1
|
Luong AU, Yong M, Hwang PH, Lin BY, Gopi P, Mohan V, Ma Y, Johnson J, Yen DM, DeMera RS, Bleier BS. Acoustic resonance therapy is safe and effective for the treatment of nasal congestion in rhinitis: A randomized sham-controlled trial. Int Forum Allergy Rhinol 2024; 14:919-927. [PMID: 37812532 DOI: 10.1002/alr.23284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Acoustic resonance therapy (ART) is a novel vibrational treatment that delivers patient-specific resonant frequency acoustic energy to the sinonasal cavities. In a pilot study, ART was effective for the acute treatment of nasal congestion. We conducted a sham-controlled randomized trial to validate the efficacy of ART when administered daily for 2 weeks. METHODS A total of 52 adult patients were enrolled in a multi-center, randomized, double-blinded, sham-controlled, interventional study evaluating ART administered by a vibrational headband. Patients received either active treatment or a non-therapeutic sham treatment twice daily over 2 weeks. Clinical endpoints were the average change in nasal congestion sub-score of the Total Nasal Symptom Score (TNSS) and the average change in composite TNSS. RESULTS ART resulted in a significantly greater mean change in the nasal congestion sub-score compared to sham (-0.87 [95% confidence interval [CI] -1.11, -0.62] vs. -0.44 [95% CI -0.64, -0.23], p = 0.008). ART also resulted in a significantly greater reduction in the composite TNSS versus sham, (-2.85 [95% CI -3.85, -1.85], vs. -1.32 [95% CI -2.27, -0.36], p = 0.027). The response rate, determined by a nasal congestion sub-score minimal clinically important difference of 0.23, was 80.8% for ART and 46.2% for sham, with an adjusted risk ratio of 1.95 (95% CI 1.26, 3.02, p = 0.003) in favor of ART. Safety endpoints showed no adverse events. CONCLUSION ART is a safe and effective non-pharmacologic alternative for the treatment of nasal congestion.
Collapse
Affiliation(s)
- Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Yong
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Bryant Y Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Vivek Mohan
- Sound Health Systems, Los Altos, California, USA
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jacob Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, Pennsylvania, USA
| | | | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Pourmehran O, Zarei K, Pourchez J, Vreugde S, Psaltis A, Wormald PJ. Advancements in acoustic drug delivery for paranasal sinuses: A comprehensive review. Int J Pharm 2023; 644:123277. [PMID: 37516215 DOI: 10.1016/j.ijpharm.2023.123277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Chronic rhinosinusitis (CRS) impacts patients' quality of life and healthcare costs. Traditional methods of drug delivery, such as nasal sprays and irrigation, have limited effectiveness. Acoustic Drug Delivery (ADD) using a nebulizer offers targeted delivery of drug to the sinuses, which may improve the treatment of CRS. This review examines the influence of aerosol particle characteristics, aero-acoustic parameters, inlet flow conditions, and acoustic waves on sinus drug delivery. Key findings reveal that smaller particles improve the ADD efficiency, whereas larger sizes or increased density impair it. The oscillation amplitude of the air plug in the ostium is crucial for the ADD efficiency. Introducing acoustic waves at the NC-sinus system's resonance frequency improves aerosol deposition within sinuses. Future research should address advanced models, optimizing particle characteristics, investigating novel acoustic waveforms, incorporating patient-specific anatomy, and evaluating long-term safety and efficacy. Tackling these challenges, ADD could offer more effective and targeted treatments for sinus-related conditions such as CRS.
