Sinonasal Conditions Research Articles

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study.

Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has exploredthe impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. Monocentric cross-sectionalobservational study. Consecutive patients affected by CRS withor without nasal polypsor by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), theSinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polypsand those suffering from CRS withoutnasal polyps or SDboth in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SDcompared to older.Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated. Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life(QoL) of patients affected by sinonasal conditions. According to our results,age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.

A systematic review of randomised controlled trials on topical nasal steroids.

Intranasal corticosteroids (INCs) are the first line of therapy for chronic sinonasal conditions such as rhinitis and rhinosinusitis. Among these, one of the most frequently used is beclomethasone dipropionate (BDP). Over the years many studies have evaluated the efficacy of BDP as part of therapy for chronic rhinosinusitis (CRS) and allergic rhinitis (AR) along with nasal washes, which seems to be very well tolerated. To analyse the data in the literature regarding the various therapeutic regimens of BDP in different sinonasal disease and their efficacy and tolerability. Using different search engines, the posology, efficacy, and tolerability of BDP were reviewed and a total of 64 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, 4 articles were reviewed. BDP is among the group of INCs with significant improvement of nasal symptoms and has good efficacy and safety. BDP nasal spray is one of the most frequently prescribed INC for rhinitis and rhinosinusitis. Treatment with BDP resulted in significant and clinically meaningful improvements in nasal symptoms associated with AR and CRS. BDP is well tolerated, and the safety profile is similar to that of placebo in most patients. These results, in conjunction with the significant benefit reported in subjects with CRS and AR, provide convincing evidence of the overall effectiveness of BDP for the treatment of the full spectrum of sinonasal disease.

Computational Fluid Dynamics and Its Potential Applications for the ENT Clinician.

This article is an examination of computational fluid dynamics in the field of otolaryngology, specifically rhinology. The historical development and subsequent application of computational fluid dynamics continues to enhance our understanding of various sinonasal conditions and surgical planning in the field today. This article aims to provide a description of computational fluid dynamics, the methods for its application, and the clinical relevance of its results. Consideration of recent research and data in computational fluid dynamics demonstrates its use in nonhistological disease pathology exploration, accompanied by a large potential for surgical guidance applications. Additionally, this article defines in lay terms the variables analyzed in the computational fluid dynamic process, including velocity, wall shear stress, area, resistance, and heat flux.

Threshold and suprathreshold component analysis in olfactory dysfunction: a retrospective study.

To analyse variations in the n-butanol threshold and odour identification scores of the Connecticut Chemosensory Clinical Research Centre test in various grades of olfactory dysfunction and in different nasal conditions leading to olfactory loss. Retrospective observational study. All grades of olfactory dysfunction were predominantly noted among males. In chronic rhinosinusitis, anosmia or severe hyposmia was seen in 87.5 per cent of patients without polyps in comparison with 68 per cent of patients with polyps. In addition, 90 per cent of patients with atrophic rhinitis and post-traumatic loss had anosmia, but only 30.7 per cent of patients with allergic rhinitis had anosmia. Pepper was the most affected smell for all the nasal diseases except atrophic rhinitis, in which asafoetida and baby powder smells were affected more. In most inflammatory sinonasal conditions, odour identification is relatively preserved even when the threshold is maximally affected. In patients with comparable olfactory dysfunction based on the Connecticut Chemosensory Clinical Research Centre test score, a relatively preserved suprathreshold odour identification score may predict better prognosis.

Normative Data for the 12-Item Sniffin' Sticks Odor Identification Test in Older Adults.

Quantitative olfactory assessment has demonstrated clinical utility for the evaluation of a range of neurologic, psychiatric, and sinonasal conditions. Here, we provide age, sex, race, and education-specific normative data for the 12-item Sniffin Sticks Odor Identification Test (SSOIT-12) in older Black and White U.S. adults without preclinical or clinical dementia or sinonasal disease. A sample of 2,224 Atherosclerosis Risk in Communities study participants aged 66-89years were included. A normative regression equation was developed using a linear model for the association of age, sex, race, and education with odor identification score. Regression-based normative mean scores and percentiles were generated by age, sex, race, and education groups. Participants (mean age = 74years, 59% women, 20% Black, 48% > high school education) had a mean SSOIT-12 score of 9.8. Age, sex, race, and education were all associated with odor identification performance (all ps < .05). A linear regression model for the predicted SSOIT-12 score was developed for use with an individual's actual SSOIT-12 score in order to calculate the Z-score and corresponding percentile for a specific age, sex, race, and education group. Data are also reported in tabular format. Our study provides SSOIT-12 normative data obtained from a large population of White and Black older adults without preclinical or clinical dementia or sinonasal disease living in the USA. These findings can aid clinicians in assessing the degree of olfactory loss, establishing concordance with a person's perception of olfactory difficulties and quantitatively monitoring changes in olfactory performance over time.

