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Becker S, Huppertz T, Möller W, Havel M, Schuster M, Becker AM, Sailer M, Schuschnig U, Johnson TR. Xenon-Enhanced Dynamic Dual-Energy CT Is Able to Quantify Sinus Ventilation Using Laminar and Pulsating Air-/Gas Flow Before and After Surgery: A Pilot Study in a Cadaver Model. FRONTIERS IN ALLERGY 2022; 3:829898. [PMID: 35386654 PMCID: PMC8974739 DOI: 10.3389/falgy.2022.829898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chronic rhinosinusitis is a common disease with a significant impact on the quality of life. Topical drug delivery to the paranasal sinuses is not efficient to prevent sinus surgery or expensive biologic treatment in a lot of cases as the affected mucosa is not reached. More efficient approaches for topical drug delivery are, therefore, necessary. In the current study, dual-energy CT (DECT) imaging was used to examine sinus ventilation before and after sinus surgery using a pulsating xenon gas ventilator in a cadaver head. Methods Xenon gas was administered to the nasal cavity of a cadaver head with a laminar flow of 7 L/min and with pulsating xenon-flow (45 Hz frequency, 25 mbar amplitude). Nasal cavity and paranasal sinuses were imaged by DECT. This procedure was repeated after functional endoscopic sinus surgery (FESS). Based on the enhancement levels in the different sinuses, regional xenon concentrations were calculated. Results Xenon-related enhancement could not be detected in most of the sinuses during laminar gas flow. By superimposing laminar flow with pulsation, DECT imaging revealed a xenon wash-in and wash-out in the sinuses. After FESS, xenon enhancement was immediately seen in all sinuses and reached higher concentrations than before surgery. Conclusion Xenon-enhanced DECT can be used to visualize and quantify sinus ventilation. Pulsating air-/gas flow was superior to laminar flow for the administration of xenon to the paranasal sinuses. FESS leads to successful ventilation of all paranasal sinuses.
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Affiliation(s)
- Sven Becker
- Department of Otolaryngology, Head and Neck Surgery, Tübingen University Hospital, Tübingen, Germany
- *Correspondence: Sven Becker
| | - Tilman Huppertz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Winfried Möller
- Institute of Lung Biology and Disease, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Munich, Germany
| | - Miriam Havel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Maria Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Anne Merle Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Martin Sailer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen University Hospital, Tübingen, Germany
| | | | - Thorsten R. Johnson
- Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
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Jiramongkolchai P, Patel S, Schneider JS. Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis. EAR, NOSE & THROAT JOURNAL 2021; 100:329-334. [PMID: 33683979 DOI: 10.1177/0145561321998521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. METHODS A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. RESULTS Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. CONCLUSIONS Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.
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Affiliation(s)
- Pawina Jiramongkolchai
- Department of Otolaryngology-Head and Neck Surgery, 12275Washington University School of Medicine in St. Louis, MO, USA
| | | | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, 12275Washington University School of Medicine in St. Louis, MO, USA
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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.
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Moghadam SJ, Navarro L, Leclerc L, Hodin S, Pourchez J. Toward smart Nebulization: Engineering acoustic airflow to penetrate maxillary sinuses in chronic rhinosinusitis. Int J Pharm 2018; 546:188-193. [PMID: 29778823 DOI: 10.1016/j.ijpharm.2018.05.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 11/15/2022]
Abstract
Treating chronic rhinosinusitis (CRS) by nebulization requires an airflow capable to deliver medication to deep target sites beyond the nasal valve. Fixed frequency acoustic airflow technology is currently available, mainly as post-surgical therapy, but still have not been able to realize the full potential of direct nose to paranasal sinuses delivery. Reported herein are the application of frequency sweep acoustic airflow and the optimization of its frequency range, sweep cycle duration and intensity. The resonant frequencies of the model's maxillary sinuses can be estimated using the Helmholtz resonator theory. Results indicated a resonant frequency of 479 Hz for the right maxillary sinus and one of 849 Hz for the left maxillary sinus. The highest intrasinus deposition within the experiments are from sweep cycle duration of 1 s, intensity of 80 dB, and frequency range of 100-850 Hz. The optimal range of frequency determined from experiments is in good agreement with the corresponding frequency range obtained from the Helmholtz resonator theory. Results reveal a significantly enhanced maxillary sinus drug deposition. This technique affords the potential of treating CRS.
