Delivery of Topical Therapies

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease of the sinonasal passages. Similar to other chronic inflammatory diseases, an essential component of the long-term control is prolonged medical therapy. To minimize the risk of adverse effects and cumulative complications of systemic medications, topical sinonasal therapy has become the primary strategy for prolonged medical therapy. The objective of this review article is to describe the evidence for the most common topical sinonasal delivery techniques. Evidence supports that high-volume irrigations provide the most reliable delivery of medical therapy to the paranasal sinuses. Low-volume nasal sprays and drops provide reliable delivery to the nasal cavity and a degree of penetration into the middle meatus and olfactory cleft; however, they do not reliably penetrate the paranasal sinuses. Sinus surgery and the head down-forward position optimize the delivery of high-volume irrigations into the paranasal sinuses. Additionally, high-volume irrigations assist in overcoming unfavorable nasal anatomy such as septal deviation and turbinate hypertrophy.