PMID- 27255595
OWN - NLM
STAT- MEDLINE
DCOM- 20171109
LR  - 20171211
IS  - 2042-6984 (Electronic)
IS  - 2042-6976 (Linking)
VI  - 6
IP  - 10
DP  - 2016 Oct
TI  - The effect of middle turbinate resection on topical drug distribution into the 
      paranasal sinuses.
PG  - 1056-1061
LID - 10.1002/alr.21791 [doi]
AB  - BACKGROUND: During sinus surgery, partial or complete resection of the middle 
      turbinate (MT) is sometimes necessary because of polypoid changes or 
      demineralization. Topical drug delivery to the paranasal sinuses is an integral 
      component in managing chronic rhinosinusitis (CRS) with and without nasal 
      polyposis. The purpose of this study was to examine the role of the MT and MT 
      resection in topical drug distribution into the sinuses via nebulization. We 
      report on a novel technique of quantitatively evaluating the delivery of 
      nebulized dye in cadavers. METHODS: Endoscopic sinus surgery was performed on 5 
      fresh cadavers. Complementary colored dyes mixed with saline were successively 
      nebulized using the following protocol: (1) fluorescein prior to MT resection; 
      (2) brilliant green following partial MT resection; and (3) methylene blue 
      following total MT resection. Photodocumentation of the sinuses was performed 
      following each nebulization and standardized photoanalysis was performed. 
      RESULTS: Successive nebulizations with fluorescein, brilliant green, and 
      methylene blue produced a complementary staining pattern that provided an easy 
      side-by-side analysis of the extent of mucosal staining. Dye delivery to the 
      frontal and sphenoid sinuses significantly increased following partial resection 
      of the MT (p = 0.013 and p = 0.0027, respectively) and complete resection of the 
      MT (p = 0.027 and p = 0.027, respectively). Following complete MTR, dye delivery 
      to the maxillary sinus significantly increased compared to baseline (MT intact) 
      (p = 0.0027). CONCLUSION: Resection of the MT appears to have a significant 
      effect on nebulized drug delivery into the frontal, maxillary, and sphenoid 
      sinuses. Future prospective studies will help delineate the clinical relevance of 
      this effect.
CI  - (c) 2016 ARS-AAOA, LLC.
FAU - Halderman, Ashleigh A
AU  - Halderman AA
AD  - Head and Neck Institute, Section of Rhinology, Sinus, and Skull Base Surgery, 
      Cleveland Clinic Foundation, Cleveland, OH.
FAU - Stokken, Janalee
AU  - Stokken J
AD  - Department of Otolaryngology, Mayo Clinic, Rochester, MN.
FAU - Sindwani, Raj
AU  - Sindwani R
AD  - Head and Neck Institute, Section of Rhinology, Sinus, and Skull Base Surgery, 
      Cleveland Clinic Foundation, Cleveland, OH. sindwar@ccf.org.
LA  - eng
PT  - Journal Article
DEP - 20160603
PL  - United States
TA  - Int Forum Allergy Rhinol
JT  - International forum of allergy & rhinology
JID - 101550261
RN  - 0 (Coloring Agents)
RN  - 0 (Quaternary Ammonium Compounds)
RN  - G0L543D370 (brilliant green)
RN  - T42P99266K (Methylene Blue)
RN  - TPY09G7XIR (Fluorescein)
SB  - IM
MH  - Administration, Intranasal
MH  - Coloring Agents/administration & dosage/*pharmacokinetics
MH  - Endoscopy
MH  - Fluorescein/administration & dosage/pharmacokinetics
MH  - Humans
MH  - Methylene Blue/administration & dosage/pharmacokinetics
MH  - Nebulizers and Vaporizers
MH  - Paranasal Sinuses/*metabolism
MH  - Quaternary Ammonium Compounds/administration & dosage/pharmacokinetics
MH  - Turbinates/*surgery
OTO - NOTNLM
OT  - chronic rhinosinusitis
OT  - endoscopic sinus surgery
OT  - nasal polyposis
OT  - topical medical therapy
EDAT- 2016/06/04 06:00
MHDA- 2017/11/10 06:00
CRDT- 2016/06/04 06:00
PHST- 2016/01/11 00:00 [received]
PHST- 2016/02/25 00:00 [revised]
PHST- 2016/03/25 00:00 [accepted]
PHST- 2016/06/04 06:00 [pubmed]
PHST- 2017/11/10 06:00 [medline]
PHST- 2016/06/04 06:00 [entrez]
AID - 10.1002/alr.21791 [doi]
PST - ppublish
SO  - Int Forum Allergy Rhinol. 2016 Oct;6(10):1056-1061. doi: 10.1002/alr.21791. Epub 
      2016 Jun 3.