title: Drug delivery to paranasal sinuses using pulsating aerosols.
abstract: Chronic rhinosinusitis (CRS) is the major disorder of the upper airways, affecting about 10-15% of the total population. Topical treatment regimens show only modest efficacy, because drug delivery to the posterior nose and paranasal sinuses is still a challenge. Therefore, there is a high rate of functional endoscopic sinus surgery in CRS patients. Most nasally administered aerosolized drugs, like nasal pump sprays, are efficiently filtered by the nasal valve and do not reach the posterior nasal cavity and the sinuses, which are poorly ventilated. However, as highlighted in this review, sinus ventilation and paranasal aerosol delivery can be achieved by using pulsating airflow, offering new topical treatment options for nasal disorders. Radioaerosol inhalation and imaging studies in nasal casts and in healthy volunteers have shown 4-6% of the nasally administered dose within the sinuses. In CRS patients, significant aerosol deposition in the sinus cavities was reported before sinus surgery. After surgery, deposition increased to the amount observed in healthy volunteers. In addition, compared with nasal pump sprays, retention kinetics of the radiolabel deposited in the nasal cavity was prolonged, both in healthy volunteers and in CRS patients. These efficiencies may be sufficient for topical aerosol therapies of sinus disorders and, due to the prolonged retention kinetics, may reduce application modes, but have to be proven in future clinical trials. Pulsating aerosols may offer additional new topical treatment options of nasal and sinus disorders before as well as after surgery.
authors.affiliation: 1 Comprehensive Pneumology Center, Institute for Lung Biology and Disease , 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: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meyer
authors.forename: Karl
authors.initials: K
authors.lastname: Häussinger
authors.forename: Otmar
authors.initials: O
authors.lastname: Schmid
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
mesh_terms: D000162:Acoustics / Q000295:instrumentation*; D000281:Administration, Intranasal; D000336:Aerosols; D002626:Chemistry, Pharmaceutical; D002908:Chronic Disease; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D009038:Motion; D010256:Paranasal Sinuses / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000737:chemistry; D010599:Pharmacokinetics; D012220:Rhinitis / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D013016:Sound
chemical_list: D000336:Aerosols; D004364:Pharmaceutical Preparations
keywords: chronic rhinosinusitis; clearance; paranasal sinus ventilation; pulsating aerosol; topical therapy