Does Nasal Irrigation Enter Paranasal Sinuses in Chronic Rhinosinusitis?

Snidvongs, Kornkiat; Chaowanapanja, Pattraporn; Aeumjaturapat, Songklot; Chusakul, Supinda; Praweswararat, Puangmali

doi:10.2500/ajr.2008.22.3221

Cited by 68 publications

(72 citation statements)

References 19 publications

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“…A relatively low dose of active drug is probably delivered to the mucosa using irrigation systems although the exact exposure is undetermined at present. 775,806,808 This may not be the case with small-volume, high-dose nebulized devices for which no safety data is as yet available. Longer-term adequately powered RCTs are needed on these safety issues.…”

Section: Viiie1 Crswnp Management:-saline (Spray and Irrigation)mentioning

confidence: 99%

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International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Viiie1 Crswnp Management:-saline (Spray and Irrigation)mentioning

confidence: 99%

“…Studies have shown that ESS increases the penetration of topical irrigation therapy from minimal absorption (<2%) to greater than 95% absorption. 717,774,775 Four RCTs and 6 systematic reviews have examined topical antibiotics in CRS (Table VII-18).…”

Section: Viie4 Crssnp Management: Antibioticsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

View full text Add to dashboard Cite

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“…[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. This difference brings about variable access and sinus penetration.…”

mentioning

confidence: 99%

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

Snidvongs

Kalish

Sacks

et al. 2013

Am J Rhinol�Allergy

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“…In studies similar to this pilot study, the amount of radiographic contrast used varied between 0.3 ml and 40 ml (drops, 1.5 ml per naris; 9 spray, 0.3-10 ml per naris; 5,8,9 syringe, 40 ml per naris; 5,8 and sinus wash, 20 ml per naris). 4 The smaller end of the spectrum was probably selected to reflect typical volumes used in nasal medications, whereas the larger amounts (i.e.…”

Section: 13mentioning

confidence: 99%

“…3 Contrast agents are employed by many imaging modalities and can easily improve signal-to-noise ratio by improving tissue contrast. Several studies used contrast agents, namely iodine, in the nasal and paranasal sinuses to assess nasal/sinus drug delivery using MDCT, 4,5 nuclear medicine [6][7][8] and CBCT. 9 To our knowledge, topical application of contrast agents in the upper airway as a method to enhance tissue contrast has not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Topical contrast agents to improve soft-tissue contrast in the upper airway using cone beam CT: a pilot study

Alsufyani

Noga²,

Finlay³

et al. 2013

Dentomaxillofacial Radiology

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The purpose of this study is to explore the topical use of radiographic contrast agents to enhance soft-tissue contrast on cone beam CT (CBCT) images. Different barium sulphate concentrations were first tested using an airway phantom. Different methods of barium sulphate application (nasal drops, syringe, spray and sinus wash) were then tested on four volunteers, and nebulized iodine was tested in one volunteer. CBCT images were performed and then assessed subjectively by two examiners for contrast agent uniformity and lack of streak artefact. 25.0% barium sulphate presented adequate viscosity and radiodensity. Barium sulphate administered via nasal drops and sprays showed non-uniform collection at the nostrils, along the inferior and/or middle nasal meatuses and posterior nasal choana. The syringe and sinus wash showed similar results with larger volumes collecting in the naso-oropharynx. Nebulized iodine failed to distribute into the nasal cavity and scarcely collected at the nostrils. All methods of nasal application failed to adequately reach or uniformly coat the nasal cavity beyond the inferior nasal meatuses. The key factors to consider for optimum topical radiographic contrast in the nasal airway are particle size, flow velocity and radio-opacity.

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Does Nasal Irrigation Enter Paranasal Sinuses in Chronic Rhinosinusitis?

Abstract: Nasal douche and spray is not effective in delivering a nasal irrigation solution into paranasal sinuses in chronic rhinosinusitis.

Cited by 68 publications

References 19 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

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

Topical contrast agents to improve soft-tissue contrast in the upper airway using cone beam CT: a pilot study

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