title: A prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers.
abstract: BACKGROUND
  Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model.
  
  
  METHODS
  Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200-mL nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols.
  
  
  RESULTS
  Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p < 0.001), percentage of stain (49.96% versus 4.19%, p < 0.001), and circumference stained (76.59% versus 12.7%, p < 0.001) with the plastic nasal irrigation squeeze bottle versus PARI device. Analysis of individual sinuses consistently showed significant increases in indices of nasal douching relative to nebulization. The PARI sinus nebulizer was noted to reach the ethmoids regularly (92% incidence), whereas the other sinuses were not reached as regularly with incidences noted at frontal (43%), maxillary (46%), and sphenoid (54%). This compares to 96% of all sinuses being stained by the squeeze bottle.
  
  
  CONCLUSIONS
  In all measured indices, the nasal douching method with the squeeze bottle was superior to the PARI sinus nebulizer in highly dissected sinonasal cadaver models.
authors.affiliation: Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide University, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Valentine
authors.forename: Theo
authors.initials: T
authors.lastname: Athanasiadis
authors.forename: May
authors.initials: M
authors.lastname: Thwin
authors.forename: Deepti
authors.initials: D
authors.lastname: Singhal
authors.forename: Erik K
authors.initials: EK
authors.lastname: Weitzel
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D002102:Cadaver; D002908:Chronic Disease; D004724:Endoscopy; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D004867:Equipment Design; D006801:Humans; D008443:Maxillary Sinus / Q000187:drug effects* / Q000601:surgery; D015523:Maxillary Sinusitis / Q000188:drug therapy* / Q000601:surgery; D008751:Methylene Blue / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D007507:Therapeutic Irrigation / Q000295:instrumentation*
chemical_list: D004791:Enzyme Inhibitors; D008751:Methylene Blue