Development of an apparatus and procedure for evaluating the efficiency of nasal irrigation.

Publisher: Springer International Country of Publication: Germany NLM ID: 9002937 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-4726 (Electronic) Linking ISSN: 09374477 NLM ISO Abbreviation: Eur Arch Otorhinolaryngol Subsets: MEDLINE

Original Publication: Heidelberg : Springer International, c1990-

Nasal Cavity*/diagnostic imaging ; Nasal Lavage*/methods; Humans ; Tomography, X-Ray Computed ; Turbinates ; Water

Background: Although different methods of nasal irrigation have been utilized, irrigation efficiency in nasal cavities has not been well assessed. The objective of this study was to develop an apparatus and procedure for evaluating the irrigation efficiency and to explore the optimal head position during irrigation.
Methods: Casts of the left sinonasal cavity from a healthy volunteer were made from high-resolution-computed tomography data using 3D printing with composite materials. An adjustable apparatus that allowed cast fixation at the different head positions was built. The yogurt was used to simulate mucus. The cast with 5 ml yogurt filled around the superior, middle, and inferior turbinate was fixed in six head positions including head tilt 10°, 45°, and 60° forward with or without leaning 30° to the right. The cast was irrigated with 120 ml, 175 ml, and 240 ml dyed water and was video recorded. The irrigation efficiency was calculated based on the weight difference of the cast before and after the irrigation.
Results: Most residual yogurt was located around the superior meatus after the irrigation under different volumes and head positions. The irrigation efficiency of the rinse bottle or the pulsatile device was volume dependent, with the highest irrigation efficiency under 240 ml water. When the left sinonasal cavity was irrigated, the head position of tilt 45° forward with leaning 30° to the right was the optimal head position for these two devices when compared to other positions. The pulsatile device with 240 ml water performed better than the rinse bottle with 240 ml water regarding the irrigation efficiency under the optimal head position (0.8700 ± 0.0138 vs 0.7536 ± 0.0099, p = 0.003).
Conclusions: The developed apparatus provided a potential method for evaluating the irrigation efficiency. The head position of tilt 45° forward with leaning 30° was suitable for patients to perform the nasal irrigation.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Comment in: Laryngorhinootologie. 2022 Nov;101(11):847-848. (PMID: 36328047)