Otolaryngologic conditions in children with neonatal abstinence syndrome: A descriptive study

PurposeLiterature on otolaryngologic sequelae of children with neonatal abstinence syndrome (NAS) has been scarce to date. Prior reports suggest some otologic conditions associated with long-term NAS outcomes, but no comprehensive exploration of these relationships currently exists. This study aims to characterize the breadth of otolaryngologic conditions diagnosed in children with NAS. MethodsThis is a retrospective descriptive study conducted at a tertiary care hospital. We identified 524 children with NAS born between 1/1/2014 and 12/31/2019 who were evaluated by the otolaryngology department. Diagnoses were categorized as otologic, oropharyngeal, sinonasal, and laryngeal. Additional diagnoses of obstructive sleep apnea (OSA) and congenital abnormalities of head and neck were noted separately. Descriptive statistics were calculated, and ANCOVA testing analyzed for differences in mean number of diagnoses. Results680 total otolaryngologic diagnoses were analyzed across 524 patients. Otologic conditions comprised 39.7 % of total diagnoses, oropharyngeal conditions 26.8 %, sinonasal conditions 18.4 %, laryngeal conditions 5.3 %, OSA 1.5 %, and congenital abnormalities 8.3 %. After adjusting for covariates, there were a significantly higher number of otologic diagnoses compared to the other subcategories with mean (standard deviation) of 0.46 (0.83), followed by oropharyngeal 0.35 (0.55), sinonasal 0.24 (0.49), and laryngeal 0.07 (0.29). Thirty total otolaryngology-related procedures were performed in our sample, with myringotomy with tube insertion as the most common. ConclusionUnderstanding the otolaryngologic sequelae of children with NAS is important as these conditions impact children's early development. Our study also highlights various socioeconomic factors that may impact pediatric ENT care and the follow-up of patients born with NAS.

An Audit of Endoscopic Sinus Surgery at a Tertiary Hospital in Tanzania.

Being a frequently used approach by otorhinolaryngologists, Endoscopic sinus surgery (ESS) has been useful in the surgical management of different sinonasal conditions in this era. Although ESS is most commonly performed for inflammatory and infectious sinus diseases since its introduction in the 1960s by Prof. Messserklinger and Wigand, the current advancement in instrumentation has led to an increase in its indications. This study therefore aimed at auditing the ESS done at a tertiary hospital in our settings. This was a retrospective descriptive cross-sectional study which was conducted at Muhimbili National Hospital. It involved all patients who underwent ESS in the department of otorhinolaryngology. Information was extracted from patients' files, ledger, and admission books. The obtained data were analyzed using a statistical package for social sciences (SPSS) version 22. Descriptive statistics were performed to present the frequency distribution of the demographic characteristics, indications for ESS, and mean for the length of hospital stay. Out of 1261 surgeries done during the study period, 6.7% (84/1261) were endoscopic sinus surgeries. Of patients who underwent ESS, an almost equal proportion of males and females was found and ages ranged from 8 to 71 years with a mean age of 32 .2 ±16 .9 years. The commonest indication for ESS was sinonasal polyposis at 50.0% (42/84) followed by chronic rhinosinusitis at 20.4% (17/84). The majority of patients 52.4% (44/84) had a hospital stay of 1-3 days. The mean length of postoperative hospital stay following ESS in this study was found to be 2.8 days. Endoscopic sinus surgeries accounted for 6.7% of all surgeries with sinonasal polyposis being the commonest indication and the estimated mean length of postoperative hospital stay being 3 days.

Ecological momentary assessment of outcomes in allergic rhinitis and chronic rhinosinusitis: A review

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) rely on patient-reported symptoms and quality-of-life measures, which are subject to bias. Ecological momentary assessment (EMA) captures data in real time through repeated short surveys, thus reducing errors/biases. EMA's use in sinonasal conditions has not been well described, and the goal of this study was to examine the literature on EMA and AR/CRS. METHODS: A literature review was performed using the following search terms: AR, CRS, and EMA. Inclusion criteria were the use of EMA reporting of sinonasal symptoms at more than one time point. Systematic reviews and non-full text articles were excluded. Population demographics, sinonasal disease, type of EMA platform used, type and severity of symptoms reported, medication use and symptom correlation with location/pollen/pollution were collected. Eight studies met the inclusion criteria, and all focused on AR. All studies were conducted outside the United States in both children and adults. Seven studies used a smartphone application for reporting symptoms, and one used WeChat surveys. EMA data collection varied, with repetitive survey intervals determined either by patients (n=6) or research team (n=2). All studies reported sinonasal severity scores, while six reported additional symptoms (e.g., ocular, pulmonary, sleep, general health). Five collected self-reported allergy medication use. Seven studies correlated symptoms with location, pollen, or pollution. Few studies in AR and no studies in CRS assessed the use of EMA. EMA may provide a better understanding of the real-time relationship of environmental triggers with symptoms, in turn guiding treatment decisions.

Social Determinants of Health and Comorbid Conditions Related to Presentation in the Healthcare Setting Among Patients with Sinonasal Conditions Farhan Salman, Raktima Dasgupta, Kamal M. Eldeirawi, Sharmilee M. Nyenhuis, Victoria S. Lee

Social determinants of health (SDOH) and comorbid conditions (CMCs) influence the setting of presentation for care; however, few studies have explored this relationship in the context of sinonasal conditions. This study aims to characterize the relationship of SDOH and CMCs with types of healthcare presentation in patients with sinonasal conditions.

Liquid volume and squeeze force effects on nasal irrigation using Volume of Fluid modelling

For various sinonasal conditions, including chronic rhinosinusitis, saline irrigation is an accepted standard-of-care treatment. This study was aimed at determining the effect of increased irrigation volumes and greater squeeze force on mucosal irrigation. A sinonasal cavity computational model was reconstructed from high-resolution CT scans of a healthy, unoperated 25-year old female. Seven combinations of irrigation volumes (70, 150, 200, and 400 mL) and squeeze forces (ramp time 0.1, 0.5, and 1.0 s) at a fixed head tilt of 0 degrees to the horizontal (Frankfort position) were performed. Velocity, pressure, and wall shear stress, together with mapping of surface coverage and residual volumes at specific locations and time were demonstrated. Higher volume irrigation (400 mL) and greater squeeze force (ramp time 0.1 s) improved irrigation coverage on the ipsilateral and contralateral sinonasal surfaces and increased shear force (approximately 140 Pa). An increase in irrigation volume from 70 to 150 mL approximately doubled sinus surface coverage and from 70 to 200 mL tripled sinus surface coverage. A faster squeeze also contributed to increased sinus surface coverage but its effect was less influential. We infer that the greater irrigation volume and squeeze force improve therapeutic benefit in terms of lavage and distribution of topical medications.

Hypothalamic-pituitary-adrenal axis suppression and intranasal corticosteroid use: A systematic review and meta-analysis.

Intranasal corticosteroids (INCS) are used in the management of sinonasal conditions. Use of exogenous steroids can be associated with hypothalamic-pituitary-adrenal axis dysfunction and adrenal insufficiency (AI). We aimed to estimate the rate of AI after INCS use in a meta-analysis, stratified by steroid type and treatment duration. Ovid Medline, Embase Classic, PubMed, Web of Science, and CINAHL databases were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies investigating INCS use and AI. AI was defined as morning serum cortisol<550nmol/L and<80nmol/L with and without adrenocorticotropic hormone stimulation. INCS were classified as first (beclomethasone dipropionate, triamcinolone acetonide, beclomethasone, budesonide, dexamethasone) and second (ciclesonide, mometasone furoate, and fluticasone propionate) generation. Duration of treatment was classified as short (<1 month), medium (1-12 months), and long-term (>12 months) time periods. This search identified 3668 articles. A total of 39 studies (1678 patients) were included in the final analysis. The pooled percentage of AI for routinely utilized first- and second-generation INCS was 0.70% (95% confidence interval [CI], 0.29-1.12%). Stratified by type, AI was observed in 0.78% (95% CI, 0.25-1.30%) of first-generation and 0.58% (95% CI, -0.1% to 1.26%) of second-generation steroids. AI was seen in 0.48% (95% CI, -0.01% to 0.96%) of short-term, 1.13% (95% CI, 0.2-2.1%) of medium-term, and 1.67% (95% CI, 0.37-2.9%) of long-term use of INCS. Overall, the use of INCS carries a low risk for AI. Although modest, this risk may differ depending on the length of duration and type of INCS used. Informing patients of these risks is of importance for the treatment of chronic sinonasal conditions.

