How uncomfortable are the various positions recommended for the instillation of nose drops?

Nose drops are widely used in the topical treatment of nasal disorders. The ir efficacy has previously been shown to depend on the position of the head adopted during instillation. All three of the commonly recommended head po sitions (head back, praying-to-Mecca, Mygind's) are uncomfortable, and this may affect patient compliance. As yet, no assessment has been made of the discomfort encountered by patients. Twenty adults from a general otolaryngo logy clinic were asked to adopt each of three positions and then rate the d iscomfort experienced on a 10 cm visual analogue scale. The results show th at although Mygind's position is well tolerated, the praying-to-Mecca posit ion was significantly more uncomfortable than any other. In the absence of any evidence that the praying-to-Mecca position is clinically more efficaci ous than Mygind's, it seems inappropriate to continue to advocate its use.