Sinus Penetration of Saline Solution Irrigation and Atomizer in a Cadaveric Polyp and Allergic Fungal Sinusitis Model

Abstract

Allergic fungal sinusitis (AFS) is a stubborn disease requiring surgical and medical management. Delivery of topical medication is paramount in these patients, but the most difficult to accomplish. We investigated heavy irrigation (nasal douche) and atomized medication delivery potential in a cadaveric sinus model of polypoid AFS disease. Three disease models were created: a control that involved unoperated sinuses and no simulated disease; an unoperated AFS with type II polyposis mode; and an operated model with recurrent allergic fungal sinusitis with type II polyposis. The maxillary sinus showed the best irrigation and overall the heavy irrigator was more efficient than the atomizer.

Sinus Penetration of a Pulsating Device Versus the Classic Squeeze Bottle in Cadavers Undergoing Sinus Surgery

“…These devices may be used for drug delivery to the nasal mucosa, 13 but a review of the literature suggests that they are not as efficacious in this respect as irrigation. 14,15…”

“…These devices may be used for drug delivery to the nasal mucosa, 13 but a review of the literature suggests that they are not as efficacious in this respect as irrigation. 14,15 The Sinugator pulsatile irrigator performed similarly to the squeeze bottle with regards to the maxillary sinus but was not as effective in reaching the dissected frontal and sphenoid sinuses. Further, the ability to reach the frontal and sphenoid sinuses decreased as the extent of surgery increased.…”

Sinus irrigations before and after surgery—Visualization through computational fluid dynamics simulations

“…Topical therapies play an integral role in the management of sinonasal disease, and high-volume irrigation delivery is more effective for achieving distribution to the sinuses than other topical delivery methods such as nasal sprays, nebulizers, or atomizers. [1][2][3][4] Saline irrigations have been recommended in a number of clinical scenarios, including chronic rhinosinusitis 5 and postoperative care. 6 High-volume irrigations have also shown benefits for medication delivery, such as with mupirocin 7 and budesonide.…”

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

“…10 Many different head positions have been tested, and the nose-to-floor (or vertex-to-wall) head position has been shown in multiple studies to allow for sufficient topical distribution to each of the sinuses when using high-volume irrigations, including the difficult-to-reach frontal sinuses. 10,13,14 To date, most studies investigating the effects of different macroscopic factors on topical irrigation delivery have been performed on cadavers, [10][11][12][13][14][15][16] some on live patients, 17,18 and a few studies have utilized computational fluid dynamic modeling. [19][20][21][22] The focus of these studies has generally been on determining the patterns of sinus distribution based on the manipulation of one or more of the macroscopic factors mentioned.…”