Effect of head position on the efficacy of topical treatment of chronic mucopurulent rhinosinusitis.

Chronic mucopurulent rhinosinusitis is a common accompaniment of chronic or recurrent bronchial sepsis-for example, in patients with bronchiectasis and cystic fibrosis. It may be treated with systemic or topical medication, or both, but the response is often unsatisfactory. The efficacy of topical medication may depend on adequate exposure of the nasal and paranasal sinus mucosa to the chosen drug.1 2 We have studied 20 patients with chronic mucopurulent rhino-sinusitis who were treated by betamethasone with neomycin nose drops (Betnesol N, Glaxo) administered either in the conventional head back (HB) position or in the head down and forwards (HDF) position.1 2 In this latter position the patient kneels with the forehead close to the knees and the vertex of the head resting on the floor. The drops are instilled and the position is held for two minutes. Methods Twenty patients (six male, 14 female, aged 23 to 72) were selected because of severe chronic symptoms. All had anterior or posterior purulent nasal discharge, or both. Nine patients also had facial pain and 12 had nasal blockage. Betamethasone with neomycin nasal drops were prescribed as two drops instilled into each nostril twice daily for two weeks. The patients were randomised to take the drops in either the HB or the HDF position. The nursing sister explained the appropriate position with the aid of a diagram, and a symptom diary card was completed daily by each patient. The following assessment was performed before and at the end of treatment by medical staff unaware of the position adopted by the patient. A nasal swab was taken for bacterial culture, sinus radiographs were performed, and nasal mucociliary clearance time was measured by the modified saccharin method.3 Nasal airways resistance was measured by active anterior rhinomanometry (Mercury NRS rhino-manometer interfaced to a BBC type B microcomputer), in which the flow (ml/s) required to achieve 150 Pa (1 1 mm Hg) of pressure on inspiration and expiration in each nostril was recorded. Patients were interviewed and examined by a surgeon.