title: Efficacy of syringe-irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions.
abstract: BACKGROUND
  Topical therapies are the best postoperative treatment option for chronic rhinosinusitis, especially those with high volume and pressure, such as the squeeze bottles. However, they are not an available option in Brazil, where irrigation syringes are used.
  
  
  OBJECTIVE
  To investigate the efficacy of topical sinonasal therapy with syringe and the influence of the middle turbinate on this process METHODS: Intervention study in training models (S.I.M.O.N.T.). After standard dissection, three interventions were performed (Nasal Spray 4 puffs, 60-mL syringe and 240-mL Squeeze Bottle) with normal and Sutured Middle Turbinate. Images of each sinus were captured after the interventions, totalizing 144 images. The images were classified by 10 evaluators according to the amount of residual volume from zero to 3, with zero and 1 being considered poor penetration and 2 and 3, good penetration. The 1440 evaluations were used in this study.
  
  
  RESULTS
  Considering all middle turbinate situations, the amount of good penetrations were 8.1% for Spray; 68.3% for Syringe, and 78.3% for Squeeze (p<0.0001). Considering all types of interventions, the Normal Middle Turbinate group had 48.2% of good penetrations and the Sutured Middle Turbinate, 55% (p=0.01). Considering only the Sutured Middle Turbinates, there was no difference between the interventions with Syringe and Squeeze (76.3% vs. 80.4%; p=0.27).
  
  
  CONCLUSIONS
  Topical therapy of irrigation with a 60-mL syringe was more effective than that with nasal spray. The status of the middle turbinate proved to be fundamental and influenced topical therapy. Irrigation with syringe was as effective as the squeeze bottle when the middle turbinate was sutured to the nasal septum.
authors.affiliation: Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil.
authors.forename: Guilherme Henrique
authors.initials: GH
authors.lastname: Wawginiak
authors.affiliation: Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Balsalobre
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil. Electronic address: edumacoto@uol.com.br.
authors.forename: Eduardo Macoto
authors.initials: EM
authors.lastname: Kosugi
authors.affiliation: Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Mangussi-Gomes
authors.affiliation: Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil.
authors.forename: Raul Ernesto
authors.initials: RE
authors.lastname: Samaniego
authors.affiliation: Complexo Hospitalar Edmundo Vasconcelos, Centro de Otorrinolaringologia e Fonoaudiologia, São Paulo, SP, Brazil.
authors.forename: Aldo Cassol
authors.initials: AC
authors.lastname: Stamm
mesh_terms: D001938:Brazil; D002908:Chronic Disease; D004724:Endoscopy; D006801:Humans; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D013594:Syringes; D007507:Therapeutic Irrigation / Q000295:instrumentation; D014420:Turbinates / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Cirurgia endoscópica por orifício natural; Cirurgia vídeoassistida; Irrigação terapêutica; Natural orifice endoscopic surgery; Sinusite/terapia; Sinusitis/therapy; Therapeutic irrigation; Video-assisted surgery