe unilateral facial pain, visual changes, severe frontal headache, or signs of infection 1, 3

Preventive Measures and Hygiene

Hand Hygiene and Infection Prevention

• Practice good hand hygiene by washing hands with soap or using alcohol-based hand rub, especially when in contact with ill individuals, as this is one of the most effective strategies for reducing viral rhinosinusitis risk 1
• Smoking increases the risk of sinusitis and should be addressed through cessation counseling 1

Nasal Saline Irrigation Benefits

• Saline nasal irrigation improves mucociliary function, decreases nasal mucosal edema, and mechanically rinses infectious debris and allergens 1
• This provides improved symptom relief and may reduce reliance on other medications 1, 4
• For chronic rhinosinusitis or after sinus surgery, saline irrigation is specifically recommended for secondary prevention 1

Special Populations Requiring Additional Support

Patients with Physical Limitations

• Those with arthritis, Parkinson's disease, or inability to coordinate breathing with spray administration may have difficulties using nasal spray devices and require additional instruction or alternative delivery methods 1
• Handling error frequency increases with age, comorbidities, lower education, and lower socioeconomic class 1

Children

• Children aged 5-16 years show significantly higher competency when taught using animated cartoons versus oral presentation alone 1
• Teaching procedures should be repeated periodically to ensure long-term correct use 1
• Children under 2 years should consult a doctor before using topical nasal products 5

When to Seek Medical Attention

Emergency Warning Signs

Patients should seek immediate medical care for: 1, 3

• Periorbital swelling or redness
• Double vision or reduced visual acuity
• Severe unilateral or bilateral frontal headache
• Frontal swelling
• Neurological signs suggesting meningitis
• Reduced consciousness

Non-Emergency Reassessment Indicators

Return for medical evaluation if: 1, 3, 6

• Symptoms persist beyond 10 days without improvement
• Symptoms worsen after initial improvement
• Fever persists or worsens
• Severe headache develops
• No improvement occurs after 3-5 days of antibiotic therapy (if prescribed)

Addressing Patient Concerns and Fears

Medication Safety Education

• Many patients and parents harbor fears about medication side effects that should be addressed individually through education to optimize adherence 1
• Educational materials should emphasize the favorable safety profile of properly used intranasal corticosteroids 1
• The chronicity of conditions like rhinitis, realistic treatment outcomes, and the effect of disease control on quality of life should be explained 1

Demonstration and Follow-Up

• Pharmacists and clinicians should demonstrate proper nasal spray technique using a placebo device rather than relying solely on written instructions 1
• Follow-up visits should assess symptom control, quality of life, compliance, and whether current therapy should be maintained, stepped up, or stepped down 1
• Patient and family education should be an integral part of each encounter 1