1
|
Cnockaert P, Vecellio L, Dubus JC, Jamar F, Reychler G. A large-volume low-pressure nasal irrigation delivers drug into the nasal cavity? An in vivo study. Drug Deliv Transl Res 2024; 14:1232-1238. [PMID: 37882984 DOI: 10.1007/s13346-023-01455-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
The nasal administration route emerged as an interesting route in systemic and brain drug delivery, and different modalities of nasal delivery are available. The nasal irrigation is one of them, but there is a lack of studies investigating the distribution of a large-volume irrigation. The main aim of this study was to assess the deposition of radiolabeled saline in the nasal cavities and paranasal sinuses following nasal irrigation by imaging. Five healthy males volunteered to perform large-volume low-pressure nasal irrigation, with a douching device containing 50 mL of radiolabeled isotonic saline. Participants underwent a scintigraphy immediately after. Both the nasal cavities and maxillary sinuses were systematically reached by the solution during nasal irrigation. The sinuses set in a lower position during nasal irrigation showed a tendency to be more irrigated than the sinuses set in a higher position (7.67% vs 22.72%; p = 0.086). Moreover, substantial inter- and intraindividual heterogeneity regarding solution deposition was observed. Large-volume low-pressure nasal irrigation is a good modality to reach the maxillary sinuses as well as the nasal cavities. In order to ensure adequate reaching of both nasal cavities and paranasal sinuses, nasal irrigation should be performed bilaterally.
Collapse
Affiliation(s)
- Pierre Cnockaert
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Louvain-La-Neuve, Belgium
| | | | - Jean-Christophe Dubus
- Pneumologie et allergologie pédiatrique, CHU Timone-Enfants, Marseille, France
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - François Jamar
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium
- Service de Médecine Nucléaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium.
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.
- Haute Ecole Vinci, Secteur Santé, Département de kinésithérapie, Brussels, Belgium.
| |
Collapse
|
2
|
Seifelnasr A, Zare F, Si XA, Xi J. Optimized gravity-driven intranasal drop administration delivers significant doses to the ostiomeatal complex and maxillary sinus. Drug Deliv Transl Res 2023:10.1007/s13346-023-01488-4. [PMID: 38044376 DOI: 10.1007/s13346-023-01488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Chronic and allergic rhinosinusitis impacts approximately 12% of the global population. Challenges in rhinosinusitis treatment include paranasal sinus inaccessibility and variability in delivery efficiency among individuals. This study addresses these challenges of drug delivery by developing a high-efficiency, low-variability protocol for nasal drop delivery to the ostiomeatal complex (OMC) and maxillary sinus. Patient-specific nasal casts were dissected to reveal the configurations of conchae and meatus, providing insights into anatomical features amendable for sinus delivery. Fluorescent dye-enhanced videos visualized the dynamic liquid translocation in transparent nasal casts, allowing real-time assessment and quick adjustment to delivery parameters. Dosimetry to the OMC and maxillary sinus were quantified as drop count and mass using a precision scale. Key delivery factors, including the device type, formulation, and head-chin orientation, were systematically investigated in a cohort of ten nasal casts. Results show that both the squeeze bottle and soft-mist nasal pump yielded notably low doses to the OMC with high variability, and no dose from these two devices was detected within the maxillary sinuses. In contrast, the proposed approach, which included a curved nozzle surpassing the nasal valve and leveraged gravity-driven liquid translocation along the lateral nasal wall, delivered significant doses to the OMC and maxillary sinus. Iterative experimentations identified the optimal head tilt to be 40° and chin tilt to be° from the lateral recumbent position. Statistical analyses established the drop count required for effective OMC/sinus delivery. The proposed delivery protocol holds the potential to enhance chronic rhinosinusitis treatment outcomes with low variability. The dual role of nasal anatomy in posing challenges and offering opportunities highlights the need for future investigations using diverse formulations in a larger cohort of nasal models. Optimized gravity-driven intranasal drop administration delivers significant doses to the ostiomeatal complex and maxillary sinus.