The role of CT and endoscopy in the evaluation of patients referred for intranasal Cryoablation

BackgroundCryoablation (CA) of the posterior nasal nerves has garnered increasing interest as an office-based procedure for chronic rhinitis (CR). Standardized preoperative evaluation, specifically the role of computed tomography (CT) and nasal endoscopy, has yet to be defined. We report a series of patients who underwent CT and endoscopy as part of CR work-up in patients referred for CA. ObjectiveHighlight the importance of both nasal endoscopy and CT scan in the evaluation of CR given significant overlap of symptoms and common occurrence of related sinonasal conditions. MethodsRetrospective analysis of all patients referred to a single tertiary rhinology practice for CA was performed. ResultsFifteen patients were sent for CA by medical allergists. Five patients were deemed CA candidates, and 1 patient received only medical CR treatment. Four patients had evidence of incomplete prior sinus surgery and/or continued chronic rhinosinusitis on endoscopic exam. These 4 patients received a combination of medical and surgical management with either complete resolution or improvement in CR symptoms. In 3 patients, CT confirmed chronic rhinosinusitis that was not apparent on endoscopy, and received a combination of medical and surgical management with symptom improvement. In the last two patients, final diagnoses were nasal valve collapse and recurrent acute rhinosinusitis. ConclusionsReferrals for CA are becoming more common and the optimal preoperative work up remains unclear. In this limited retrospective review, 67% of patients had diagnoses other than CR and thus were not deemed candidates for CA. Both CT and endoscopy are complementary to a detailed history and physical examination and can aid in CA candidate selection.

A historical review of the evolution of nasal lavage systems.

Nasal lavage is an ancient practice that still has a fundamental role in the management of sinonasal conditions. The history related to these devices is extensive and remarkable. By reviewing it, it is hoped that a broader view can be achieved on what is currently possible with nasal lavage and how advances may be made in the future. A careful review of different sources, such as ancient manuscripts, registered patents and scientific papers, was conducted to achieve a thorough examination of the history related to nasal rinsing devices. Nasal lavage has evolved significantly since first considered for medical use and has always played a central role in the treatment of patients with sinonasal conditions. Further innovation is still necessary to surmount the shortcomings of current nasal lavage systems.

Dupilumab Improves Asthma and Sinonasal Outcomes in Adults with Moderate to Severe Atopic Dermatitis

Dupilumab has demonstrated efficacy with acceptable safety in clinical trials in patients with moderate to severe atopic dermatitis (AD). To assess dupilumab's impact on asthma and sinonasal conditions in adult patients with moderate to severe AD in four randomized, double-blinded, placebo-controlled trials. In LIBERTY AD SOLO 1 (NCT02277743), SOLO 2 (NCT02755649), CHRONOS (NCT02260986), and CAFÉ (NCT02755649), patients received placebo, dupilumab 300 mg every 2 weeks (q2w), or dupilumab 300 mg weekly (qw). In CHRONOS and CAFÉ, patients received concomitant topical corticosteroids. This post hoc analysis assessed Asthma Control Questionnaire-5 (ACQ-5) scores in patients with asthma, Sino-Nasal Outcome Test-22 (SNOT-22) scores in patients with sinonasal conditions, and AD signs and symptoms in all patients. Of the 2444 patients, 463 had asthma with baseline ACQ-5 ≥ 0.5 (19%); 1171 had sinonasal conditions (48%); and 311 had both (13%). At week 16, ACQ-5 scores (least squares mean change from baseline [standard error]) improved by 0.27 (0.07), 0.59 (0.08), and 0.56 (0.07) in placebo-, q2w-, and qw-treated patients with asthma, respectively, whereas SNOT-22 scores improved by 5.1 (0.8), 9.9 (0.9), and 10.8 (0.8) in patients with sinonasal conditions (P < .01 for all dupilumab vs placebo). Improvements in ACQ-5 and SNOT-22 were also seen in patients with both conditions. Dupilumab also significantly improved AD signs and symptoms among all subgroups. In this first analysis of patients with comorbid moderate to severe AD, asthma, and/or chronic sinonasal conditions, dupilumab improved all three diseases in a clinically meaningful and statistically significant manner (vs placebo), based on validated outcome measures.

