Pre- and postoperative sinus penetration of nasal irrigation.
OBJECTIVE
Endoscopic sinus surgery is an accepted treatment for medically recalcitrant chronic rhinosinusitis. Effective saline douching may improve long-term outcomes of chronic rhinosinusitis but is often impaired by postoperative ostial stenosis. The aim of this study is to determine a critical ostial size at which douching solution reliably enters the sinus cavities.


METHODS
Prospective study of consecutive patient cohort.


METHODS
Seventeen preoperative or well-healed postoperative endoscopic sinus surgery patients were irrigated with 5 mL blue food coloring mixed with 200 mL buffered saline from a squeeze bottle. The degree of sinus penetration, sinus ostial patency, and ostial size were endoscopically determined.


RESULTS
Sinuses penetrated by blue dye had a significantly larger minimal ostial dimension (7.31 mm; 95% confidence interval 5.54-9.08) than those that had no blue dye penetration (1.26 mm; 95% confidence interval 0.86-1.66) as determined by Student t test. Chi-square analysis showed that operated sinuses were more likely to be penetrated than nonoperated sinuses (P = .0016) and obstructed sinuses (P = .0325). Logistic regression showed a 95% probability of penetration when the minimum ostial dimension is 3.95 mm or greater.


CONCLUSIONS
Unoperated sinuses or cases with gross sinus ostial obstruction will not be reliably penetrated by sinus irrigant. A 3.95-mm ostial diameter seems to be the minimum size to guarantee penetration in paranasal sinuses to maximize the potential for topical sinus treatment.
Grobler
Alethea
A
Department of Surgery-Otolaryngology, Head and Neck Surgery, University of Adelaide and Flinders University, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Weitzel
Erik K
EK
Buele
Achim
A
Jardeleza
Camille
C
Cheong
Yew C
YC
Field
John
J
Wormald
Peter-John
PJ
D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010256:Paranasal Sinuses / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods*