Surfactant improves irrigant penetration into unoperated sinuses.
BACKGROUND
Saline irrigations are proving to be a valuable intervention in the treatment of chronic sinusitis. The use of surfactants is a well established additive to topical treatments known to reduce surface tension and may prove to be a simple, nonoperative intervention  to improve intrasinus douching penetration.


METHODS
Six 30-mL, flat-bottomed medicine cups with circular holes cut through the bottom center and varying in diameter from 1 to 6 mm were created with punch biopsies. Water, saline, saline/dye, and saline/dye/surfactant were  compared for maximum holding pressure via these modeled ostia. Holding pressures also were determined for cups with septal mucosa fused to the bottom with holes ranging from 1 to 6 mm. In addition, analysis was carried out with blood and blood/surfactant. Finally, five thawed, fresh-frozen  cadaver heads were evaluated before any sinus surgery with water/dye and water/dye/surfactant for intrasinus penetration.


RESULTS
Surfactant significantly improved the ability of all solutions to penetrate ostia in both the plastic cup and fused septal mucosa model. All  nonsurfactant-containing solutions were not statistically different from one another, nor did surfactant change the ostial penetration of blood. Surfactant significantly improved the ability of sinus irrigant to penetrate unoperated sinus cavities (3.12 vs 3.5, p = .021).


CONCLUSIONS
The addition of surfactant to saline irrigation improves ostial penetration in undissected and undiseased cadavers. This has practical implications for unoperated patients seeking care for sinus-related symptoms in that we have now described a method for improving topical treatment of  target sinus mucosa prior to surgical intervention.
Department of Otolaryngology Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236, USA.
Joseph W
JW
Rohrer
Greg R
GR
Dion
Pryor S
PS
Brenner
Wesley M
WM
Abadie
Kevin C
KC
McMains
Roy F
RF
Thomas
Erik K
EK
Weitzel
D002102:Cadaver; D002908:Chronic Disease; D006801:Humans; D010256:Paranasal Sinuses / Q000187:drug effects* / Q000473:pathology; D012852:Sinusitis / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013501:Surface-Active Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014867:Water / Q000008:administration & dosage* / Q000009:adverse effects
D013501:Surface-Active Agents; D014867:Water; D012965:Sodium Chloride