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Affiliation(s)
- Shima Jowhari Moghadam
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France
| | - Laurent Navarro
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France
| | - Lara Leclerc
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France
| | - Sophie Hodin
- Université de Lyon, F-42023 Saint-Etienne, France; INSERM, U1059 Sainbiose, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France
| | - Jérémie Pourchez
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France.
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5
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Sanan A, Rabinowitz M, Rosen M, Nyquist G. Topical Therapies for Refractory Chronic Rhinosinusitis. Otolaryngol Clin North Am 2017; 50:129-141. [PMID: 27888909 DOI: 10.1016/j.otc.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Topical therapy has become an important tool in the otolaryngologist's armamentarium for refractory chronic rhinosinusitis (CRS). Daily high-volume sinonasal saline irrigation and standard metered-dose topical nasal steroid therapy are supported by the most evidence. Nonstandard topical sinonasal steroid therapies are a potential option for refractory CRS. Current evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using spray and nebulized techniques in routine cases of CRS. Stents are a new modality with preliminary data showing they are an option when traditional treatment has failed. Further research with long-term effects and outcomes studies for refractory CRS are needed.
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Affiliation(s)
- Akshay Sanan
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mindy Rabinowitz
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Marc Rosen
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gurston Nyquist
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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6
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Xi J, Si XA, Peters S, Nevorski D, Wen T, Lehman M. Understanding the mechanisms underlying pulsating aerosol delivery to the maxillary sinus: In vitro tests and computational simulations. Int J Pharm 2017; 520:254-266. [PMID: 28189854 DOI: 10.1016/j.ijpharm.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/15/2017] [Accepted: 02/05/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pulsating aerosol delivery has been demonstrated in depositing medications into paranasal sinuses. However, its mechanisms are not fully understood. Influences of the nasal anatomy and sound frequency on intrasinus delivery are not yet clear. OBJECTIVES This study aimed to gain a better understanding of the mechanisms for enhanced intrasinus delivery with pulsating sound. Specifically, effects of the pulsation frequency, ostium size, and sinus shape on the intrasinus dosage and resonance frequency would be examined. METHODS AND MATERIALS Both experiments and computational modeling were conducted to understand the pulsating aerosol delivery in both idealized (two-bottle) and realistic nose-sinus models. A computational model of intrasinus pulsation delivery was developed using COMSOL and was cross-validated with both experimental and theoretical results. RESULTS In contrast to previous studies, seemingly erratic relations between the intrasinus dosage and ostium diameter were observed in experiments, which suggested a more complicated particle transport mechanism. Improved agreement was achieved when grouping the ostium size and sinus volume into the resonance frequency, and therefore, validated the hypothesis that intrasinus deposition strongly depends on the resonance frequency. Extensive computational simulations revealed that the deposition was highest at the resonance frequency and decreased gradually at off-resonance frequencies. The resonance frequency depended on the ostium and sinus morphology, but was independent of the nasal cavity. CONCLUSION Results of this study verified the hypothesis of resonance being the mechanism for enhanced particle deposition in the maxillary sinus. A better knowledge of the relationship between sinus dosages, pulsating frequency, and nasal morphometry is essential for improving the design of intrasinus delivery devices.
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Affiliation(s)
- Jinxiang Xi
- School of Engineering and Technology, Central Michigan University, Mount Pleasant, MI, USA.