A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice.

BackgroundCommon sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient‐reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations.MethodsA search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis.ResultsIn total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5).ConclusionOverall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.

Nasal saline irrigation: prescribing habits and attitudes of physicians and pharmacists

Objectives To explore the opinions, the usage and the patient education given on nasal saline irrigation by physicians and pharmaceutical personnel working in Finland. Design An internet-based survey with predetermined, multiple-choice answers. Setting Primary care centres, occupational health centres and private care centres in Eastern Finland as well as pharmacies in Finland. Main outcome measures Healthcare professionals views, practice and general knowledge of nasal irrigation for sinonasal symptoms and conditions. Results We received 595 completed surveys (110 physicians, 485 pharmacists). The majority of the respondents recommended nasal saline irrigation for their patients either as a symptomatic treatment (98.0%) or to treat a specific condition (97.5%) such as acute rhinosinusitis, chronic rhinosinusitis and allergic rhinitis. Nasal saline irrigation was also often recommended as a prophylaxis for airway-infections (71.9%) and to enhance the health of the nasal mucosa (58.2%). In general, the possible adverse effects were recognised poorly by both professions. There was a clear difference between the two professions, as physicians were more conservative in recommending nasal saline irrigation and recognised possible adverse effects, such as epistaxis, pain, and dryness of the nose, better (75% vs. 59%, p = 0.002). Conclusions Nasal saline irrigation seems to be a popular treatment recommended by many health care professionals in Finland. Physicians and pharmaceutical personnel had variable opinions on the indications, utility and risks of nasal saline irrigation. There are also clear differences between physicians and pharmaceutical personnel’s practices. There is a need to better educate professionals about nasal saline irrigation and to further study whether nasal saline irrigation is efficient and safe option for the different common sinonasal conditions. KEY POINTS Little information is available on how physicians and pharmacists recommend nasal saline irrigation as a symptomatic treatment. Physicians and pharmacists seem to have variable opinions about the indications, utility and safety of nasal saline irrigation. The patient education given is in general very heterogenous. Both professions require more education to ensure that the usage remains as safe as possible for the patient.

Management of coexistent sinonasal pathology in patients undergoing endoscopic cerebrospinal fluid rhinorrhea repair

IntroductionPatients who undergo endoscopic cerebrospinal fluid rhinorrhea repair may occasionally present with coexistent sinonasal pathology which may or may not need to be addressed prior to surgical repair. Some patients may develop new onset nasal morbidity related to endoscopic repair. ObjectiveTo study the prevalence and management of additional sinonasal pathology in patients who undergo endoscopic repair of cerebrospinal fluid rhinorrhea MethodsA retrospective review of patients who underwent endoscopic cerebrospinal fluid leak repair was conducted to note the presence of coexistent sinonasal morbidity preoperatively and in the followup period. ResultsOf a total of 153 patients who underwent endoscopic closure of cerebrospinal fluid leak, 97 (63.4%) were female and 56 (36.6%) males. Most patients (90.2%) were aged between 21 and 60 years, with a mean of 40.8 years. Sixty-four patients (41.8%) were found to have coexistent sinonasal morbidity preoperatively, the commonest being symptomatic deviated nasal septum (17.6%), chronic rhinosinusitis without polyps (11.1%) and chronic rhinosinusitis with polyps (3.3%). Rare instances of septal hemangioma (0.7%) and inverting papilloma (0.7%) were also seen. Postoperatively, there was cessation of cerebrospinal fluid rhinorrhea in 96.7% which rose to 100% after revision surgery in those with recurrence. Resolution of coexistent sinonasal pathology occurred in all patients with followup ranging from 10 to 192 months. New onset sinonasal morbidity which developed postoperatively included synechiae between middle turbinate and lateral nasal wall (5.9%) and sinonasal polyposis (1.3%). ConclusionPatients who undergo endoscopic cerebrospinal fluid leak repair may have coexistent sinonasal pathology which needs to be addressed prior to or along with repair of the dural defect. New onset sinonasal morbidity, which may arise in a few patients postoperatively, may require additional treatment. A protocol for the management of coexistent sinonasal conditions ensures a successful outcome.

