The effect of inferior turbinate hypertrophy on nasal spray distribution to the middle meatus

Abstract

The distribution of topical nasal sprays is suboptimal, the main obstruction to adequate delivery in normal volunteers being the nasal valve. We aimed to test the hypothesis that, in patients with rhino-sinusitis, hypertrophy of the inferior turbinate also limits the distribution of administered drug to the middle meatus. We modelled the effect of inferior turbinate hypertrophy and reduction by effecting congestion (by ipsilateral isometric exercise) and decongestion (topical oxymetazoline) in normal volunteers. The method chosen to estimate drug delivery to the middle meatus used endoscopic photography after the administration of dyed aqueous spray. A randomized cross-over study design was used and 20 nasal cavities were studied. The congestion/decongestion manoeuvres significantly altered nasal airflow, as measured by peak inspiratory nasal flow (P < 0.001). Congestion diminished significantly drug delivery to the middle meatus, as compared with decongestion (P = 0.026). This may support a clinical role for inferior turbinate reduction to improve the efficacy of topical nasal therapy, as well as improving nasal airflow.

Effects of septal deviation on the airflow characteristics: Using computational fluid dynamics models

“…The exclusion criteria were as follows: significantly abnormal anatomic structure, previous nasal surgery, history of rhinitis, or any related diseases in the nose or sinuses, upper respiratory tract infection within the previous month, use of topical steroids or any related medical drugs in the nose [8,12]. Fifteen patients with septal deviation, who attended our hospital between January and May 2010, underwent the same examinations.…”

Drug delivery in the nasal cavity after functional endoscopic sinus surgery: a computational fluid dynamics study

“…5 Various researchers have monitored drug deposition within the nose using in vivo human studies involving computed tomography (CT), 6 gamma scintigraphy with radio-enhanced particles, 7 and endoscopic video imaging using dyed test formulations. 8,9 However, these techniques are invasive and/or difficult to implement in live human subjects, and may involve radiation exposure or deposition of foreign particles within the lung.…”

A Computational Fluid Dynamics Model for Drug Delivery in a Nasal Cavity with Inferior Turbinate Hypertrophy

“…(6,7) These techniques are invasive or difficult to implement in human studies, and could cause exposure to radiation or lung deposition of foreign particles. In addition, the need to decongest the nose to perform endoscopic examinations is a pitfall because the operation results may not be general and cannot extrapolate to patients with rhinosinusitis.…”