| | - Xiuhua April Si
- Department of Mechanical Engineering, California Baptist University, Riverside, CA, USA
| | - Shannon Peters
- School of Engineering and Technology, Central Michigan University, Mount Pleasant, MI, USA
| | - Dannielle Nevorski
- School of Engineering and Technology, Central Michigan University, Mount Pleasant, MI, USA
| | - Tianshu Wen
- School of Engineering and Technology, Central Michigan University, Mount Pleasant, MI, USA
| | - Mark Lehman
- Department of Speech-Language Pathology, Central Michigan University, Mount Pleasant, MI, USA
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Esposito S, Rosazza C, Sciarrabba CS, Principi N. Inhaled Antibiotic Therapy for the Treatment of Upper Respiratory Tract Infections. J Aerosol Med Pulm Drug Deliv 2017; 30:14-19. [DOI: 10.1089/jamp.2016.1300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Susanna Esposito
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Rosazza
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Calogero Sathya Sciarrabba
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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8
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Steroid transnasal nebulization in the treatment of chronic rhinosinusitis. Curr Opin Allergy Clin Immunol 2016; 16:39-44. [PMID: 26658013 DOI: 10.1097/aci.0000000000000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Chronic rhinosinusitis (CRS) is a challenging disease entity, affecting 8-15% of the general population. Topical steroids have been recommended as an integral part of the strategy for management of CRS. This review focuses on steroid transnasal nebulization as an alternative treatment option for CRS treatment. RECENT FINDINGS Modern inhalation devices comprise nebulizers, pressurized metered-dose inhalers and dry powder inhalers. Transnasal nebulization with pulsating flow can enhance sinus ventilation and increase drug deposition with longer residence time. Short-term steroid transnasal nebulization provides an effective and safe treatment option for CRS patients, as evidenced by significant clinically relevant improvements and lack of serious side-effects. The underlying mechanisms involve a combination of reduction in inflammatory cells, suppression of inflammatory cell-associated cytokines and chemotactic factors, and regulation of tissue remodeling. Efficacy of transnasal nebulization outweighs commonly used nasal sprays and nasal irrigation as delivery options for topical steroids; however, long-term safety with nebulized steroids needs to be investigated further. SUMMARY Steroid transnasal nebulization offers an alternative or a complementary treatment option to nasal sprays and nasal irrigation for management of patients with CRS. Long-term dose-dependent studies with nebulized steroids will be needed to fully appreciate the benefits of this treatment modality.
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El Merhie A, Navarro L, Delavenne X, Leclerc L, Pourchez J. A new Strategy to Improve Drug Delivery to the Maxillary Sinuses: The Frequency Sweep Acoustic Airflow. Pharm Res 2015; 33:1074-84. [PMID: 26718952 DOI: 10.1007/s11095-015-1851-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Enhancement of intranasal sinus deposition involves nebulization of a drug superimposed by an acoustic airflow. We investigated the impact of fixed frequency versus frequency sweep acoustic airflow on the improvement of aerosolized drug penetration into maxillary sinuses. METHODS Fixed frequency and frequency sweep acoustic airflow were generated using a nebulizing system of variable frequency. The effect of sweep cycle and intensity variation was studied on the intranasal sinus deposition. We used a nasal replica created from CT scans using 3D printing. Sodium fluoride and gentamicin were chosen as markers. RESULTS Studies performed using fixed frequency acoustic airflow showed that each of maxillary sinuses of the nasal replica required specific frequency for the optimal aerosol deposition. Intranasal sinus drug deposition experiments under the effect of the frequency sweep acoustic airflow showed an optimal aerosol deposition into both maxillary sinus of the nasal replica. Studies on the effect of the duration of the sweep cycle showed that the shorter the cycle the better the deposition. CONCLUSIONS We demonstrate the benefit of frequency sweep acoustic airflow on drug deposition into maxillary sinuses. However further in vivo studies have to be conducted since delivery rates cannot be obviously determined from a nasal replica.
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Affiliation(s)
- Amira El Merhie
- Ecole Nationale Supérieure des Mines, CIS-EMSE, Sainbiose UMR INSERM 1059, SFR FED 4166 - IFRESIS, F-42023, Saint-Etienne, France
| | - Laurent Navarro
- Ecole Nationale Supérieure des Mines, CIS-EMSE, Sainbiose UMR INSERM 1059, SFR FED 4166 - IFRESIS, F-42023, Saint-Etienne, France
| | - Xavier Delavenne
- Laboratoire de Pharmacologie - Toxicologie, Sainbiose UMR INSERM 1059, CHU de Saint-Etienne, F-42055, Saint-Etienne, France
| | - Lara Leclerc
- Ecole Nationale Supérieure des Mines, CIS-EMSE, Sainbiose UMR INSERM 1059, SFR FED 4166 - IFRESIS, F-42023, Saint-Etienne, France.
