Irrigation penetration of nasal delivery systems: a cadaver study

To determine the sinus penetration potential of several commercially available irrigation systems in maximally operated sinus cavities; cadaveric study in a tertiary care center.

Seven fresh cadaver heads with brains removed were maximally dissected to include a Draf III frontal sinusotomy, wide maxillary antrostomy, and complete sphenoethmoidectomy. Drill-holes (4 mm) were created to allow visualization of the irrigations from within the respective sinus cavity. Seven commercially available irrigation systems were then tested according to manufacturer recommendation, and the data recorded using an ordinal scale for comparison.

Among the 3 atomized particle delivery systems tested, the squeeze atomizer took 1.15 attempts, the pump atomizer took 1.85 attempts, and the mechanized atomizer required 30 seconds of continuous application for intrasinus delivery of aerosol (p = 0.009). Penetration with 4 heavy irrigators showed significant variability depending on the sinus cavity being tested. The NeilMed irrigator showed more consistent penetration than any other tested device (p < 0.01). The other systems tested had varying degrees of efficacy, dependent on sinus cavity irrigated.

Delivery of irrigant to maximally operated sinus cavities is variable and highly dependent on the method of nasal delivery. Use of these systems should be tailored appropriately for the desired effect.