title: [Pari sinus inhalation versus metered pump spray in postoperative care after FESS].
abstract: OBJECTIVE
  To evaluate which way of topical drug application would result in a better deposition pattern after FESS.
  
  
  METHODS
  We compared the deposition pattern of a nasal steroid after application with a metered pump spray or inhalation using the Pari sinus device. Visualization was achieved via colouring using 1% Sodium-fluorescein solution. All patients had a well healed sinus system with an endoscopically wide open access after FESS. We looked for the deposition with Blue-light-endoscopy directly after application and after washing out using a nasal douche. Analysis was performed blinded by two independent experienced sinus surgeons via representative single shots.
  
  
  RESULTS
  Data of 11 patients revealed, that deposition after metered pump spray application was superior than after inhalation for all localisations. By far most part of the drug was deposited in the anterior nasal cavity, followed by the head of the middle turbinate, ethmoid. Small amounts reached the maxillary sinus, the anterior wall of the sphenoid sinus, the olfactory cleft and the entrance to the frontal sinus. The frontal sinus itself was not reached in any case. Washing out led to a decrease of deposition intensity, in some cases to a better distribution into the maxillary and sphenoid sinus and frontal recess.
  
  
  CONCLUSIONS
  Postoperative deposition of topical nasal steroids after FESS is insufficient. We need better methods and devices to optimize efficacy of topical treatment.
authors.affiliation: Städtisches Klinikum Karlsruhe, HNO-Klinik, Karlsruhe, Germany. espenschied@klinikum-karlsruhe.com
authors.forename: S
authors.initials: S
authors.lastname: Espenschied
authors.forename: J
authors.initials: J
authors.lastname: Dodenhöft
authors.forename: S
authors.initials: S
authors.lastname: Lehr
authors.forename: P
authors.initials: P
authors.lastname: Bõhne-Lampert
authors.forename: R
authors.initials: R
authors.lastname: Weber
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000336:Aerosols; D000465:Algorithms; D001682:Biological Availability; D002908:Chronic Disease; D004724:Endoscopy; D019793:Fluorescein; D006801:Humans; D036501:Metered Dose Inhalers; D009298:Nasal Polyps / Q000188:drug therapy / Q000601:surgery*; D011182:Postoperative Care; D020551:Pulse Therapy, Drug / Q000295:instrumentation*; D012852:Sinusitis / Q000188:drug therapy / Q000601:surgery*; D014741:Video Recording
chemical_list: D000305:Adrenal Cortex Hormones; D000336:Aerosols; D019793:Fluorescein