In vitro Comparison of Safety and Efficacy of Diluted Isotonic Seawater and Electrodialyzed Seawater for Nasal Hygiene.

BackgroundNasal irrigation is often used for managing sinonasal conditions and maintaining nasal hygiene, which is critical to overall nasal health and to provide protection against airborne contaminants and pathogens. However, studies comparing efficacies of different solutions are needed.PurposeThis in vitro study evaluated the ionic balance of an isotonic diluted seawater solution (Stérimar Nasal Hygiene, SNH) and its safety and efficacy for regular nasal hygiene in comparison to electrodialyzed seawater (EDS).Materials and MethodsIonic balance of SNH, EDS and pure seawater was measured by mass spectrometry and chromatography to be compared to the ionic balance of human plasma as reported in the literature. Safety was measured through cytotoxicity (lactate dehydrogenase release) and pro-inflammation (interleukin-8 secretion) assays using a 3D-reconstituted human nasal epithelium model. For efficacy, adenosine 5′-triphosphate (ATP) release assays, and histological (alcian blue) and immunohistochemical (aquaporin 3) stainings were performed on tissues under hypotonic challenge where saline solution was used as the negative control.ResultsCompared to EDS, the ionic balance of SNH was more similar to human plasma and pure seawater. SNH reduced hypotonic stress-associated ATP release and maintained tissue morphology more effectively and lastingly compared to EDS. Both solutions were safe to use on nasal epithelium, as neither of them caused cytotoxicity or induced (pro-) inflammation.ConclusionIn comparison to EDS, this study confirms the safety and efficacy of SNH in maintaining good nasal hygiene consistent with its benefits reported in clinical trials.

Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study.

BackgroundEndoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities.MethodsA normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures.ResultsThe analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models.ConclusionsA significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides.

Characterization of nasal irrigation flow from a squeeze bottle using computational fluid dynamics.

Nasal saline irrigation has become standard of care in various sinonasal conditions, including allergic and nonallergic rhinitis, chronic rhinosinusitis, and in the postoperative patient. Evidence regarding the mechanisms and dynamics of liquid flow through the sinonasal cavity remains limited due to inadequate experimental models (cadaveric, 3-dimensional [3D] printed, imaging of labeled dyes and radioisotopes). We aimed to develop a computational fluid dynamics (CFD) model of nasal irrigation to demonstrate sinonasal surface coverage, residence times across the mucosal surfaces, and shearing force of irrigation. A nasal cavity geometry derived from high-resolution paranasal sinus computed tomography (CT) scans of a healthy, unoperated, 25-year-old patient was created. CFD analysis was performed to assess the distribution of nasal irrigation from a tapered nozzle bottle at a forward head-tilt position of 45 degrees with a 2-second burst at 35 mL/second. The model demonstrates nasal irrigation from ipsilateral to contralateral with precise measures of velocity, pressure, wall shear stress, and mapping of surface coverage and residence times at specific locations and times. The nasal cavity experiences almost complete coverage of irrigation, while overflow from the nasal cavity facilitates moderate coverage of the ipsilateral maxillary (40%) and anterior ethmoid sinuses (30%). Negligible coverage of the sphenoid and frontal sinuses was noted. Detailed physical mechanisms of liquid irrigation injected from a commonly used squeeze bottle were shown. Ipsilateral maxillary and ethmoid sinus penetration are primarily due to overflow rather than direct jet entry, confirming the recommendation of larger volumes of irrigation to "flood" the sinus ostia.