Collapse
Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA
| | - Farhad Zare
- Department of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Xiuhua April Si
- Department of Mechanical Engineering, California Baptist University, Riverside, CA, USA
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA.
| |
Collapse
|
3
|
Koch EV, Bendas S, Nehlsen K, May T, Reichl S, Dietzel A. The Path from Nasal Tissue to Nasal Mucosa on Chip: Part 2-Advanced Microfluidic Nasal In Vitro Model for Drug Absorption Testing. Pharmaceutics 2023; 15:2439. [PMID: 37896199 PMCID: PMC10610000 DOI: 10.3390/pharmaceutics15102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The nasal mucosa, being accessible and highly vascularized, opens up new opportunities for the systemic administration of drugs. However, there are several protective functions like the mucociliary clearance, a physiological barrier which represents is a difficult obstacle for drug candidates to overcome. For this reason, effective testing procedures are required in the preclinical phase of pharmaceutical development. Based on a recently reported immortalized porcine nasal epithelial cell line, we developed a test platform based on a tissue-compatible microfluidic chip. In this study, a biomimetic glass chip, which was equipped with a controlled bidirectional airflow to induce a physiologically relevant wall shear stress on the epithelial cell layer, was microfabricated. By developing a membrane transfer technique, the epithelial cell layer could be pre-cultivated in a static holder prior to cultivation in a microfluidic environment. The dynamic cultivation within the chip showed a homogenous distribution of the mucus film on top of the cell layer and a significant increase in cilia formation compared to the static cultivation condition. In addition, the recording of the ciliary transport mechanism by microparticle image velocimetry was successful. Using FITC-dextran 4000 as an example, it was shown that this nasal mucosa on a chip is suitable for permeation studies. The obtained permeation coefficient was in the range of values determined by means of other established in vitro and in vivo models. This novel nasal mucosa on chip could, in future, be automated and used as a substitute for animal testing.
Collapse
Affiliation(s)
- Eugen Viktor Koch
- Institute of Microtechnology, TU Braunschweig, Alte Salzdahlumer Str. 203, 38124 Braunschweig, Germany
- Center of Pharmaceutical Engineering, Franz-Liszt Str. 35 a, 38106 Braunschweig, Germany; (S.B.)
| | - Sebastian Bendas
- Center of Pharmaceutical Engineering, Franz-Liszt Str. 35 a, 38106 Braunschweig, Germany; (S.B.)
- Institute of Pharmaceutical Technology and Biopharmaceutics, TU Braunschweig, Mendelssohnstr. 1, 38106 Braunschweig, Germany
| | | | - Tobias May
- InSCREENeX GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany
| | - Stephan Reichl
- Center of Pharmaceutical Engineering, Franz-Liszt Str. 35 a, 38106 Braunschweig, Germany; (S.B.)
- Institute of Pharmaceutical Technology and Biopharmaceutics, TU Braunschweig, Mendelssohnstr. 1, 38106 Braunschweig, Germany
| | - Andreas Dietzel
- Institute of Microtechnology, TU Braunschweig, Alte Salzdahlumer Str. 203, 38124 Braunschweig, Germany
- Center of Pharmaceutical Engineering, Franz-Liszt Str. 35 a, 38106 Braunschweig, Germany; (S.B.)
| |
Collapse
|
4
|
Jin L, Tan S, Fan K, Wang Y, Yu S. Research Progress of Hydrogen on Chronic Nasal Inflammation. J Inflamm Res 2023; 16:2149-2157. [PMID: 37220503 PMCID: PMC10200111 DOI: 10.2147/jir.s413179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/06/2023] [Indexed: 05/25/2023] Open
Abstract
Chronic nasal mucosal inflammatory disease is a common nasal disease, which is involved by inflammatory cells and a variety of cytokines. Its main pathological features are inflammatory reaction, increased secretion, mucosal swelling and thickening of nasal cavity or paranasal sinuses.It mainly includes chronic rhinitis (divided into allergic rhinitis, non-allergic rhinitis), chronic sinusitis (divided into with nasal polyps, without nasal polyps type), etc.The main symptoms of chronic rhinitis are nasal itching, sneezing, runny nose, and nasal congestion. The main symptoms of chronic sinusitis are nasal congestion, purulent or sticky nasal discharge, headache, and reduced sense of smell. They are a type of disease with a high incidence rate and seriously affect the quality of human life.Although the etiology and treatment of this type of disease have been extensively studied, there are still many aspects that are unclear.Currently, oxidative stress is believed to be an important link in the pathogenesis of chronic inflammatory diseases of the nasal mucosa. Therefore, anti-oxidative stress is a direction of research for the treatment of chronic nasal mucosal inflammatory diseases.Hydrogen, as a medically therapeutic gas, has been extensively studied for its antioxidant, anti-inflammatory, and anti-damage properties, and has been used in the treatment of various diseases.Although there are relatively few studies on the use of hydrogen for nasal inflammation, its positive effects have also been found. This article systematically summarizes the relevant research on the use of hydrogen to improve chronic nasal mucosal inflammation, with the aim of clarifying the ideas and indicating the direction for further research in the future.