Collapse
Affiliation(s)
- Oveis Pourmehran
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
| | - Kavan Zarei
- Faculty of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Jeremie Pourchez
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Alkis Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
| |
Collapse
|
3
|
Leclerc L, Prévôt N, Hodin S, Delavenne X, Mentzel H, Schuschnig U, Pourchez J. Acoustic Aerosol Delivery: Assessing of Various Nasal Delivery Techniques and Medical Devices on Intrasinus Drug Deposition. Pharmaceuticals (Basel) 2023; 16:135. [PMID: 37259287 PMCID: PMC9962259 DOI: 10.3390/ph16020135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 07/31/2023] Open
Abstract
This study aims to evaluate the impact of the nasal delivery technique and nebulizing technologies (using different frequencies of oscillating airflow) for acoustic aerosol targeting of maxillary sinuses. Sodium fluoride (chemical used as a marker), tobramycin (drug used as a marker) and 99mTc-DTPA (radiolabel aerosol) were used to assess the intrasinus aerosol deposition on a nasal cast. Two commercial medical devices (PARI SINUS nebulizer and NL11SN ATOMISOR nebulizer) and various nasal delivery techniques (one or two nostrils connected to the aerosol inlet, the patient with the soft palate closed or open during the acoustic administration of the drug, the presence or not of flow resistance in the nostril opposite to the one allowing the aerosol to be administered) were evaluated. The closed soft palate condition showed a significant increase in drug deposition even though no significant difference in the rest of the nasal fossae was noticed. Our results clearly demonstrated a higher intrasinus aerosol deposition (by a factor 2-3; respectively 0.03 ± 0.007% vs. 0.003 ± 0.0002% in the right maxillary sinus and 0.027 ± 0.006% vs. 0.013 ± 0.004% in the left maxillary sinus) using the acoustic airflow generated by the PARI SINUS compared to the NL11SN ATOMISOR. The results clearly demonstrated that the optimal conditions for aerosol deposition in the maxillary sinuses were obtained with a closed soft palate. Thus, the choice of the nebulizing technology (and mainly the frequency of the pulsating aerosol generated) and also the recommendation of the best nasal delivery technique are key factors to improve intrasinus aerosol deposition.
Collapse
Affiliation(s)
- Lara Leclerc
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| | - Nathalie Prévôt
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, Sainbiose U1059, F-42023 Saint-Etienne, France
- Nuclear Medicine Unit, CHU Saint-Etienne, F-42055 Saint-Etienne, France
| | - Sophie Hodin
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, Sainbiose U1059, F-42023 Saint-Etienne, France
| | - Xavier Delavenne
- Université Jean Monnet Saint-Étienne, Mines Saint-Etienne, INSERM, Sainbiose U1059, F-42023 Saint-Etienne, France
| | | | | | - Jérémie Pourchez
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| |
Collapse
|
4
|
Pourmehran O, Arjomandi M, Cazzolato B, Tian Z, Vreugde S, Javadiyan S, Psaltis AJ, Wormald PJ. Acoustic drug delivery to the maxillary sinus. Int J Pharm 2021; 606:120927. [PMID: 34303821 DOI: 10.1016/j.ijpharm.2021.120927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
Acoustic drug delivery (ADD) is an innovative method for drug delivery to the nose and paranasal sinuses and can be used to treat chronic rhinosinusitis (CRS). The underlying mechanism of ADD is based on the oscillatory exchange of air between the nasal cavity (NC) and the maxillary sinus (MS) through the ostium, which assists with the transfer of the drug particles from the NC to the sinuses. This study aims to examine the efficacy of ADD for drug delivery to the MS using an acoustic wave applied to nebulised aerosols entering the nostril. Here, the effect of acoustic frequency, amplitude, and nebulisation flowrate on the efficiency of ADD to the MS is investigated experimentally. A computational fluid dynamics model was also developed to understand the deposition and transport patterns of the aerosols. The results showed that superimposing an acoustic frequency of 328 Hz, which is the resonance frequency of the selected 3D printed model of the NC-MS combination, on the nebulised aerosols could improve the efficiency of the drug delivery to the MS by 75-fold compared with non-acoustic drug delivery case (p < 0.0001). The experimental data also shows that an increase in the amplitude of excitation, increases the concentration of aerosol deposition in the MS significantly; however, it reaches to a plateau at a sound pressure level of 120 dB re 20 µPa.
