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Influence of anatomy and head position on intranasal drug deposition

  • Rhinology
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Abstract

The objective of this study was to determine the influence of individual anatomical differences on intranasal drug deposition. The data of a comparison of seven different administration techniques in ten healthy volunteers was used in this single-blind crossover pilot study. After intranasal administration of a dyed test formulation, endoscopic video imaging was done on seven non-sequential days. The deposition pattern per individual around the head of the middle turbinate was analyzed for each technique and correlated with the individual anatomy. Decreased deposition of dyed test formulation in the target area around the head of the middle turbinate was observed in the presence of minor septal deviations, narrow nasal valve areas, or inferior turbinate hypertrophy; a lateral head position helps to bypass a minor septal deviation. Although results are preliminary, we conclude that anatomy and head position are important factors in the deposition of topical nasal drugs and may be the key to improving individual local nasal (steroid) treatment.

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References

  1. Aggarwal R, Cardozo A, Homer JJ (2004) The assessment of topical nasal drug distribution. Clin Otolaryngol 29:201–205

    Article  CAS  PubMed  Google Scholar 

  2. Aukema AA, Mulder PG, Fokkens WJ (2005) Treatment of nasal polyposis and chronic rhinosinusitis with fluticasone propionate nasal drops reduces need for sinus surgery. J Allergy Clin Immunol 115(5):1017–1023

    Article  PubMed  CAS  Google Scholar 

  3. Benninger MS, Hadley JA, Osguthorpe JD, Marple BF, Leopold DA, Derebery MJ, Hannley M (2004) Techniques of intranasal steroid use. Otolaryngol Head Neck Surg 130:5–24

    Article  PubMed  Google Scholar 

  4. Chalton R, Mackay I, Wilson R, Cole P (1985) Double-blind, placebo-controlled trial of betamethasone nasal drops for nasal polyposis. Br Med J 291:788

    Article  CAS  Google Scholar 

  5. Dowley AC, Homer JJ (2001) The effect of inferior turbinate hypertrophy on nasal spray distribution to the middle meatus. Clin Otolaryngol 26:488–490

    Article  CAS  PubMed  Google Scholar 

  6. Fokkens WJ, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, Jones N, Kalogjera L, Kennedy D, Kowalski M, Malmberg H, Mullol J, Passali D, Stammberger H, Stierna P (2005) EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 60(5):583–601

    Article  PubMed  CAS  Google Scholar 

  7. Hardy JG, Lee SW, Wilson CG (1985) Intranasal drug delivery by sprays and drops. J Pharm Pharmacol 37:294–297

    PubMed  CAS  Google Scholar 

  8. Homer JJ, Maughan J, Burniston M (2002) A quantitative analysis of the intranasal delivery of topical nasal drugs to the middle meatus: spray versus drop administration. J Laryngol Otol 116:10–13

    PubMed  CAS  Google Scholar 

  9. Homer JJ, Raine CH (1998) An endoscopic photographic comparison of nasal drug delivery by aqueous spray. Clin Otolaryngol 23:560–563

    Article  CAS  PubMed  Google Scholar 

  10. Karagama YG, Lancaster JL, Karkanevatos A, O’Sullivan G (2001) Delivery of nasal drops to the middle meatus: which is the best head position? Rhinology 39:226–229

    PubMed  CAS  Google Scholar 

  11. Kayarkar R, Clifton NJ, Woolford TJ (2002) An evaluation of the best head position for instillation of steroid nose drops. Clin Otolaryngol 27:18–21

    Article  CAS  PubMed  Google Scholar 

  12. Lund VJ, Flood J, Sykes AP, Richards DH (1998) Effect of fluticasone in severe polyposis. Arch Otolaryngol Head Neck Surg 124:513–518

    PubMed  CAS  Google Scholar 

  13. Mackay I (1997) Infective rhinitis and sinusitis. In: Scott Browne, Otolaryngology 6th edn. Butterworth Heinemann, Oxford, p 4/8/24

  14. Merkus P, Ebbens FA, Muller B, Fokkens WJ (2006) The “best method” of topical nasal drug delivery: a comparison of seven techniques. Rhinology 44:102–110

    Google Scholar 

  15. Morén F, Bjornek K, Klint T, Wagner ZG (1988) A comparative distribution study of two procedures for administration of nose drops. Acta Otolaryngol 106:286–290

    Article  PubMed  Google Scholar 

  16. Mygind N (1979) Conventional medical treatment. In: Nasal allergy, 2nd edn. Blackwell Scientific Publications, Oxford, pp257–270

  17. Parkinson SN (1933) A lateral head-low position for nasal and sinus treatment. Arch Otolaryngol 17:787–788

    Google Scholar 

  18. Parkinson SN (1939) Non-traumatic ventilation treatment of the nose and sinuses. J Laryngol Otol 54:611–620

    Article  Google Scholar 

  19. Proetz AW (1926) Displacement irrigation of nasal sinuses. Arch Otolaryngol 4:1–13

    Google Scholar 

  20. Proetz AW (1927) Further data on the displacement method in sinuses. Ann Otol Rhinol Laryngol 36:297–323

    Google Scholar 

  21. Raghavan U, Logan BM (2000) New method for the effective instillation of nasal drops. J Laryngol Otol 114:456–459

    PubMed  CAS  Google Scholar 

  22. Stammberger H (1986) Endoscopic endonasal surgery: concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg 94:143–147

    PubMed  CAS  Google Scholar 

  23. Tabor MP, Braakhuis BJ, van der Wal JE, van Diest PJ, Leemans CR, Brakenhoff RH, Kummer JA (2003) Comparative molecular and histological grading of epithelial dysplasia of the oral cavity and the oropharynx. J Pathol 199(3):354–360

    Article  PubMed  CAS  Google Scholar 

  24. Tsikoudas A, Homer JJ (2001) The delivery of topical nasal sprays and drops to the middle meatus: a semiquantitative analysis. Clin Otolaryngol 26:294–297

    Article  CAS  PubMed  Google Scholar 

  25. Weber R, Keerl R (1996) Einsatz moderner Bilddatenverarbeitung in der klinisch-rhinologischen Forschung. Eur Arch Otorhinolaryngol Suppl 1:271–296

    PubMed  CAS  Google Scholar 

  26. Weber R, Keerl R, Radziwill R, Schick B, Jaspersen D, Dshambazov, Mlynski G, Draf W (1999) Videoendoscopic analysis of nasal steroid distribution. Rhinology 37:69–73

    PubMed  CAS  Google Scholar 

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Acknowledgment

We wish to thank Valois (France) for their support with the single-unit dose device.

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Authors and Affiliations

  1. Department of Otorhinolaryngology & Head and Neck Surgery, VU University Medical Center, KNO 1D-116, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands

    Paul Merkus

  2. Department of Otorhinolaryngology & Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Fenna A. Ebbens, Barbara Muller & Wytske J. Fokkens

Authors
  1. Paul Merkus
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  2. Fenna A. Ebbens
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  3. Barbara Muller
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  4. Wytske J. Fokkens
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Correspondence to Paul Merkus.

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Merkus, P., Ebbens, F.A., Muller, B. et al. Influence of anatomy and head position on intranasal drug deposition. Eur Arch Otorhinolaryngol 263, 827–832 (2006). https://doi.org/10.1007/s00405-006-0071-5

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  • DOI: https://doi.org/10.1007/s00405-006-0071-5

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