| | - Jérémie Pourchez
- Ecole Nationale Supérieure des Mines, CIS-EMSE, Sainbiose UMR INSERM 1059, SFR FED 4166 - IFRESIS, F-42023, Saint-Etienne, France
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10
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Leclerc L, Merhie AE, Navarro L, Prévôt N, Durand M, Pourchez J. Impact of acoustic airflow on intrasinus drug deposition: New insights into the vibrating mode and the optimal acoustic frequency to enhance the delivery of nebulized antibiotic. Int J Pharm 2015; 494:227-34. [PMID: 26276255 DOI: 10.1016/j.ijpharm.2015.08.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Abstract
AIM We investigated the impact of vibrating acoustic airflow, the high frequency (f≥100 Hz) and the low frequency (f≤45 Hz) sound waves, on the enhancement of intrasinus drug deposition. METHODS (81m)Kr-gas ventilation study was performed in a plastinated human cast with and without the addition of vibrating acoustic airflow. Similarly, intrasinus drug deposition in a nasal replica using gentamicin as a marker was studied with and without the superposition of different modes of acoustic airflow. RESULTS Ventilation experiments demonstrate that no sinus ventilation was observed without acoustic airflow although sinus ventilation occurred whatever the modes of acoustic airflow applied. Intrasinus drug deposition experiments showed that the high frequency acoustic airflow led to 4-fold increase in gentamicin deposition into the left maxillary sinus and to 2-fold deposition increase into the right maxillary sinus. Besides, the low frequency acoustic airflow demonstrated a significant increase of 4-fold and 2-fold in the right and left maxillary sinuses, respectively. CONCLUSION We demonstrated the benefit of different modes of vibrating acoustic airflow for maxillary sinus ventilation and intrasinus drug deposition. The degree of gentamicin deposition varies as a function of frequency of the vibrating acoustic airflow and the geometry of the ostia.
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Affiliation(s)
- Lara Leclerc
- Ecole Nationale Supérieure des Mines, CIS-EMSE, EA 4624-LINA, SFR FED 4166-IFRESIS, 10 rue de la Marandière-42270 Saint-Priest en Jarez, F-42023 Saint-Etienne, France.
| | - Amira El Merhie
- Ecole Nationale Supérieure des Mines, CIS-EMSE, EA 4624-LINA, SFR FED 4166-IFRESIS, 10 rue de la Marandière-42270 Saint-Priest en Jarez, F-42023 Saint-Etienne, France
| | - Laurent Navarro
- Ecole Nationale Supérieure des Mines, CIS-EMSE, EA 4624-LINA, SFR FED 4166-IFRESIS, 10 rue de la Marandière-42270 Saint-Priest en Jarez, F-42023 Saint-Etienne, France
| | - Nathalie Prévôt
- University of Lyon, Jean Monnet University, EA 4624-LINA, SFR FED 4166-IFRESIS, F-42023 Saint-Etienne, France; University Hospital CHU, Nuclear Medicine Department, Saint-Etienne, France
| | - Marc Durand
- University of Lyon, Jean Monnet University, EA 4624-LINA, SFR FED 4166-IFRESIS, F-42023 Saint-Etienne, France; Centre Hospitalier Emile Roux, ENT Department, F-43012 Le Puy en Velay, France
| | - Jérémie Pourchez
- Ecole Nationale Supérieure des Mines, CIS-EMSE, EA 4624-LINA, SFR FED 4166-IFRESIS, 10 rue de la Marandière-42270 Saint-Priest en Jarez, F-42023 Saint-Etienne, France
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11
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The nasal approach to delivering treatment for brain diseases: an anatomic, physiologic, and delivery technology overview. Ther Deliv 2014; 5:709-33. [PMID: 25090283 DOI: 10.4155/tde.14.41] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The intricate pathophysiology of brain disorders, difficult access to the brain, and the complexity and high risks and costs of drug development represent major hurdles for improving therapies. Nose-to-brain drug transport offers an attractive alternative or addition to formulation-only strategies attempting to enhance drug penetration into the CNS. Although still a matter of controversy, many studies in animals claim direct nose-to-brain transport along the olfactory and trigeminal nerves, circumventing the traditional barriers to CNS entry. Some clinical trials in man also suggest nose-to-brain drug delivery, although definitive proof in man is lacking. This review focuses on new nasal delivery technologies designed to overcome inherent anatomical and physiological challenges and facilitate more efficient and targeted drug delivery for CNS disorders.
