Affiliation:
1. Department of Otolaryngology‐Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York–Presbyterian Hospital New York New York USA
2. Department of Otolaryngology–Head and Neck Surgery Emory University School of Medicine Atlanta Georgia USA
3. Department of Otolaryngology–Head and Neck Surgery University of California San Diego School of Medicine La Jolla California USA
4. Department of Otolaryngology–Head and Neck Surgery Medical University of South Carolina Mt. Pleasant South Carolina USA
5. Department of Otolaryngology–Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
6. Department of Otorhinolaryngology–Head and Neck Surgery University of Pennsylvania Health System Philadelphia Pennsylvania USA
Abstract
AbstractBackgroundEustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS).MethodsSixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0‐ to 3‐point scale, with ratings averaged for analysis.ResultsInterrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21–10.09; p = 0.021) and post‐ESS (OR, 9.00; 95% CI, 1.95–41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44–104.85; p = 0.001).ConclusionsEDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.
Subject
Otorhinolaryngology,Immunology and Allergy