title: Topical drug delivery in chronic rhinosinusitis patients before and after sinus surgery using pulsating aerosols.
abstract: OBJECTIVE
  Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery.
  
  
  METHODS
  (99m)Tc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging.
  
  
  RESULTS
  In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses.
  
  
  CONCLUSIONS
  In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways.
authors.affiliation: Institute for Lung Biology and Disease (iLBD), Helmholtz Zentrum München, Neuherberg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Möller
authors.forename: Uwe
authors.initials: U
authors.lastname: Schuschnig
authors.forename: Gülnaz
authors.initials: G
authors.lastname: Celik
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Münzing
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Karl
authors.initials: K
authors.lastname: Häussinger
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Kreyling
authors.forename: Martin
authors.initials: M
authors.lastname: Knoch
authors.forename: Martin
authors.initials: M
authors.lastname: Canis
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
mesh_terms: D000281:Administration, Intranasal / Q000379:methods*; D000328:Adult; D000336:Aerosols; D016022:Case-Control Studies; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps; D059085:Nasal Sprays; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D016284:Technetium Tc 99m Pentetate / Q000737:chemistry; D014057:Tomography, X-Ray Computed
chemical_list: D000336:Aerosols; D059085:Nasal Sprays; D016284:Technetium Tc 99m Pentetate
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