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Development of an apparatus and procedure for evaluating the efficiency of nasal irrigation

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Although different methods of nasal irrigation have been utilized, irrigation efficiency in nasal cavities has not been well assessed. The objective of this study was to develop an apparatus and procedure for evaluating the irrigation efficiency and to explore the optimal head position during irrigation.

Methods

Casts of the left sinonasal cavity from a healthy volunteer were made from high-resolution-computed tomography data using 3D printing with composite materials. An adjustable apparatus that allowed cast fixation at the different head positions was built. The yogurt was used to simulate mucus. The cast with 5 ml yogurt filled around the superior, middle, and inferior turbinate was fixed in six head positions including head tilt 10°, 45°, and 60° forward with or without leaning 30° to the right. The cast was irrigated with 120 ml, 175 ml, and 240 ml dyed water and was video recorded. The irrigation efficiency was calculated based on the weight difference of the cast before and after the irrigation.

Results

Most residual yogurt was located around the superior meatus after the irrigation under different volumes and head positions. The irrigation efficiency of the rinse bottle or the pulsatile device was volume dependent, with the highest irrigation efficiency under 240 ml water. When the left sinonasal cavity was irrigated, the head position of tilt 45° forward with leaning 30° to the right was the optimal head position for these two devices when compared to other positions. The pulsatile device with 240 ml water performed better than the rinse bottle with 240 ml water regarding the irrigation efficiency under the optimal head position (0.8700 ± 0.0138 vs 0.7536 ± 0.0099, p = 0.003).

Conclusions

The developed apparatus provided a potential method for evaluating the irrigation efficiency. The head position of tilt 45° forward with leaning 30° was suitable for patients to perform the nasal irrigation.

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References

  1. Orlandi RR, Kingdom TT, Smith TL et al (2021) International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 11(3):213–739

    Article  Google Scholar 

  2. Fokkens WJ, Lund VJ, Hopkins C et al (2020) European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 58(S29):1–464

    PubMed  Google Scholar 

  3. Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA et al (2018) International consensus statement on allergy and rhinology: allergic rhinitis. Int Forum Allergy Rhinol 8(2):108–352

    PubMed  PubMed Central  Google Scholar 

  4. Cabaillot A, Vorilhon P, Roca M, Boussageon R, Eschalier B, Pereirad B (2020) Saline nasal irrigation for acute upper respiratory tract infections in infants and children: a systematic review and meta-analysis. Paediatr Respir Rev 36:151–158

    PubMed  Google Scholar 

  5. Succar EF, Turner JH, Chandra RK et al (2019) Nasal saline irrigation: a clinical update. Int Forum Allergy Rhinol 9(S1):S4–S8

    Article  Google Scholar 

  6. Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C et al (2018) Saline irrigation for allergic rhinitis. Cochrane Data Syst Rev. https://doi.org/10.1002/14651858.CD012597.pub2

    Article  Google Scholar 

  7. Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R (2012) Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy 26(5):119–125

    Article  Google Scholar 

  8. Elkins MR, Bye PT (2011) Mechanisms and applications of hypertonic saline. J Royal Soc Med 104(1_suppl):2–5

    Article  Google Scholar 

  9. Bonnomet A, Luczka E, Coraux C et al (2016) Non-diluted seawater enhances nasal ciliary beat frequency and wound repair speed compared to diluted seawater and normal saline. Int Forum Allergy Rhinol 6(10):1062–1068

    Article  Google Scholar 

  10. Wormald PJ, Cain T, Oates L, Hawke L, Wong I (2004) A comparative study of three methods of nasal irrigation. Laryngoscope 114(12):2224–2227

    Article  Google Scholar 

  11. Chen PG, Murphy J, Alloju LM, Boase S, Wormald P-J (2017) Sinus penetration of a pulsating device versus the classic squeeze bottle in cadavers undergoing sinus surgery. Ann Otol Rhinol Laryngol 126(1):9–13

    Article  Google Scholar 

  12. Craig JR, Palmer JN, Zhao K (2017) Computational fluid dynamic modeling of nose-to-ceiling head positioning for sphenoid sinus irrigation. Int Forum Allergy Rhinol 7(5):474–479

    Article  Google Scholar 

  13. Thomas WW 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ (2013) Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol 3(9):691–703

    Article  Google Scholar 

  14. Mozzanica F, Preti A, Bandi F, Fazio E, Cardella A, Gallo S et al (2021) Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model. J Laryngol Otol 135(3):234–240

    Article  CAS  Google Scholar 

  15. Barham HP, Hall CA, Hernandez SC et al (2020) Impact of Draf III, Draf IIb, and Draf IIa frontal sinus surgery on nasal irrigation distribution. Int Forum Allergy Rhinol 10(1):49–52

    Article  Google Scholar 

  16. Grobler A, Weitzel EK, Buele A et al (2008) Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope 118(11):2078–2081

    Article  Google Scholar 

  17. Harvey RJ, Goddard JC, Wise SK, Schlosser RJ (2008) Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg 139(1):137–142

    Article  Google Scholar 

  18. Bleier BS, Debnath I, Harvey RJ, Schlosser RJ (2011) Temporospatial quantification of fluorescein-labeled sinonasal irrigation delivery. Int Forum Allergy Rhinol 1(5):361–365

