Pre‐ and Postoperative Sinus Penetration of Nasal Irrigation

Abstract

Unoperated sinuses or cases with gross sinus ostial obstruction will not be reliably penetrated by sinus irrigant. A 3.95-mm ostial diameter seems to be the minimum size to guarantee penetration in paranasal sinuses to maximize the potential for topical sinus treatment.

Sinuplastia com balão, avaliação inicial: 10 casos, resultados e seguimento

“…This size was of 3.96 mm in diameter 18 . We used 5 mm balloons, but we cannot be sure that after dilatation, these regions remain with such diameter.…”

“…Surgery is carried out so that we can open the PNS ostia to promote ventilation, proper secretion drainage and penetration of topical medication 1,18 . Notwithstanding, a frequent doubt surgeons have is the size of PNS ostia broadening.…”

Sinus Surgery and Delivery Method Influence the Effectiveness of Topical Corticosteroids for Chronic Rhinosinusitis: Systematic Review and Meta-Analysis

“…Sinus surgery greatly affects the amount of corticosteroid, which comes into contact with paranasal sinus mucosa. [4][5][6] The edematous inflammatory mucosa and ostiomeatal occlusion often seen in CRS allows Ͻ1% of solution volume to enter the sinus cavities before surgery. 7 The extent of sinus surgery varies across institutions.…”

“…An adequate ostial dimension has been shown to be necessary for appropriate topical drug distribution. 4,[8][9][10] Additionally, an appropriate device and delivery technique is required for adequate administration. 4,8 Simple nasal delivery methods such as drops, sprays, aerosols, nebulizers, and atomizers provide good nasal cavity contact but poor sinus delivery.…”

O papel das medicações tópicas no tratamento da rinossinusite crônica

“…Desired properties of all topical therapies include complete sinus distribution, high local drug absorption, low systemic absorption, and minimal toxicity to the cilia and sinonasal mucosa. Understandably, the benefits of saline irrigation and topical therapies are greatest in patients who have had prior functional endoscopic sinus surgery (FESS) 3,4 . Clinical studies support this finding, with distribution of topical solutions in the unoperated sinuses on the order of less than 2% of the total irrigation volume, with almost no penetration in the frontal and sphenoid sinuses 4 .…”