Collapse
Affiliation(s)
- Ling Jin
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
| | - Shiwang Tan
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
| | - Kai Fan
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
| | - Yang Wang
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
| | - Shaoqing Yu
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
- Department of Allergy, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People’s Republic of China
| |
Collapse
|
5
|
Senanayake P, Warfield-McAlpine P, Salati H, Bradshaw K, Wong E, Inthavong K, Singh N. The Impact of Adhesions on Nasal Airflow: A Quantitative Analysis Using Computational Fluid Dynamics. Am J Rhinol Allergy 2022; 37:273-283. [PMID: 36373577 DOI: 10.1177/19458924221137982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated. Objective We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects. Methods CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject's NA-free control model. Results 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs ( P < .001) and 0.63 °C for the internal valve NAs ( P < .001). Conclusion NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.
Collapse
Affiliation(s)
- Praween Senanayake
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | | | - Hana Salati
- School of Engineering, RMIT University, Melbourne, Australia
| | - Kimberley Bradshaw
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Kiao Inthavong
- School of Engineering, RMIT University, Melbourne, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
6
|
Salati H, Singh N, Khamooshi M, Vahaji S, Fletcher DF, Inthavong K. Nasal Irrigation Delivery in Three Post-FESS Models From a Squeeze-bottle Using CFD. Pharm Res 2022; 39:2569-2584. [PMID: 36056272 PMCID: PMC9556402 DOI: 10.1007/s11095-022-03375-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Purpose Nasal saline irrigation is highly recommended in patients following functional endoscopic sinus surgery (FESS) to aid the postoperative recovery. Post-FESS patients have significantly altered anatomy leading to markedly different flow dynamics from those found in pre-op or non-diseased airways, resulting in unknown flow dynamics. Methods This work investigated how the liquid stream disperses through altered nasal cavities following surgery using Computational Fluid Dynamics (CFD). A realistic squeeze profile was determined from physical experiments with a 27-year-old male using a squeeze bottle with load sensors. The administration technique involved a head tilt of 45-degrees forward to represent a head position over a sink. After the irrigation event that lasted 4.5 s, the simulation continued for an additional 1.5 s, with the head orientation returning to an upright position. Results The results demonstrated that a large maxillary sinus ostium on the right side allows saline penetration into this sinus. The increased volume of saline entering the maxillary sinus limits the saline volume available to the rest of the sinonasal cavity and reduces the surface coverage of the other paranasal sinuses. The average wall shear stress was higher on the right side than on the other side for two patients. The results also revealed that head position alters the sinuses’ saline residual, especially the frontal sinuses. Conclusion While greater access to sinuses is achieved through FESS surgery, patients without a nasal septum limits posterior sinus penetration due to the liquid crossing over to the contralateral cavity and exiting the nasal cavity early.
Collapse
Affiliation(s)
- Hana Salati
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, 2145, Westmead, New South Wales, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, 3004, Melbourne, Victoria, Australia
| | - Sara Vahaji
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - David F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, 2145, New South Wales, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia.
