Irrigation penetration of nasal delivery systems: A cadaver study

Abstract

Delivery of irrigant to maximally operated sinus cavities is variable and highly dependent on the method of nasal delivery. Use of these systems should be tailored appropriately for the desired effect.

Frontal sinus surgery and sinus distribution of nasal irrigation

“…For high-volume devices, proper head position may be less critical for solutions to reach the sinuses in the postoperative state. 7,9 In this study, surgical state was the most significant factor in improving irrigation distribution to the frontal sinus. A standard Draf IIa frontal sinusotomy resulted in poor distribution to the frontal sinus in 50% of irrigations, regardless of head position and irrigation volume.…”

“…It has been demonstrated that more extensive sinus surgery results in improved "sinus" distribution of irrigation solutions. 7 The goal of this study was to evaluate different surgical modifications of the frontal recess in regard to distribution of topical therapies to the frontal sinus (Draf IIa vs Draf III); a secondary aim was to assess the influence of irrigation volume and head position to frontal sinus distribution.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…High-volume devices (>60 mL, but generally >100 mL) or heavy irrigators have been found to The Lying-Head-Back position was superior improve delivery into the sinuses. 811,812 This definition of "high-volume" is rather arbitrary, but clinical evidence suggests it may play an important role for mechanical cleaning or lavage and drug delivery. 700 High-volume devices can unfortunately carry unwanted side effects, with Eustachian tube dysfunction and local irritation reported in up to one-fourth of patients.…”

“…However, in the postoperative cavity, sinus delivery is improved with the head down and forward position, although the influence of head position is overcome with high-volume devices, especially to the frontal sinus. 811,812 The head down and forward position appears to be optimal for topical delivery into the sinuses but may be impractical or difficult for those with limited mobility. For high-volume devices, proper head position is less critical for solutions to reach the sinuses in the postoperative state.…”

Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

“…1 Recently there has been a perception that sprays and aerosols are not able to reach paranasal sinuses, and that, in most cases, these products do not even reach the middle meatus area. If that is so, such methods should be disregarded in favor of high-volume methods, 14,15 with a daily irrigation of at least 200 mL. 11 In view of evidence of superiority of high volume/pressure solutions with respect to sinus penetration, nasal irrigation with corticosteroids at daily doses ranging from 250 g to 1 mg of budesonide have been used, with encouraging results.…”