Xhance is an FDA-approved prescription nasal spray that delivers fluticasone propionate, a corticosteroid, using a unique breath-powered device designed to reach deep into the nasal and sinus passages. It is approved for treating chronic rhinosinusitis in adults, both with and without nasal polyps. What sets it apart from standard nasal sprays like Flonase is not the medication itself, but how and where the device deposits it.
How Xhance Differs From Regular Nasal Sprays
Standard nasal sprays deliver most of their medication to the front and lower parts of the nasal cavity. A significant portion drips out or gets swallowed before it reaches the upper and deeper areas where sinuses actually drain and ventilate. Xhance was designed to solve this problem. Studies show it deposits medication substantially more broadly throughout the nasal cavity, particularly into the superior and posterior regions that conventional sprays largely miss.
The device itself looks nothing like a typical spray bottle. It has two ends: a cone-shaped nosepiece and a flexible mouthpiece. You insert the nosepiece into one nostril, place the mouthpiece in your mouth, take a deep breath, and then blow out through the mouthpiece while pressing the bottle to release the spray. This creates what engineers call “bidirectional” airflow. Your exhaled breath carries the medication through one side of your nose, around the back of the nasal septum, and out the other nostril.
The key to the whole system is what happens to your soft palate (the soft tissue at the back of the roof of your mouth). When you blow against the device’s internal resistance, your soft palate rises and seals off your mouth from your nasal passages. This forces the burst of air and medication to travel the only path available: deep into the sinus drainage areas. A valve inside the device holds back your breath until you press the bottle, then releases both the medication and a burst of exhaled air simultaneously. You should not sniff or inhale through your nose during this process, and you should leave your other nostril open so the air can exit freely.
What Xhance Treats
Xhance is FDA-approved for two conditions in adults:
- Chronic rhinosinusitis with nasal polyps: Ongoing sinus inflammation accompanied by soft, noncancerous growths in the nasal passages that cause persistent congestion, reduced smell, and facial pressure.
- Chronic rhinosinusitis without nasal polyps: The same type of chronic sinus inflammation and symptoms, just without visible polyps.
It is not approved for use in children. It is also not the same as using over-the-counter fluticasone (Flonase) for seasonal allergies. Xhance targets a different, more difficult-to-reach area of the sinuses and is specifically intended for chronic sinus disease rather than hay fever.
How Well It Works
Xhance was tested in two large randomized, placebo-controlled clinical trials called NAVIGATE, each lasting 16 weeks. The trials measured two things: how much nasal congestion improved after 4 weeks, and how much nasal polyps shrank after 16 weeks.
On congestion, patients using Xhance experienced roughly double the improvement in congestion scores compared to placebo within the first four weeks. This improvement was consistent across both trials and at multiple dose levels. For polyp reduction, the results were similarly clear. In one trial, polyp size scores dropped about twice as much with Xhance as with placebo. In the second trial, the difference was even more pronounced, with polyps shrinking roughly two to two-and-a-half times more than placebo. All of these differences were statistically significant.
Two additional randomized trials, called ReOpen1 and ReOpen2, further confirmed the drug’s effectiveness for chronic rhinosinusitis. The consistent finding across all these studies is that getting the corticosteroid deeper into the sinus drainage pathways produces better outcomes than what standard delivery methods achieve.
Common Side Effects
The most frequently reported side effects are nosebleeds, upper respiratory infections (nasopharyngitis), and nasal ulceration. Nosebleeds are by far the most common. In clinical trials, about 20% of patients on Xhance showed some evidence of nasal bleeding compared to 6% on placebo. That number includes minor bleeding detected only during medical exams, though. When counting only nosebleeds that patients themselves noticed and reported, the rate was closer to 10-12%.
Nasal ulcerations along the septum occurred in about 7% of patients at the approved doses, compared to roughly 2% on placebo. These are small sores inside the nose caused by the corticosteroid’s effect on the nasal lining.
Despite these numbers, very few people stopped using Xhance because of side effects. In the 16-week trials, only about 2% of patients on the active drug discontinued due to adverse events. In longer open-label safety studies lasting up to a year, 4.8% discontinued, with nosebleeds being the most common reason at 1.2%.
Risks to Be Aware Of
Because Xhance delivers a corticosteroid, it carries the same class of warnings as other nasal and inhaled steroids, with a few specific to its deeper delivery.
Nasal septal perforation (a hole developing in the wall between your nostrils) is rare but possible. In controlled trials, it occurred in one patient out of roughly 300 on Xhance. Three additional cases appeared in longer-term studies. People with a history of nasal surgery may be at higher risk. You should avoid spraying directly onto the septum, and periodic nasal exams are recommended for long-term users.
Corticosteroids used in the nose can also contribute to increased eye pressure and cataracts over time. In the 16-week trials, new or worsening cataracts appeared in about 1.2% of Xhance patients. People with a history of glaucoma, cataracts, or changes in vision should be monitored more closely. If you have had recent nasal surgery, nasal trauma, or nasal ulcers, you should wait until healing is complete before starting Xhance, since corticosteroids slow wound healing.
How to Use It
Using Xhance correctly matters more than with a standard spray, because the delivery system only works as intended when you follow the technique. Here is the process:
- Insert the cone-shaped nosepiece gently but deeply into one nostril, creating a tight seal.
- Place the flexible mouthpiece in your mouth.
- Take a deep breath through your mouth.
- Begin blowing out steadily through the mouthpiece.
- While still blowing, push the bottle upward to release the spray.
- Repeat in the other nostril to complete one full dose.
Two important details: do not sniff or inhale through your nose at any point during the process, and do not block the opposite nostril. The exhaled air needs to flow through one nostril, around the back of the nasal septum, and out the other side. Blocking that exit prevents the bidirectional flow that makes the device effective. The device is used twice daily, once in each nostril per session.