    Article  Google Scholar 

  19. Snidvongs K, Chaowanapanja P, Aeumjaturapat S, Chusakul S, Praweswararat P (2008) Does nasal irrigation enter paranasal sinuses in chronic rhinosinusitis? Am J Rhinol 22(5):483–486

    Article  Google Scholar 

  20. Siu J, Johnston JJ, Pontre B, Inthavong K, Douglas RG (2019) Magnetic resonance imaging evaluation of the distribution of spray and irrigation devices within the sinonasal cavities. Int Forum Allergy Rhinol 9(9):958–970

    Article  Google Scholar 

  21. Djupesland PG, Messina JC, Palmer JN (2020) Deposition of drugs in the nose and sinuses with an exhalation delivery system vs conventional nasal spray or high-volume irrigation in Draf II/III post-surgical anatomy. Rhinology 58(2):175–183

    CAS  PubMed  Google Scholar 

  22. Hazeri M, Faramarzi M, Sadrizadeh S, Ahmadi G, Abouali O (2021) Regional deposition of the allergens and micro-aerosols in the healthy human nasal airways. J Aerosol Sci 152:105700

    Article  CAS  Google Scholar 

  23. de Gabory L, Reville N, Baux Y, Boisson N, Bordenave L (2018) Numerical simulation of two consecutive nasal respiratory cycles: toward a better understanding of nasal physiology. Int Forum Allergy Rhinol 8(6):676–685

    Article  Google Scholar 

  24. Inthavong K, Shang Y, Wong E, Singh N (2020) Characterization of nasal irrigation flow from a squeeze bottle using computational fluid dynamics. Int Forum Allergy Rhinol 10(1):29–40

    Article  Google Scholar 

  25. Salati H, Bartley J, White DE (2020) Nasal saline irrigation—a review of current anatomical, clinical and computational modelling approaches. Respir Physiol Neurobiol 273:103320

    Article  Google Scholar 

  26. Singhal D, Weitzel EK, Lin E et al (2010) Effect of head position and surgical dissection on sinus irrigant penetration in cadavers. Laryngoscope 120(12):2528–2531

    Article  Google Scholar 

  27. Harvey RJ, Schlosser RJ (2009) Local drug delivery. Otolaryngol Clin North Am 42(5):829–845

    Article  Google Scholar 

  28. Griggs ZH, Williams AM, Craig JR (2019) Head and bottle angles achieved by patients during high-volume sinonasal irrigations. Am J Rhinol Allergy 33(3):302–309

    Article  Google Scholar 

  29. Shrestha K, Salati H, Fletcher D, Singh N, Inthavong K (2021) Effects of head tilt on squeeze-bottle nasal irrigation—a computational fluid dynamics study. J Biomech 123:110490

    Article  Google Scholar 

  30. de Gabory L, Kérimian M, Baux Y, Boisson N, Bordenave L (2020) Computational fluid dynamics simulation to compare large volume irrigation and continuous spraying during nasal irrigation. Int Forum Allergy Rhinol 10(1):41–48

    Article  Google Scholar 

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Funding

Beijing Hospitals Authority Youth Program (QML20190617 to DW), Beijing Science and Technology Nova Program (Z201100006820086 to DW), Natural Science Foundation of China (82000954 to DW), and Beijing Hospitals Authority Clinical Medicine Development of Special Funding (XMLX202136 to DW).

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Authors and Affiliations

  1. Department of Otolaryngology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road 2, Chaoyang District, Beijing, 100029, People’s Republic of China

    Dawei Wu & Junsheng Hong

  2. Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, People’s Republic of China

    Feifan Chang

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China

    Yongxiang Wei

Authors
  1. Dawei Wu
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  2. Feifan Chang
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  3. Junsheng Hong
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  4. Yongxiang Wei
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Contributions

All authors have made substantial contributions to the conception, analysis, and interpretation of data in this article approved the submitted version and agreed both to be personally accountable for our contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which we are not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Corresponding author

Correspondence to Dawei Wu.

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Conflict of interest

DW was an inventor of the apparatus for evaluating the efficiency of nasal irrigation. The rest of the authors declare that they have no relevant conflicts of interest.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 19558 KB) Video 1. Rinsing with the rinse bottle and the dynamic fluid flow within the left nasal cavity with pure dyed water (175 ml, head tilt 10 degrees forward with leaning 30 degrees to the right).

Supplementary file2 (MP4 24413 KB) Video 2. Rinsing with the pulsatile device and the dynamic fluid flow within the left nasal cavity with pure dyed water (240 ml, head tilt 10 degrees forward with leaning 30 degrees to the right).

Supplementary file3 (MP4 27082 KB) Video 3. Rinsing with the rinse bottle in the cast filled with simulated nasal mucus (175ml, head tilt 10 degrees forward with leaning 30 degrees to the right).

Supplementary file4 (MP4 23286 KB) Video 4. Rinsing with the pulsatile device in the cast filled with simulated nasal mucus (240 ml, head tilt 10 degrees forward with leaning 30 degrees to the right).

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Wu, D., Chang, F., Hong, J. et al. Development of an apparatus and procedure for evaluating the efficiency of nasal irrigation. Eur Arch Otorhinolaryngol 279, 3997–4005 (2022). https://doi.org/10.1007/s00405-021-07249-8

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  • DOI: https://doi.org/10.1007/s00405-021-07249-8

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