Collapse
Affiliation(s)
- Oveis Pourmehran
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia.
| | - Maziar Arjomandi
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Benjamin Cazzolato
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Zhao Tian
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Shari Javadiyan
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
5
|
Montigaud Y, Pourchez J, Leclerc L, Tillement O, Clotagatide A, Bal C, Pinaud N, Ichinose N, Zhang B, Perinel S, Lux F, Crémillieux Y, Prevot N. Nebulised Gadolinium-Based Nanoparticles for a Multimodal Approach: Quantitative and Qualitative Lung Distribution Using Magnetic Resonance and Scintigraphy Imaging in Isolated Ventilated Porcine Lungs. Int J Nanomedicine 2020; 15:7251-7262. [PMID: 33061379 PMCID: PMC7533906 DOI: 10.2147/ijn.s260640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose This study aims at determining lung distribution of gadolinium-based polysiloxane nanoparticles, AGuIX® (small rigid platform - SRP), as a potential theranostic approach by the pulmonary route. Methods First, the aerodynamic size distribution and the aerosol output rate were thoroughly characterized. Then, a multimodal approach using magnetic resonance (MR) and gamma-camera (GC) imaging allows to assess the deposition of the aerosolised nanoparticles in the respiratory tract using isolated ventilated porcine lungs. Results The SRP has proven to be radiolabelled by radioisotope with a good yield. Crude SRP or radiolabelled ones showed the same aerodynamic size distribution and output as a conventional molecular tracer, as sodium fluoride. With MR and GC imaging approaches, the nebulised dose represented about 50% of the initial dose of nanoparticles placed in the nebuliser. Results expressed as proportions of the deposited aerosol showed approximately a regional aerosol deposition of 50% of the deposited dose in the lungs and 50% in the upper airways. Each technique assessed a homogeneous pattern of deposited nanoparticles in Lungs. MR observed a strong signal enhancement with the SRP, similar to the one obtained with a commonly used MRI contrast agent, gadoterate meglumine. Conclusion As a known theranostic approach by intravenous administration, SRP appeared to be easily aerosolised with a conventional nebuliser. The present work proves that pulmonary administration of SRP is feasible in a human-like model and allows multimodal imaging with MR and GC imaging. This work presents the proof of concept of SRP nebulisation and aims to generate preclinical data for the potential clinical transfer of SRP for pulmonary delivery.
Collapse
Affiliation(s)
- Yoann Montigaud
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Lara Leclerc
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | | | - Anthony Clotagatide
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, France
| | | | | | | | - Bei Zhang
- Canon Medical Systems Europe, Zoetermeer, Netherlands
| | - Sophie Perinel
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, France
| | - François Lux
- Institut Lumière Matière, Université de Lyon, Villeurbanne, France.,Institut Universitaire de France (IUF), Paris, France
| | | | - Nathalie Prevot
- INSERM U 1059 Sainbiose, Université Jean Monnet, Saint-Etienne, France.,CHU Saint-Etienne, Saint-Etienne, France
| |
Collapse
|
6
|
Le Guellec S, Allimonnier L, Heuzé-Vourc’h N, Cabrera M, Ossant F, Pourchez J, Vecellio L, Plantier L. Low-Frequency Intrapulmonary Percussive Ventilation Increases Aerosol Penetration in a 2-Compartment Physical Model of Fibrotic Lung Disease. Front Bioeng Biotechnol 2020; 8:1022. [PMID: 32984287 PMCID: PMC7483496 DOI: 10.3389/fbioe.2020.01022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
In patients with fibrotic pulmonary disease such as idiopathic pulmonary fibrosis (IPF), inhaled aerosols deposit mostly in the less affected region of the lungs, resulting in suboptimal pharmacokinetics of airway-delivered treatments. Refinement of aerosol delivery technique requires new models to simulate the major alterations of lung physiology associated with IPF, i.e., heterogeneously reduced lung compliance and increased airway caliber. A novel physical model of the respiratory system was constructed to simulate aerosol drug delivery in spontaneously breathing (negative pressure ventilation) IPF patients. The model comprises upper (Alberta ideal throat) and lower airway (plastic tubing) models and branches into two compartments (Michigan lung models) which differ in compliance and caliber of conducting airway. The model was able to reproduce the heterogeneous, compliance-dependent reduction in ventilation and aerosol penetration (using NaF as a model aerosol) seen in fibrotic lung regions in IPF. Of note, intrapulmonary percussive ventilation induced a 2-3-fold increase in aerosol penetration in the low-compliance/high airway caliber compartment of the model, demonstrating the responsiveness of the model to therapeutic intervention.
