[Pari sinus inhalation versus metered pump spray in postoperative care after FESS]

Area of Science:

• Otolaryngology
• Rhinology
• Drug Delivery Systems

Background:

• Functional endoscopic sinus surgery (FESS) alters sinonasal anatomy, impacting topical drug delivery.
• Optimizing topical drug deposition is crucial for managing sinonasal conditions post-FESS.

Purpose of the Study:

• To compare the nasal deposition patterns of topical steroids delivered via metered pump spray versus an inhalation device (Pari sinus) after FESS.
• To assess the effectiveness of different topical drug application methods in reaching key sinonasal regions.

Main Methods:

• A comparative study involving 11 patients with healed sinonasal cavities post-FESS.
• Nasal steroid deposition visualized using sodium fluorescein, assessed via blue-light endoscopy.
• Deposition patterns analyzed immediately post-application and after nasal irrigation, with blinded evaluation.

Main Results:

• Metered pump spray application resulted in superior deposition compared to the inhalation device across all evaluated sinonasal locations.
• The anterior nasal cavity, middle turbinate head, and ethmoid regions showed the highest drug deposition.
• Limited drug reached the maxillary sinus, sphenoid sinus, olfactory cleft, and frontal sinus recess; the frontal sinus was never reached.

Conclusions:

• Postoperative topical nasal steroid deposition following FESS is suboptimal with current delivery methods.
• There is a clear need for the development of enhanced devices and techniques to improve topical treatment efficacy in the sinonasal cavity.