A Comparison between Mygind and Kaiteki positions in administration of drops to the olfactory cleft

Milk, Dafna Gershnabel; Khong, Grace; Çam, Osman Halit; Alfaro-Iraheta, Fernando; Tierney, Claire; Kassem, Firas; Leong, Samuel

doi:10.1111/coa.13690

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…That might explain why local steroids direct into the olfactory cleft demonstrated exact treatment effect in patients with PVOD. Similarly, head positions including Kaiteki and Mygind positions delivered the nasal drops effectively to the olfactory epithelium, and further studies should evaluate the effect of nasal steroid drops with these two head positions in patients with PVOD (Mori et al, 2016;Milk et al, 2021). When comparing the uses of steroids in patients with PVOD, two studies showed the TDI scores improved from 14.39 to 18.86, 15.2 to 16.9 in the systemic steroids group, while the TDI scores even decreased in the nasal steroids group (Jaeschke et al, 1989;Schriever et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Steroids and Olfactory Training for Postviral Olfactory Dysfunction: A Systematic Review

et al. 2021

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Background: Postviral olfactory dysfunction (PVOD) is a clinical challenge due to limited therapeutic options and poor prognosis. Both steroids and olfactory training have been proved to be effective for olfactory dysfunction with varied etiologies. We sought to perform a systematic review to summarize the evidence of steroids or olfactory training for patients with PVOD.Methods: A systematic literature review using PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify studies assessing olfactory change in patients with PVOD receiving steroid or olfactory training.Results: Of the initial 273 abstracts reviewed, 20 articles with data from 2,415 patients with PVOD were included. Treatments including topical steroids, systemic steroids, classical olfactory training (COT), modified olfactory training (MOT), and olfactory training with steroid were analyzed. Both psychophysical olfactory testing and subjective symptom scores were utilized to assess the olfactory function. The routine use of nasal steroid spray alone during the management of PVOD seems to have no positive effect on olfactory dysfunction. Direct injection of steroid or nasal steroid spray into the olfactory cleft significantly improved the olfactory function in patients with PVOD. Olfactory improvement is greater than that of the natural course of the disease with short-term COT. Patients with PVOD would benefit more from long-term COT (>12 weeks). Treatment duration, various odorants, olfactory training devices, changing the types of odors periodically, different molecular odorants, and different concentrations of odorants tended to increase the efficiency of MOT. Clinically significant improvement after olfactory training was defined as an increase of threshold, discrimination, and identification (TDI) score ≥6. From week 24 to week 36, both COT and MOT groups reached the maximum therapeutic effect regarding the number of participants achieving clinically significant improvement. A combination of local or oral steroids with olfactory training is more efficient than COT only.Conclusion: Olfactory function in patients with PVOD was effectively improved through direct steroid administration in the olfactory cleft, COT, or modification of COT. The addition of topical steroids to COT therapy showed a tendency for greater olfactory improvement in patients with PVOD.

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Section: Discussionmentioning

confidence: 99%

Steroids and Olfactory Training for Postviral Olfactory Dysfunction: A Systematic Review

et al. 2021

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“…This technique was shown to distribute particles from the anterior to the middle turbinate in the lateral aspect of the nose, which is the region of maximal inflammatory response in sinonasal conditions 13 . The Kaiteki position which recommends the lateral decubitus position with the neck and chin tilted upwards has also been recommended to increase particle distribution to the OC more than the upright position 14 . While these positions promote better deposition patterns of IN drugs, they are often difficult to perform and can result in improper application technique.…”

Section: Discussionmentioning

confidence: 99%

Spatial analysis of transnasal olfactory cleft access: a computed tomography study