| |
Collapse
|
7
|
Jin L, Fan K, Tan S, Liu S, Ge Q, Wang Y, Ai Z, Yu S. The Beneficial Effects of Hydrogen-Rich Saline Irrigation on Chronic Rhinitis: A Randomized, Double-Blind Clinical Trial. J Inflamm Res 2022; 15:3983-3995. [PMID: 35873384 PMCID: PMC9296884 DOI: 10.2147/jir.s365611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Chronic rhinitis (CR) is a common chronic inflammation of the nasal mucosa. Nasal saline irrigation has been demonstrated to be an effective treatment for CR. In this study, we investigated the beneficial effects of hydrogen-rich saline irrigation as an anti-inflammatory irrigation therapy for CR and compared its effectiveness over saline irrigation. Hydrogen-rich saline (HRS) was investigated due to its antioxidant and anti-inflammatory properties. Methods A total of 120 patients with CR were randomly divided into two groups, patients irrigated with HR (HRS group) and the control group irrigated with saline (NS group). A randomized, double-blind control study was performed. The main observation index in this study was the total score of nasal symptoms (TNSS). In addition, eosinophilic protein (ECP) of the nasal secretions, nasal nitric oxide (nNO) levels, and levels of regulatory T cells (Treg) and regulatory B cells (Breg) were also compared between the two groups. Furthermore, patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were also evaluated based on serum-specific IgE positivity. Results After treatment, TNSS and nasal ECP in the two groups decreased significantly (P<0.05), with patients in the HRS group showing significantly lower levels compared to the NS group (P<0.05). There were no significant differences in Treg and Breg levels between the two groups. Subgroup analysis showed that TNSS in the AR-HRS group showed a more significant reduction compared to the AR-NS group (P<0.05); however, there were no significant differences for the other inflammatory biomarkers (P>0.05). ECP levels were reduced significantly in the NAR subgroup compared to NS irrigation (P<0.05). There were no obvious adverse events observed in patients during the entire treatment period. Conclusion Compared to saline irrigation, HRS nasal irrigation was found to improve CR clinical symptoms, especially in patients with AR. HRS could effectively be used for the clinical treatment of patients with CR. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/8YpkEFCYNzI
Collapse
Affiliation(s)
- Ling Jin
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Kai Fan
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Shiwang Tan
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Shangxi Liu
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Qin Ge
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Yang Wang
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, 200331, People's Republic of China
| | - Shaoqing Yu
- Department of Otolaryngology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, People's Republic of China
| |
Collapse
|
8
|
Wu D, Chang F, Hong J, Su B, Wei Y. A novel irrigation device with superior nasal irrigation efficiency to the classic rinse bottle. J Otolaryngol Head Neck Surg 2022; 51:19. [PMID: 35505412 PMCID: PMC9066877 DOI: 10.1186/s40463-022-00575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The ability of saline irrigation to detach the mucous and the flow-limiting effect of the nasal valve has not been well explored. The objective of this study was to compare the removal efficiency of a novel irrigation device with an extended nozzle versus a classic rinse bottle. Methods Transparent casts of the unoperated sinonasal cavity were made by 3D printing. Yogurt was used to simulate mucous. The cast filled with 5 ml yogurt was fixed in six head positions and irrigated with 120 ml, 175 ml, and 240 ml dyed water through the novel device and the rinse bottle. The irrigation efficiency was the ratio of the weight of yogurt washed away divided by the total weight of yogurt. Results The irrigation stream of a long nozzle with a side opening was different from the irrigation stream of the outlet within the nasal vestibule. The novel devices presented with continuous water stream directly upwards to the anterior part of the olfactory cleft. Depending on different head positions, it was easy for the novel devices to achieve an irrigation efficiency of 100% when the cast was irrigated with 120 ml or 175 ml water. There was still a tiny amount of yogurt left in the olfactory cleft when the cast was irrigated with 240 ml water under each head position for the rinse bottle. The irrigation efficiency was volume-dependent, and the average irrigation efficiency of the rinse bottle at 240 ml only reached 69.1%. Conclusions The novel irrigation device presented with superior nasal irrigation efficiency to the classic rinse bottle. A continuous water stream directly upwards to the anterior part of the olfactory cleft combined with an extended nozzle overcoming the flow-limiting effect of the nasal valve promotes nasal irrigation efficiency. Graphical Abstract ![]()
Collapse
Affiliation(s)
- Dawei Wu
- Department of Otolaryngology-Head and Neck Surgery, Peking University Third Hospital, Beijing, People's Republic of China.
| | - Feifan Chang
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People's Republic of China
| | - Junsheng Hong
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Baihan Su
- Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongxiang Wei
- Department of Otorhinolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| |
Collapse
|
9
|
Park DY, Choi JH, Kim DK, Jung YG, Mun SJ, Min HJ, Park SK, Shin JM, Yang HC, Hong SN, Mo JH. Clinical Practice Guideline: Nasal Irrigation for Chronic Rhinosinusitis in Adults. Clin Exp Otorhinolaryngol 2022; 15:5-23. [PMID: 35158420 PMCID: PMC8901942 DOI: 10.21053/ceo.2021.00654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
The Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean Rhinologic Society appointed a guideline development group (GDG) to establish a clinical practice guideline, and the GDG developed a guideline for nasal irrigation for adult patients with chronic rhinosinusitis (CRS). The guideline focuses on knowledge gaps, practice variations, and clinical concerns associated with nasal irrigation. Nasal irrigation has been recommended as the first-line treatment for CRS in various guidelines, and its clinical effectiveness has been demonstrated through a number of studies with robust evidence. However, no guidelines have presented a consistent nasal irrigation method. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. The committee developed 11 evidence-based recommendations. This guideline focuses on the evidence-based quality improvement opportunities deemed the most important by the GDG. Moreover, the guideline addresses whether nasal lavage helps treat CRS, what type of rinsing solution should be used, and the effectiveness of using additional medications to increase the therapeutic effect.
Collapse
Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Min Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seung-No Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
10
|
Development of an apparatus and procedure for evaluating the efficiency of nasal irrigation. Eur Arch Otorhinolaryngol 2022; 279:3997-4005. [PMID: 34999922 DOI: 10.1007/s00405-021-07249-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although different methods of nasal irrigation have been utilized, irrigation efficiency in nasal cavities has not been well assessed. The objective of this study was to develop an apparatus and procedure for evaluating the irrigation efficiency and to explore the optimal head position during irrigation. METHODS Casts of the left sinonasal cavity from a healthy volunteer were made from high-resolution-computed tomography data using 3D printing with composite materials. An adjustable apparatus that allowed cast fixation at the different head positions was built. The yogurt was used to simulate mucus. The cast with 5 ml yogurt filled around the superior, middle, and inferior turbinate was fixed in six head positions including head tilt 10°, 45°, and 60° forward with or without leaning 30° to the right. The cast was irrigated with 120 ml, 175 ml, and 240 ml dyed water and was video recorded. The irrigation efficiency was calculated based on the weight difference of the cast before and after the irrigation. RESULTS Most residual yogurt was located around the superior meatus after the irrigation under different volumes and head positions. The irrigation efficiency of the rinse bottle or the pulsatile device was volume dependent, with the highest irrigation efficiency under 240 ml water. When the left sinonasal cavity was irrigated, the head position of tilt 45° forward with leaning 30° to the right was the optimal head position for these two devices when compared to other positions. The pulsatile device with 240 ml water performed better than the rinse bottle with 240 ml water regarding the irrigation efficiency under the optimal head position (0.8700 ± 0.0138 vs 0.7536 ± 0.0099, p = 0.003). CONCLUSIONS The developed apparatus provided a potential method for evaluating the irrigation efficiency. The head position of tilt 45° forward with leaning 30° was suitable for patients to perform the nasal irrigation.
Collapse
|
11
|
Shrestha K, Salati H, Fletcher D, Singh N, Inthavong K. Effects of head tilt on squeeze-bottle nasal irrigation - A computational fluid dynamics study. J Biomech 2021; 123:110490. [PMID: 34022532 DOI: 10.1016/j.jbiomech.2021.110490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
Nasal irrigation is a widely recognized treatment for several sinonasal diseases. However, there is a lack of clear evidence-based guidelines for optimal irrigation delivery to improve lavage and topical drug delivery. This study uses computational fluid dynamics (CFD) to assess the effects of different head tilt positions on sinonasal coverage, residence time and shear stresses in squeeze-bottle nasal irrigation. A sinonasal cavity computational model was constructed from a high-resolution CT scan of a healthy, 25-year-old Asian female. The Volume of Fluid method was used to track the interface between the two immiscible fluids (air and water). The direction of gravity was varied to simulate different head tilt-positions (0° Straight, 45° Forward, 45° Left, 45° Right and 45° Backward) during nasal irrigation with 150 mL liquid via a squeeze bottle through the left nostril for 2 s with a 0.1 s acceleration/deceleration time. The results showed that the 45° backward head tilt position was the most effective in delivering irrigation to the ethmoid, frontal and sphenoid sinuses. Altering head tilt had minimal impact on irrigation delivery to the maxillary sinuses. Maximum wall shear stresses seen in localized areas of the sinus mucosa varied significantly with different head tilt angles. However, the difference in mean wall shear stress on the sinus surfaces was marginal with changing head tilt position. The findings suggest that an optimized head tilt position can be identified to improve liquid irrigation to targeted sinuses, as per treatment requirements (lavage and topical drug delivery).