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12
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Laube BL. The expanding role of aerosols in systemic drug delivery, gene therapy and vaccination: an update. TRANSLATIONAL RESPIRATORY MEDICINE 2014; 2:3. [PMID: 25505695 PMCID: PMC4215822 DOI: 10.1186/2213-0802-2-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/23/2013] [Indexed: 01/06/2023]
Abstract
Until the late 1990s, aerosol therapy consisted of beta2-adrenergic agonists, anti-cholinergics, steroidal and non-steroidal agents, mucolytics and antibiotics that were used to treat patients with asthma, COPD and cystic fibrosis. Since then, inhalation therapy has matured to include drugs that: (1) are designed to treat diseases outside the lung and whose target is the systemic circulation (systemic drug delivery); (2) deliver nucleic acids that lead to permanent expression of a gene construct, or protein coding sequence, in a population of cells (gene therapy); and (3) provide needle-free immunization against disease (aerosolized vaccination). During the evolution of these advanced applications, it was also necessary to develop new devices that provided increased dosing efficiency and less loss during delivery. This review will present an update on the success of each of these new applications and their devices. The early promise of aerosolized systemic drug delivery and its outlook for future success will be highlighted. In addition, the challenges to aerosolized gene therapy and the need for appropriate gene vectors will be discussed. Finally, progress in the development of aerosolized vaccination will be presented. The continued expansion of the role of aerosol therapy in the future will depend on: (1) improving the bioavailability of systemically delivered drugs; (2) developing gene therapy vectors that can efficiently penetrate the mucus barrier and cell membrane, navigate the cell cytoplasm and efficiently transfer DNA material to the cell nucleus; (3) improving delivery of gene vectors and vaccines to infants; and (4) developing formulations that are safe for acute and chronic administrations.
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Affiliation(s)
- Beth L Laube
- The Johns Hopkins Medical Institutions, Suite 3015, The David M. Rubenstein Building, 200 North Wolfe Street, Baltimore, MD 21287 USA
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13
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Leclerc L, Pourchez J, Prevot N, Vecellio L, Le Guellec S, Cottier M, Durand M. Assessing sinus aerosol deposition: benefits of SPECT-CT imaging. Int J Pharm 2013; 462:135-41. [PMID: 24374606 DOI: 10.1016/j.ijpharm.2013.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Aerosol inhalation therapy is one of the methods to treat rhinosinusitis. However the topical drug delivery to the posterior nose and paranasal sinuses shows only limited efficiency. A precise sinusal targeting remains a main challenge for aerosol treatment of sinus disorders. This paper proposes a comparative study of the nasal deposition patterns of micron and submicron particles using planar gamma-scintigraphy imaging vs. a new 3-dimensional (3D) imaging approach based on SPECT-CT measurements. METHODS Radiolabelled nebulizations have been performed on a plastinated model of human nasal cast coupled with a respiratory pump. First, the benefits provided by SPECT-CT imaging were compared with 2D gamma-scintigraphy and radioactive quantification of maxillary sinus lavage as reference for the sonic 2.8 μm aerosol sinusal deposition. Then, the impact on nasal deposition of various airborne particle sizes was assessed. RESULTS The 2D methodology overestimates aerosol deposition in the maxillary sinuses by a factor 9 whereas the 3D methodology is in agreement with the maxillary sinus lavage reference methodology. Then with the SPECT-CT approach we highlighted that the higher particle size was mainly deposited in the central nasal cavity contrary to the submicron aerosol particles (33.8 ± 0.6% of total deposition for the 2.8 μm particles vs. 1 ± 0.3% for the 230 nm particles). CONCLUSION Benefits of SPECT/CT for the assessment of radiolabelled aerosol deposition in rhinology are clearly demonstrated. This 3D methodology should be preferentially used for scintigraphic imaging of sinusal deposition in Human.
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Affiliation(s)
- Lara Leclerc
- Université Jean Monnet, LINA EA 4624, Université de Lyon, F-42023 Saint-Etienne, France; Ecole Nationale Supérieure des Mines, CIS-EMSE, LINA EA 4624, F-42023 Saint-Etienne, France; SFR IFRESIS, F-42023 Saint-Etienne, France.