Chan¹,

Lee²,

Thamboo³

2023

Acta Otorhinolaryngol Ital

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SUMMARY Objective To our knowledge, the spatial access of naris to olfactory cleft has not been quantified. We aimed to study the relationship and space of middle turbinate, septum, anterior nasal spine and cribriform plate to improve topical medication delivery and drug applicators. Methods One hundred CT scans of patients (50 males, 50 females) over the age of 18 were included. Subjects with radiographic sinonasal pathology, previous surgery, or specific variant nasal anatomy were excluded. Scans were independently reviewed and bilateral measurements on bony landmarks were taken by two blinded authors. Inter-rater reliability was analysed with intraclass correlation. Results The average age was 46.26 years (σ = 14.0). Average distance from the anterior nasal spine to olfactory cleft was 52.3 mm (σ = 4.2 mm), and the average length of cribriform plate was 18.8 mm (σ = 3.8) with an angle relative to hard palate averaging -8.8 degrees below parallel (σ = 5.5 degree). The widths of the olfactory cleft at anterior and posterior edges of cribriform plate were 2.3 mm (σ = 0.7 mm) and 2.0 mm (σ = 0.7 mm). Conclusions The findings suggest a 52.3 mm distance from the naris to the anterior border of cribriform plate. The average width along this path was 3.2 mm, suggesting devices narrower than this could potentiate direct drug delivery access.

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“…However, based on the observation of a ninefold increase or so for both the baseline and optimized cases ( Table 2 ), it is speculated that a similar OL dose enhancement can be expected for other cases. Second, different head positions have been proposed in olfactory dosing besides the vertex-to-floor or Mecca position, such as the upright-head-back position, lying-head-back (or Mygind) position, and Kattecki position (lying on one side with neck turned and chin lifted) [ 28 , 29 , 30 , 31 , 53 , 54 ], whose effect on OL dose enhancement is unclear. Thirdly, the “optimized” system of this study was based on a limited number of test cases, not an exhaustive peak search in the design space.…”

Section: Discussionmentioning

confidence: 99%

“…Mori et al [ 30 ] tested the Kaiteki position (lying on the side with the head titled and chin lifted) in healthy subjects and reported that nasal spray could reach the olfactory region in 96% of the decongested subjects and 75% of the untreated cases. Milk et al [ 31 ] compared the administration of nasal drops to the olfactory region between the lying-head-back (Mygind) position and the vertex-to-floor (Mecca) position and reported comparable doses from these two head positions. In the above studies, different methods, such as isotopes, dyes, endoscopy, and pledget collection, have been used to visualize the intranasal distribution of nasal spray distributions; this variability makes the comparison between studies difficult [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Liquid Film Translocation Significantly Enhances Nasal Spray Delivery to Olfactory Region: A Numerical Simulation Study

April

Sami

2021

Pharmaceutics

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Previous in vivo and ex vivo studies have tested nasal sprays with varying head positions to enhance the olfactory delivery; however, such studies often suffered from a lack of quantitative dosimetry in the target region, which relied on the observer’s subjective perception of color changes in the endoscopy images. The objective of this study is to test the feasibility of gravitationally driven droplet translocation numerically to enhance the nasal spray dosages in the olfactory region and quantify the intranasal dose distribution in the regions of interest. A computational nasal spray testing platform was developed that included a nasal spray releasing model, an airflow-droplet transport model, and an Eulerian wall film formation/translocation model. The effects of both device-related and administration-related variables on the initial olfactory deposition were studied, including droplet size, velocity, plume angle, spray release position, and orientation. The liquid film formation and translocation after nasal spray applications were simulated for both a standard and a newly proposed delivery system. Results show that the initial droplet deposition in the olfactory region is highly sensitive to the spray plume angle. For the given nasal cavity with a vertex-to-floor head position, a plume angle of 10° with a device orientation of 45° to the nostril delivered the optimal dose to the olfactory region. Liquid wall film translocation enhanced the olfactory dosage by ninefold, compared to the initial olfactory dose, for both the baseline and optimized delivery systems. The optimized delivery system delivered 6.2% of applied sprays to the olfactory region and significantly reduced drug losses in the vestibule. Rheological properties of spray formulations can be explored to harness further the benefits of liquid film translocation in targeted intranasal deliveries.

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A Comparison between Mygind and Kaiteki positions in administration of drops to the olfactory cleft

Cited by 8 publications

References 21 publications

Steroids and Olfactory Training for Postviral Olfactory Dysfunction: A Systematic Review

Steroids and Olfactory Training for Postviral Olfactory Dysfunction: A Systematic Review

Spatial analysis of transnasal olfactory cleft access: a computed tomography study

Liquid Film Translocation Significantly Enhances Nasal Spray Delivery to Olfactory Region: A Numerical Simulation Study

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