Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; Department of Otorhinolaryngology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
Auris Nasus Larynx. 2020 Aug;47(4):536-543. doi: 10.1016/j.anl.2020.05.026. Epub 2020 Jul 1.
Chronic rhinosinusitis (CRS) is a common health issue associated with a significant life quality impairment. Intranasal glucocorticoid is the treatment of choice both as initial therapy as well as after surgery. In contrast to nasal spray, liquid glucocorticoids in form of nasal drops have the advantage of reaching the middle and upper meatus. The efficiency of the glucocorticoid nasal drops is nevertheless strictly dependent on the head position they are being applied in. Several head positions have been described in the literature but no clear recommendation towards the best suited position exist to date.
A systematic review was completed using the PubMed database. Journal articles assessing the effect of head position on intranasal drop fluid distribution, clinical effectiveness, or factors affecting patient compliance were included.
In total 15 publications meeting the inclusion criteria have been found, out of which 9 cover the effect of head position as a primary outcome using quantitative measures.
The positions Lying Head Back, Lateral Head Low, and variations of those can be recommended equally at the moment. Evidence speaks against the use of the classic Head Back position because of poor clinical outcome, and against the position Head Down and Forward as initial therapeutic approach because of high discomfort. For the olfactory cleft, a new head position has been described (Kaiteki), although no comparisons to other positions exist to date.
慢性鼻-鼻窦炎（CRS）是一种常见的健康问题，会严重影响生活质量。鼻内糖皮质激素是治疗 CRS 的首选药物，无论是作为初始治疗还是手术治疗后。与鼻腔喷雾剂相比，以滴鼻剂形式存在的液体糖皮质激素具有到达中鼻道和上鼻道的优势。然而，糖皮质激素滴鼻剂的疗效严格依赖于滴入时的头部位置。文献中已经描述了几种头部位置，但迄今为止，尚无明确的最佳位置推荐。
使用 PubMed 数据库完成了系统评价。纳入评估头部位置对鼻腔滴液分布、临床疗效或影响患者依从性因素影响的研究。
共找到 15 篇符合纳入标准的文献，其中 9 篇使用定量测量方法主要评估了头部位置的影响。
目前可以同等推荐仰卧头后仰位、侧头低位和这些位置的变体。由于临床效果不佳，不推荐使用经典的头后仰位；由于不适度高，也不推荐将头低位和前位作为初始治疗方法。对于嗅裂区，可以采用一种新的头位（Kaiteki），但迄今为止，尚无与其他位置的比较。