| | - Jérémie Pourchez
- Ecole Nationale Supérieure des Mines, CIS-EMSE, LINA EA 4624, F-42023 Saint-Etienne, France; SFR IFRESIS, F-42023 Saint-Etienne, France
| | - Nathalie Prevot
- Université Jean Monnet, LINA EA 4624, Université de Lyon, F-42023 Saint-Etienne, France; SFR IFRESIS, F-42023 Saint-Etienne, France; CHU de Saint-Etienne, Nuclear Medicine Department, F-42055 Saint-Etienne, France
| | - Laurent Vecellio
- Centre d'Etudes des Pathologies Respiratoires INSERM U1100/EA 6305, Faculté de Médecine, Université François Rabelais, Tours, France; DTF Aerodrug, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Sandrine Le Guellec
- Centre d'Etudes des Pathologies Respiratoires INSERM U1100/EA 6305, Faculté de Médecine, Université François Rabelais, Tours, France; DTF Aerodrug, Faculté de Médecine, Université François Rabelais, Tours, France
| | - Michèle Cottier
- Université Jean Monnet, LINA EA 4624, Université de Lyon, F-42023 Saint-Etienne, France; SFR IFRESIS, F-42023 Saint-Etienne, France
| | - Marc Durand
- Université Jean Monnet, LINA EA 4624, Université de Lyon, F-42023 Saint-Etienne, France; SFR IFRESIS, F-42023 Saint-Etienne, France; Centre Hospitalier Emile Roux, ENT Department, F-43012 Le Puy en Velay, France
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Möller W, Schuschnig U, Celik G, Münzing W, Bartenstein P, Häussinger K, Kreyling WG, Knoch M, Canis M, Becker S. Topical drug delivery in chronic rhinosinusitis patients before and after sinus surgery using pulsating aerosols. PLoS One 2013; 8:e74991. [PMID: 24040372 PMCID: PMC3770586 DOI: 10.1371/journal.pone.0074991] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 08/08/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery. METHODS (99m)Tc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging. RESULTS In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses. CONCLUSION In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways.
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Affiliation(s)
- Winfried Möller
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | | | - Gülnaz Celik
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | - Wolfgang Münzing
- Department of Nuclear Medicine, LMU Medical Center Grosshadern, München, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU Medical Center Grosshadern, München, Germany
| | - Karl Häussinger
- Department of Pulmonary Medicine, Asklepios Hospital, München-Gauting, Gauting, Germany
| | - Wolfgang G. Kreyling
- Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany
| | - Martin Knoch
- BU Pharma, PARI Pharma GmbH, Gräfelfing, Germany
| | - Martin Canis
- Department for Otolaryngology, University Göttingen Medical Center, Göttingen, Germany
| | - Sven Becker
- Department of Otolaryngology, Head and Neck Surgery, LMU Medical Center Grosshadern, München, Germany
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Abstract
Chronic rhinosinusitis is a multifactorial disorder that may be heterogeneous in presentation and clinical course. While the introduction of endoscopic sinus surgery revolutionized surgical management and has led to significantly improved patient outcomes, medical therapy remains the foundation of long-term care of chronic rhinosinusitis, particularly in surgically recalcitrant cases. A variety of devices and pharmaceutical agents have been developed to apply topical medical therapy to the sinuses, taking advantage of the access provided by endoscopic surgery. The goal of topical therapy is to address the inflammation, infection, and mucociliary dysfunction that underlies the disease. Major factors that impact success include the patient's sinus anatomy and the dynamics of the delivery device. Despite a growing number of topical treatment options, the evidence-based literature to support their use is limited. In this article, we comprehensively review current delivery methods and the available topical agents. We also discuss biotechnological advances that promise enhanced delivery in the future, and evolving pharmacotherapeutical compounds that may be added to rhinologist's armamentarium. A complete understand of topical drug delivery is increasingly essential to the management of chronic rhinosinusitis when traditional forms of medical therapy and surgery have failed.
