Choosing nasal devices: a dilemma in clinical practice

Choosing nasal devices: a dilemma in clinical practice


  • Attilio Varricchio
  • Francesco Brunese
  • Ignazio La Mantia
  • Enrico Ascione
  • Giorgio Ciprandi


upper airway diseases; intranasal therapy; delivery device; methylene blue; clinical practice.


Background and aim: Upper airway diseases are frequent and recognize different etiopathogenetic mechanisms, including infection, inflammation, and allergy. Therefore, topical treatments are preferable in comparison with systemic medications. Several delivery devices are available on the market, including nasal drops, syringes, sprays, nebulizers, and douches. However, it is clinically relevant to know the better way to use it.

Methods: The present experience compared five different devices that were tested: i) a nasal dropper, ii) a standard nasal spray device, iii) a mucosal atomization device with a nozzle tip, iv) a nebulizer device, and v) a nasal douche. Saline solution with methylene blue was the marker to evaluate the intranasal distribution.

Results: The findings showed an apparent difference in area distribution among these delivery devices.

Conclusion The present experience showed that doctors should choose the most appropriate device for the current disease in clinical practice.


Varricchio A, La Mantia I, Brunese FP, Ciprandi G. Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies. It J Pediatr 2020;46:18

Benninger M, Ahmad N, and Marple BF. The safety of intranasal steroids. Otolaryngol Head Neck Surgery. 2003; 129: 739–750

Moffa A, Costantino A, Rinaldi V, Sabatino L, Trecca EMC, Baptista P, et al. Nasal delivery devices: a comparative study on cadaver model. BioMed Res Int 2019; 4602651

FDA Guidance for Industry, Nasal Spray and Inhalation Solution, Suspension, and Spray Drug Products - Chemistry, Manufacturing, and Controls Documentation, U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research. 2002

Zhao K, Craig JR, Cohen NA. Sinus irrigations before and after surgery-visualization through computational fluid dynamics simulations. Laryngoscope 2016; 126: 90–96

Laube BL. Devices for aerosol delivery to treat sinusitis. JAerosol Med Pulm Drug Delivery. 2007; 20: S5-S18

Albu S. Novel drug-delivery systems for patients with chronic rhinosinusitis. Drug Design Develop Ther 2012; 6: 125–132

O'Neil LM, Jefferson ND. Direct Visualization of Laryngeal Mucociliary Clearance in Adults. Ann Otol Rhinol Laryngol. 2019; 128: 1048-1053

Varricchio A, Avvisati F, Varricchio AM, Tortoriello G, Ciprandi G. The nose and paranasal sinuses. Int J Immunopathol Pharmacol 2010; 23(1 Suppl): 1-3

Ciprandi G, Gelardi M. Open and clean: the healthy nose. Acta Biomed. 2019;90(2-S):4-6







How to Cite

Varricchio A, Brunese F, La Mantia I, Ascione E, Ciprandi G. Choosing nasal devices: a dilemma in clinical practice. Acta Biomed [Internet]. 2023 Feb. 13 [cited 2024 Jul. 16];94(1):e2023034. Available from: