Efficacy of topical therapy of irrigation with syringe and the influence of the middle turbinate in sinus penetration of solutions

Publication date: Available online 31 July 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Guilherme Henrique Wawginiak, Leonardo Balsalobre, Eduardo Macoto Kosugi, João Paulo Mangussi-Gomes, Raul Ernesto Samaniego, Aldo Cassol Stamm
IntroductionThe topical therapies are the best postoperative treatment option for chronic rhinosinusitis, especially those with high volume and pressure, such as the squeeze bottles. However, they are not an available option in Brazil, where irrigation syringes are used.ObjectiveTo investigate the efficacy of topical sinonasal therapy with syringe and the influence of this process on the middle turbinate.MethodsIntervention study in training models (S.I.M.O.N.T.). After standard dissection, three interventions were performed (Nasal Spray 4 puffs, 60-mL syringe and 240-mL Squeeze Bottle) with normal and Sutured Middle Turbinate. Images of each sinus were captured after the interventions, totaling 144 images. The images were classified by 10 evaluators according to the amount of residual volume from zero to 3, with zero and 1 being considered poor penetration and 2 and 3, good penetration. The 1440 evaluations were used in this study.ResultsConsidering all middle turbinate situations, the amount of good penetrations were 8.1% for Spray; 68.3% for Syringe, and 78.3% for Squeeze (p<0.0001). Considering all types of interventions, the Normal Middle Turbinate had 48.2% of good penetrations and the Sutured Middle Turbinate, 55% (p=0.01). Considering only Sutured Middle Turbinate, there was no difference between the interventions with Syringe and Squeeze (76.3% vs. 80.4%; p=0.27).ConclusionTopical therapy of irrigation with a 60-mL syringe was more effective than that with nasal spray. The status of the middle turbinate proved to be fundamental and influenced topical therapy. Irrigation with syringe was as effective as the squeeze bottle when the middle turbinate was sutured to the nasal septum.



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