The effect of functional endoscopic sinus surgery on nasal spray distribution to the middle meatus in patients with rhinosinusitis

Minimally invasive surgery under local anaesthesia for chronic rhinosinusitis with nasal polyps: our experience in older adults

OBJECTIVE

This paper aims to report our experience with a minimally invasive surgical procedure for the treatment of chronic rhinosinusitis with nasal polyps, performed in a day-surgery setting under local anaesthesia.

METHODS

A retrospective study of 30 patients with chronic rhinosinusitis with nasal polyps was conducted. Sino-Nasal Outcome Test 22 and modified Lund-Kennedy scores were collected. Intra- and post-operative pain was evaluated using a 10-point visual analogue scale.

RESULTS

The mean Sino-Nasal Outcome Test 22 score decreased from 41.8 ± 15.8 pre-operatively to 13.3 ± 9.5 post-operatively (p < 0.001). Accordingly, the mean endoscopic score decreased from 6.8 ± 1.8 to 0.2 ± 0.7 (p < 0.001). The mean intra-operative pain score was 2.9 ± 3.2, and 29 patients (96.7 per cent) reported no pain in the post-operative period (visual analogue scale score = 0).

CONCLUSION

Our study confirms that minimally invasive surgery represents a safe, repeatable procedure that results in remarkable subjective and objective improvement, without intra- and post-operative pain or discomfort.

Septoplasty and decongestant improve distribution of nasal spray

This study prospectively examined the intranasal distribution of nasal spray after nasal septal correction and decongestant administration. A cohort of 20 patients was assessed for the distribution of nasal spray before and after nasal septum surgery. Sprays were dyed and administered one puff per nostril when patients hold their head up in an upright position. Before and after decongestant administration, the intranasal distribution was semi-quantitatively determined by nasal endoscopy. The results showed that the dyed drug was preferentially sprayed onto the nasal vestibule, the head of the inferior turbinate, the anterior part of septum and nasal floor. As far as the anterior-inferior segment of the nasal cavity was concerned, the distribution was found to be influenced neither by the decongestant nor by the surgery (P>0.05). However, both the decongestant and surgery expanded the distribution to the anatomical structures in the superior and posterior nasal cavity such as olfactory fissure, middle turbinate head and middle nasal meatus. No distribution was observed in the sphenoethmoidal recess, posterior septum, tail of inferior turbinate and nasopharynx. It was concluded that nasal septum surgery and decongestant administration significantly improves nasal spray distribution in the nasal cavity.

Radiographic distribution of drops and sprays within the sinonasal cavities

BACKGROUND

Topical nasal sprays are commonly prescribed for sinonasal disease. Nasal drops applied in a head-down position are described alternatively to sprays. Multiple research methods have investigated the deposition pattern of intranasal medications, each with limitations. This pilot study analyzed the use of a conebeam computed tomography (CBCT) scanner to study deposition patterns of intranasal sprays and drops using radiopaque contrast solution.

METHODS

Nine volunteers participated in this two-trial study. In trial 1, participants instilled 3 sprays of contrast into each nostril. After 3 minutes a CBCT scan was performed. In trial 2, 3 drops of contrast were instilled into the participants' nostrils in the "vertex-to-floor" position. Again, after 3 minutes a CBCT scan was performed. Two otolaryngologists and a neuroradiologist reviewed the images and scored 21 sites within the sinonasal cavity for the presence of contrast.

RESULTS

Contrast was detected in the nasal vestibule and inferior nasal vault in nearly every trial with the spray and drops. Nasal spray was more diffusely distributed within the nasal cavity and was detected at a greater proportion on the floor of the nose, inferior meatus, anterior inferior nasal cavity, and nasopharynx. Neither spray nor drops were consistently detected in spaces superior to the middle turbinate.

CONCLUSION

Radiopaque contrast delivered by nasal spray and drops were detected by the CBCT scanner, with a significant difference at one subsite. Neither spray nor drops were detected in superior nasal spaces. The CBCT scan provides an alternative to conventional CT scans in future studies using this technique.