Collapse
Affiliation(s)
- Kendra Shrestha
- Mechanical & Automotive Engineering, RMIT University, Bundoora, Victoria 3083, Australia
| | - Hana Salati
- Mechanical & Automotive Engineering, RMIT University, Bundoora, Victoria 3083, Australia
| | - David Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Australia
| | - Narinder Singh
- Dept of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Australia; School of Medicine, The University of Sydney, NSW 2006, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, RMIT University, Bundoora, Victoria 3083, Australia.
| |
Collapse
|
12
|
Salati H, Bartley J, White DE. Computational Fluid Dynamics Simulation of Wall Shear Stress and Pressure Distribution from a Neti Pot During Nasal Saline Irrigation. J Med Biol Eng 2021. [DOI: 10.1007/s40846-020-00589-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Can computational fluid dynamic models help us in the treatment of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2020; 29:21-26. [PMID: 33315616 DOI: 10.1097/moo.0000000000000682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review the recent literature (January 2017-July 2020) on computational fluid dynamics (CFD) studies relating to chronic rhinosinusitis (CRS), including airflow within the pre and postoperative sinonasal cavity, virtual surgery, topical drug and saline delivery (sprays, nebulizers and rinses) and olfaction. RECENT FINDINGS Novel CFD-specific parameters (heat flux and wall shear stress) are highly correlated with patient perception of nasal patency. Increased ostial size markedly improves sinus ventilation and drug delivery. New virtual surgery tools allow surgeons to optimize interventions. Sinus deposition of nasal sprays is more effective with smaller, low-inertia particles, outside of the range produced by many commercially available products. Saline irrigation effectiveness is improved using greater volume, with liquid entering sinuses via 'flooding' of ostia rather than direct jet entry. SUMMARY CFD has provided new insights into sinonasal airflow, air-conditioning function, the nasal cycle, novel measures of nasal patency and the impact of polyps and sinus surgery on olfaction. The deposition efficiency of topical medications on sinus mucosa can be markedly improved through parametric CFD experiments by optimising nasal spray particle size and velocity, nozzle angle and insertion location, while saline irrigation effectiveness can be optimized by modelling squeeze bottle volume and head position. More sophisticated CFD models (inhalation and exhalation, spray particle and saline irrigation) will increasingly provide translational benefits in the clinical management of CRS.
Collapse
|
14
|
Salati H, Bartley J, Yazdi SG, Jermy M, White DE. Neti pot irrigation volume filling simulation using anatomically accurate in-vivo nasal airway geometry. Respir Physiol Neurobiol 2020; 284:103580. [PMID: 33161119 DOI: 10.1016/j.resp.2020.103580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022]
Abstract
Nasal saline irrigation is frequently utilised in rhinosinusitis management, and after nasal and sinus surgery. Nasal saline irrigation improves mucociliary transport and assists inflammatory mediator and post-surgical debris removal. The aim of this study was to assess the influence different head positions, irrigation inflow nostril, and the nasal cycle have on Neti pot nasal saline volume filling within the nasal passages and maxillary sinuses. Computational fluid dynamics modelling using anatomically correct nasal geometry found only minor difference in nasal cavity volume filling with inflow from either side of the nose however both head position and inflow direction were both found to have a major influence on maxillary sinus volume filling. Computational modelling flow velocity results at the nasopharynx were validated using particle image velocimetry. It was also found that directing irrigation inflow into the patent side of the nose while in the head-back position achieved the highest volume filling of both maxillary sinuses.
Collapse
Affiliation(s)
- Hana Salati
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jim Bartley
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - Sina G Yazdi
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
| | - Mark Jermy
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
| | - David E White
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| |
Collapse
|
15
|
Dong D, Cai F, Huang S, Zhu X, Geng J, Liu J, Lv L, Zhang Y, Zhao Y. Assessment of three types of intranasal nebulization devices in three‐dimensional printed models and volunteers: a pilot study. Int Forum Allergy Rhinol 2020; 10:1300-1308. [PMID: 32687694 DOI: 10.1002/alr.22657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Dong Dong
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, China
| | - Fangyu Cai
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuman Huang
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyuan Zhu
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Geng
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Lv
- College of Information Science and Engineering, Henan University of Technology, Zhengzhou, China
| | - Yanbing Zhang
- School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, China
| | - Yulin Zhao
- Department of Rhinology, The ENT Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|