Return to basics with Naseptin�

13 June 2006

Sir,

I read with great interest how Badran et al.1 described a

method of applying Naseptin� with a rubber tip. While I

agree that both digital or tube nozzle application are

traumatic and unhygienic, this novel method adds further

complexity to the administration of the cream. Any

method of therapy has to be pragmatic and straightfor-

ward, thus ensuring greater patient compliance. Fitting

the rubber tip onto the nozzle requires a level of manual

dexterity, which often eludes the elderly who also suffer

from epistaxis, not just children. Furthermore, instructing

the patient to insert the tip into the nose may cause fur-

ther trauma as the cut tip is not bevelled. Should the tip

come loose in the nose, a foreign body and its associated

problems will ensue. Removal of the foreign body may

cause further trauma, recurrent epistaxis or require a

general anaesthetic. Satisfactory feeling of Naseptin� in

the nasal cavity may mean applying too much cream.

This may cause nasal obstruction, discomfort and may

adversely affect patient compliance.

In the ever present climate of budgetary constrains,

spending an extra £3 for a urinary catheter in each patient

presenting with epistaxis may be difficult to justify. Epis-

taxis remains a very common presentation to hospital.

Additional funding from ENT or A&E departments to

implement this method may be hard to come by. The evi-

dence for Naseptin� in epistaxis may yet be balanced by

the need to maintain cost-effectiveness. Additionally, the

task of cutting the catheter into 2 cm segments is time con-

suming; whose task is it remains undefined.

In my experience, Naseptin� can be easily and effect-

ively applied by the following method:

1. Fold the edge of a tissue or handkerchief into a tip.

2. Apply a blob of Naseptin� onto the tip (Fig. 1).

3. Place the tip at the nostril, and snort several times

while occluding the contra-lateral side.

4. Massage the alar to evenly distribute the cream within

the nose.

This is a no-touch technique, which ensures the tube

nozzle does not come into contact with the nose. The

issue of contamination is thus kept to a minimum. This

method also ensures that too much cream is not applied

into the nasal cavity.

The method described by Badran et al. may be effective

in the clinical setting but Naseptin� is normally self-

administered. Application of Naseptin� with a rubber tip

is of uncertain value as the issues of cost, compliance and

effectiveness remain unconvincing. We should remind

ourselves to keep things simple for patients. A return to

basics with Naseptin� is all that is needed.

Leong, S.C.L.Department of Otolaryngology,

Derby Royal Infirmary, Derby, UK

Reference

1 Badran K. & Jani P. (2006) Novel approach to Naseptin� cream

application using a rubber tip. Clin. Otolaryngol. 31, 243–244

Fig. 1. Place the tip at the nostril, and snort several times while

occluding the contra-lateral side.

CO

RR

ES

PO

ND

EN

CE

466 Correspondence

� 2006 The Authors

Journal compilation � 2006 Blackwell Publishing Limited, Clinical Otolaryngology, 31, 456–469