Proper Technique and Angle for Fluticasone Nasal Spray in Turbinate Hypertrophy
Use the contralateral hand technique—hold the spray bottle in the opposite hand relative to the nostril being treated, aim the nozzle away from the nasal septum toward the lateral nasal wall (outer corner of the eye), and keep the head upright during administration. 1
Step-by-Step Administration Technique
Pre-Administration Preparation
- Prime the bottle before first use by shaking and actuating several test sprays until a fine mist appears 1
- Have the patient blow their nose to clear secretions before spraying 1
- If using nasal saline irrigations, perform them prior to administering fluticasone to avoid rinsing out the medication 1
Correct Spray Angle and Hand Position
- Hold the spray bottle in the opposite hand from the nostril being treated (right hand for left nostril, left hand for right nostril) 1
- Keep the head in an upright position—do not tilt the head back 1
- Aim the spray nozzle laterally toward the outer wall of the nose (toward the outer corner of the eye), directing it away from the nasal septum 1
- This contralateral technique reduces epistaxis risk by four times compared to ipsilateral technique where patients spray toward the septum 1
During Administration
- Do not close the opposite nostril during spraying 1
- Instruct the patient to breathe in gently during actuation 1
- Avoid spraying directly at the nasal septum, as this increases local irritation, bleeding, and rare risk of septal perforation 1, 2
Dosing for Turbinate Hypertrophy
Standard Dosing
- Adults and adolescents ≥12 years: 2 sprays per nostril once daily (200 mcg total daily dose) 1, 2
- Children 4-11 years: 1 spray per nostril once daily (100 mcg total daily dose) 1, 3
Higher Dosing for Severe Cases
- For patients with severe nasal congestion unresponsive to standard dosing, consider 2 sprays per nostril twice daily initially, then reduce to maintenance dosing once symptoms are controlled 1
- This approach is particularly relevant for turbinate hypertrophy, which represents significant mucosal swelling 4
Clinical Context for Turbinate Hypertrophy
Fluticasone propionate has been objectively demonstrated to reduce mucosal area of the lower turbinates and thickness of nasal mucosa in patients with turbinate hypertrophy, with statistically significant reductions after 3 months of treatment compared to placebo 5. The medication works by reducing the mucosal swelling that characterizes turbinate hypertrophy, which affects approximately 20% of the population with chronic nasal obstruction 4.
Expected Timeline and Duration
- Onset of action is delayed by approximately 12 hours, with maximal efficacy reached over days to weeks 1, 2
- Counsel patients to continue therapy for at least 2 weeks after initiation, as full benefit may not be evident during this period 1
- Long-term continuous use is safe and effective for turbinate hypertrophy, with studies demonstrating safety for up to 52 weeks 1
- Treatment should be regular daily use rather than as-needed to maintain optimal symptom control 1, 2
Common Pitfalls to Avoid
- Improper spray angle toward the septum is the most common error, increasing epistaxis risk and reducing efficacy 1
- Discontinuing therapy prematurely before the 2-week minimum period prevents adequate assessment of benefit 1
- Using as rescue therapy rather than maintenance therapy—fluticasone is not a decongestant and requires consistent daily use 1
- Failing to teach proper technique using visual aids or demonstrations significantly reduces treatment success 1
When Medical Therapy May Be Insufficient
If no improvement occurs after 3 months of intranasal corticosteroid therapy, medical treatment may not be successful in shrinking the nasal mucosa, and surgical options should be considered 4. The degree of shrinkage with topical decongestants during examination can help predict success of medical therapy versus need for surgical intervention 4.