Head and Bottle Angles Achieved by Patients During High-Volume Sinonasal Irrigations

Abstract

Background Certain head positions can optimize topical irrigation distribution to specific sinuses. No studies have assessed whether patients attain these positions when irrigating. Objective The purpose of this study was to assess head and bottle angles achieved when patients irrigate based on instructions from an irrigation device or from a Rhinologist. Methods Study approval was obtained from Henry Ford Health System’s Institutional Review Board (10604). Forty-two patients with various rhinologic conditions were equally divided into groups based on irrigation instruction type: pictoral instructions from an irrigation device or written/verbal instructions from a Rhinologist. Both groups’ instructions directed nose-to-floor head positioning. Simulating home irrigations, patients irrigated 120 mL of saline into each naris using 240 mL squeeze bottles. Frontal and lateral views were captured using video cameras. On frontal view, angles were measured between (1) nasal dorsum (ND) and bottle tip (BT; n = 84) and (2) ND and vertical (V; n = 84). On lateral view, angles were measured between (1) line from nasion-to-pogonion (NTP) and horizontal (H) (n = 73) and (2) NTP and BT (n = 73). Results On lateral view, average angle between NTP and H was 20.0° (standard deviation [SD] = 13.1, 95% confidence interval [CI] = 17.0–23.0) and between NTP and BT was 59.4° (SD = 15.8, 95% CI = 55.8–63.1). On frontal view, average angle between ND and V was 9.5° (SD = 19.5, 95% CI = 5.3–13.6) and between ND and BT was 24.5° (SD = 12.0, 95% CI = 21.9–27.0). There were no significant angle differences between sides or instruction types. Conclusion When instructed to irrigate in the nose-to-floor head position, patients achieved a head position uprotated 20° on lateral view and vertex rotated 10° away from the side of irrigation on frontal view.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Head Positioning . Head position improves delivery in the previously operated patient, especially for low volume devices 1260,1261 . Very limited sinus delivery occurs in the unoperated patient regardless of head position.…”

“…The findings of the cumulative studies show that surgery followed by high volume delivery devices are critical for effective delivery of topical therapies within the paranasal sinuses. 1259 t 1077,1085 Head position appears to affect distribution 1260,1261 but neither position nor volume seems to overcome the influence of surgical state 1262 …”

Using 3D printed sinonasal models to visualize and optimize personalized sinonasal sinus irrigation strategies

“…The 3D-printed model may also educate patients on the importance of the precision of head angles. Griggs et al (21) showed that patients in a rhinology clinic irrigated on average about 20° up-rotated on lateral view, and vertex rotated 10° away from the side of irrigation on frontal view. As was shown in the current study, head positions are not all created equal, and perhaps with a 3D printed model, patients would be more likely to irrigate in a more precise manner since they know an error will not result in maximal sinus delivery.…”

A novel irrigation device with superior nasal irrigation efficiency to the classic rinse bottle

“…Although head tilt positions with large angle (e.g., nose-to-floor or nose-to-ceiling head position) was optimal to irrigate during the irrigation, it may be difficult for patients of different age to adopt and maintain the position [ 31 , 32 ]. Therefore, relatively low water volume, high irrigation efficiency, and a comfortable head position to follow were desirable strategies for choosing the nasal irrigation technique.…”