Collapse
Affiliation(s)
- Sandrine Le Guellec
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- DTF Aerodrug, Tours, France
- Université de Tours, Tours, France
| | - Laurine Allimonnier
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Nathalie Heuzé-Vourc’h
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Maria Cabrera
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | | | - Jérémie Pourchez
- Mines Saint-Etienne, Univ. Lyon, Univ. Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, Saint-Etienne, France
| | - Laurent Vecellio
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
| | - Laurent Plantier
- INSERM, Research Center for Respiratory Diseases, U1100, Tours, France
- Université de Tours, Tours, France
- CHRU de Tours, Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Tours, France
| |
Collapse
|
7
|
Acoustically-driven drug delivery to maxillary sinuses: Aero-acoustic analysis. Eur J Pharm Sci 2020; 151:105398. [PMID: 32485346 DOI: 10.1016/j.ejps.2020.105398] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
Abstract
This paper investigates the effect of aero-acoustic parameters on the efficiency of acoustically-driven drug delivery (ADD) to human maxillary sinus (MS). To be more specific, the effect of the frequency, amplitude at the acoustic excitation, and the inlet mean flow rate on the efficiency of ADD to the MS is studied. Direct computational aero-acoustics, using a validated computational fluid dynamics (CFD) model, has been utilised to carry out the parametric study. The transport pattern of the particles (drugs) in the presence of an external acoustic field has been investigated through the discrete phase model. Extensive computational simulations have revealed that the most important parameter in acoustically-driven drug delivery to the MS is the amplitude of the oscillation of the air plug in the ostium, which is largest when the combination of nasal cavity and MS is at resonance. Also, it has been found that the amplitude of the inlet acoustic wave has a direct correlation with the efficiency of the drug delivery to the MS. Moreover, the inlet mean airflow rate adversely affects the efficiency of the drug delivery to the MS. The results of this study suggest that applying an external acoustic field after distributing the drug particles with no mean flow results in a better drug delivery than in the presence of an inlet mean flow.
Collapse
|
8
|
The impact of geometrical parameters on acoustically driven drug delivery to maxillary sinuses. Biomech Model Mechanobiol 2019; 19:557-575. [PMID: 31573057 DOI: 10.1007/s10237-019-01230-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
Acoustically driven nebulized drug delivery (acoustic aerosol delivery) is the most efficient noninvasive technique for drug delivery to maxillary sinuses (MS). This method is based on the oscillation of the air plug inside the ostium to transport drug particles from the nasal cavity (NC) to the MS. The larger the wavelength of the air plug oscillation in the ostium, the greater the penetration of drug particles to the MS. However, using this technique, the maximum drug delivery efficiency achieved to date is 5%, which means 95% of the aerosolized drugs do not enter the MS and are wasted. Since the largest amplitude of the air plug oscillation occurs at its resonance frequency, to achieve an improved MS drug delivery efficiency, it is important to determine the resonance frequency of the nose-sinus combination accurately. This paper aims to investigate the impact of geometrical parameters on the resonance frequency of the nose-sinus model. Both experimental and computational acoustic models, along with the theoretical analysis, were conducted to determine the resonance frequency of an idealized nose-sinus model. The computational modeling was carried out using computational fluid dynamics (CFD) and finite element analysis (FEA), whereas in the analytical solution, the mathematical relationships developed for a conventional Helmholtz resonator were employed. A series of experiments were also conducted to measure the resonance frequency of a realistic NC-MS combination. The results demonstrated a good agreement between the experimental and CFD modeling, while the FEA and theoretical analysis showed a significant deviation from the experimental data. Also, it was shown that the resonance frequency of the idealized nose-sinus model increases by up to twofold with increasing the ostium diameter from 3 to 9 mm; however, it has an inverse relationship with the ostium length and sinus volume. It was also reported that the resonance frequency of the nose-sinus model is independent of the NC width and MS shape.
Collapse
|