Orlandi RR, Kingdom TT, Smith TL et al (2021) International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 11(3):213–739. (PMID: 10.1002/alr.22741)
Fokkens WJ, Lund VJ, Hopkins C et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58(S29):1–464. (PMID: 32078669)
Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA et al (2018) International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol 8(2):108–352. (PMID: 294386027286723)
Cabaillot A, Vorilhon P, Roca M, Boussageon R, Eschalier B, Pereirad B (2020) Saline nasal irrigation for acute upper respiratory tract infections in infants and children: a systematic review and meta-analysis. Paediatr Respir Rev 36:151–158. (PMID: 32312677)
Succar EF, Turner JH, Chandra RK et al (2019) Nasal saline irrigation: a clinical update. Int Forum Allergy Rhinol 9(S1):S4–S8. (PMID: 10.1002/alr.22330)
Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C et al (2018) Saline irrigation for allergic rhinitis. Cochrane Data Syst Rev. https://doi.org/10.1002/14651858.CD012597.pub2. (PMID: 10.1002/14651858.CD012597.pub2)
Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R (2012) Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy 26(5):119–125. (PMID: 10.2500/ajra.2012.26.3787)
Elkins MR, Bye PT (2011) Mechanisms and applications of hypertonic saline. J Royal Soc Med 104(1_suppl):2–5. (PMID: 10.1258/JRSM.2011.S11101)
Bonnomet A, Luczka E, Coraux C et al (2016) Non-diluted seawater enhances nasal ciliary beat frequency and wound repair speed compared to diluted seawater and normal saline. Int Forum Allergy Rhinol 6(10):1062–1068. (PMID: 10.1002/alr.21782)
Wormald PJ, Cain T, Oates L, Hawke L, Wong I (2004) A comparative study of three methods of nasal irrigation. Laryngoscope 114(12):2224–2227. (PMID: 10.1097/01.mlg.0000149463.95950.c5)
Chen PG, Murphy J, Alloju LM, Boase S, Wormald P-J (2017) Sinus penetration of a pulsating device versus the classic squeeze bottle in cadavers undergoing sinus surgery. Ann Otol Rhinol Laryngol 126(1):9–13. (PMID: 10.1177/0003489416671532)
Craig JR, Palmer JN, Zhao K (2017) Computational fluid dynamic modeling of nose-to-ceiling head positioning for sphenoid sinus irrigation. Int Forum Allergy Rhinol 7(5):474–479. (PMID: 10.1002/alr.21908)
Thomas WW 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ (2013) Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol 3(9):691–703. (PMID: 10.1002/alr.21172)
Mozzanica F, Preti A, Bandi F, Fazio E, Cardella A, Gallo S et al (2021) Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model. J Laryngol Otol 135(3):234–240. (PMID: 10.1017/S0022215120002662)
Barham HP, Hall CA, Hernandez SC et al (2020) Impact of Draf III, Draf IIb, and Draf IIa frontal sinus surgery on nasal irrigation distribution. Int Forum Allergy Rhinol 10(1):49–52. (PMID: 10.1002/alr.22447)
Grobler A, Weitzel EK, Buele A et al (2008) Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope 118(11):2078–2081. (PMID: 10.1097/MLG.0b013e31818208c1)
Harvey RJ, Goddard JC, Wise SK, Schlosser RJ (2008) Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg 139(1):137–142. (PMID: 10.1016/j.otohns.2008.04.020)
Bleier BS, Debnath I, Harvey RJ, Schlosser RJ (2011) Temporospatial quantification of fluorescein-labeled sinonasal irrigation delivery. Int Forum Allergy Rhinol 1(5):361–365. (PMID: 10.1002/alr.20041)
Snidvongs K, Chaowanapanja P, Aeumjaturapat S, Chusakul S, Praweswararat P (2008) Does nasal irrigation enter paranasal sinuses in chronic rhinosinusitis? Am J Rhinol 22(5):483–486. (PMID: 10.2500/ajr.2008.22.3221)
Siu J, Johnston JJ, Pontre B, Inthavong K, Douglas RG (2019) Magnetic resonance imaging evaluation of the distribution of spray and irrigation devices within the sinonasal cavities. Int Forum Allergy Rhinol 9(9):958–970. (PMID: 10.1002/alr.22376)
Djupesland PG, Messina JC, Palmer JN (2020) Deposition of drugs in the nose and sinuses with an exhalation delivery system vs conventional nasal spray or high-volume irrigation in Draf II/III post-surgical anatomy. Rhinology 58(2):175–183. (PMID: 31813944)
Hazeri M, Faramarzi M, Sadrizadeh S, Ahmadi G, Abouali O (2021) Regional deposition of the allergens and micro-aerosols in the healthy human nasal airways. J Aerosol Sci 152:105700. (PMID: 10.1016/j.jaerosci.2020.105700)
de Gabory L, Reville N, Baux Y, Boisson N, Bordenave L (2018) Numerical simulation of two consecutive nasal respiratory cycles: toward a better understanding of nasal physiology. Int Forum Allergy Rhinol 8(6):676–685. (PMID: 10.1002/alr.22086)
Inthavong K, Shang Y, Wong E, Singh N (2020) Characterization of nasal irrigation flow from a squeeze bottle using computational fluid dynamics. Int Forum Allergy Rhinol 10(1):29–40. (PMID: 10.1002/alr.22476)
Salati H, Bartley J, White DE (2020) Nasal saline irrigation—a review of current anatomical, clinical and computational modelling approaches. Respir Physiol Neurobiol 273:103320. (PMID: 10.1016/j.resp.2019.103320)
Singhal D, Weitzel EK, Lin E et al (2010) Effect of head position and surgical dissection on sinus irrigant penetration in cadavers. Laryngoscope 120(12):2528–2531. (PMID: 10.1002/lary.21092)
Harvey RJ, Schlosser RJ (2009) Local drug delivery. Otolaryngol Clin North Am 42(5):829–845. (PMID: 10.1016/j.otc.2009.07.005)
Griggs ZH, Williams AM, Craig JR (2019) Head and bottle angles achieved by patients during high-volume sinonasal irrigations. Am J Rhinol Allergy 33(3):302–309. (PMID: 10.1177/1945892419825612)
Shrestha K, Salati H, Fletcher D, Singh N, Inthavong K (2021) Effects of head tilt on squeeze-bottle nasal irrigation—a computational fluid dynamics study. J Biomech 123:110490. (PMID: 10.1016/j.jbiomech.2021.110490)
de Gabory L, Kérimian M, Baux Y, Boisson N, Bordenave L (2020) Computational fluid dynamics simulation to compare large volume irrigation and continuous spraying during nasal irrigation. Int Forum Allergy Rhinol 10(1):41–48. (PMID: 10.1002/alr.22458)

QML20190617 Beijing Hospitals Authority Youth Program; Z201100006820086 Beijing Science and Technology Nova Program; 82000954 Natural Science Foundation of Jilin Province; XMLX202136 Beijing Hospitals Authority Clinical Medicine Development of Special Funding

Keywords: 3D printing modeling; Apparatus; Head position; Irrigation efficiency; Nasal irrigation

059QF0KO0R (Water)

Date Created: 20220109 Date Completed: 20220706 Latest Revision: 20221107

20240829

10.1007/s00405-021-07249-8

34999922