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16
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Zhu JH, Lee HP, Lim KM, Gordon BR, Wang DY. Effect of accessory ostia on maxillary sinus ventilation: a computational fluid dynamics (CFD) study. Respir Physiol Neurobiol 2012; 183:91-9. [PMID: 22750570 DOI: 10.1016/j.resp.2012.06.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/15/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
We evaluated, by CFD simulation, effects of accessory ostium (AO) on maxillary sinus ventilation. A three-dimensional nasal model was constructed from an adult CT scan with two left maxillary AOs (sinus I) and one right AO (sinus II), then compared to an identical control model with all AOs sealed (sinuses III and IV). Transient simulations of quiet inspiration and expiration at 15 L/min, and nasal blow at 48 L/min, were calculated for both models using low-Reynolds-number turbulent analysis. At low flows, ventilation rates in sinuses with AOs (I ≈ 0.46 L/min, II ≈ 0.54 L/min), were both more than a magnitude higher than sinuses without AOs (II I ≈ 0.019 L/min, IV ≈ 0.020 L/min). Absence of AO almost completely prevented sinus ventilation. Increased ventilation of sinuses with AOs is complex. Under high flow conditions mimicking nose blowing, in sinuses II, III, and IV, the sinus flow rate increased. In contrast, the airflow direction through sinus I reversed between inspiration and expiration, while it remained almost constant throughout the respiration cycle in sinus II. CFD simulation demonstrated that AOs markedly increase maxillary sinus airflow rates and alter sinus air circulation patterns. Whether these airflow changes impact maxillary sinus physiology or pathophysiology is unknown.
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Affiliation(s)
- Jian Hua Zhu
- Department of Mechanical Engineering, National University of Singapore, Singapore.
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17
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Albu S. Novel drug-delivery systems for patients with chronic rhinosinusitis. DRUG DESIGN DEVELOPMENT AND THERAPY 2012; 6:125-32. [PMID: 22745531 PMCID: PMC3383347 DOI: 10.2147/dddt.s25199] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic rhinosinusitis, one of the most common chronic medical complaints in the United States, seems to be increasing in incidence and prevalence, and has a significant impact on quality of life. Topical forms of medical therapy represent an attractive alternative for drug delivery to the nasal cavity and paranasal sinuses. Topical drug delivery has the advantage of directly acting on the site of inflammation, producing a higher concentration at the target site while avoiding systemic side effects. Although considerable research has been undertaken into improving nasal formulations in order to enhance absorption, little attention has so far been directed to upgrading the delivery devices. The aim of this review is to present current knowledge on the novel drug-delivery devices in use in the management of chronic rhinosinusitis patients, and to present the current available knowledge on topical drug penetration into the sinuses using various delivery devices. Additionally, methods used to enhance fluid sinus deposition are presented and the published clinical studies on the results of nebulized antibiotics in the treatment of chronic rhinosinusitis patients are discussed.
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Affiliation(s)
- Silviu Albu
- Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
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18
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Thieme SF, Möller W, Becker S, Schuschnig U, Eickelberg O, Helck AD, Reiser MF, Johnson TRC. Ventilation imaging of the paranasal sinuses using xenon-enhanced dynamic single-energy CT and dual-energy CT: a feasibility study in a nasal cast. Eur Radiol 2012; 22:2110-6. [PMID: 22610534 DOI: 10.1007/s00330-012-2483-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/21/2012] [Accepted: 03/27/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To show the feasibility of dual-energy CT (DECT) and dynamic CT for ventilation imaging of the paranasal sinuses in a nasal cast. METHODS In a first trial, xenon gas was administered to a nasal cast with a laminar flow of 7 L/min. Dynamic CT acquisitions of the nasal cavity and the sinuses were performed. This procedure was repeated with pulsating xenon flow. Local xenon concentrations in the different compartments of the model were determined on the basis of the enhancement levels. In a second trial, DECT measurements were performed both during laminar and pulsating xenon administration and the xenon concentrations were quantified directly. RESULTS Neither with dynamic CT nor DECT could xenon-related enhancement be detected in the sinuses during laminar airflow. Using pulsating flow, dynamic imaging showed a xenon wash-in and wash-out in the sinuses that followed a mono-exponential function with time constants of a few seconds. Accordingly, DECT revealed xenon enhancement in the sinuses only after pulsating xenon administration. CONCLUSION The feasibility of xenon-enhanced DECT for ventilation imaging was proven in a nasal cast. The superiority of pulsating gas flow for the administration of gas or aerosolised drugs to the paranasal sinuses was demonstrated. KEY POINTS • Ventilation of the paranasal sinuses is poorly understood. • Dual-energy CT ventilation imaging has been explored using phantom simulation. • Xenon can be seen in the paranasal sinuses using pulsating xenon flow. • Dual-energy CT uses a lower radiation dose compared with dynamic ventilation CT.
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Affiliation(s)
- Sven F Thieme
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Klinikum Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20:73-5. [DOI: 10.1097/moo.0b013e32834f8a1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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