Peter-John Wormald has a financial interest/arrangement with Medtronic Xomed for royalties received from the design of surgical instruments.
Pre- and Postoperative Sinus Penetration of Nasal Irrigation†
Article first published online: 2 JAN 2009
Copyright © 2008 The Triological Society
Volume 118, Issue 11, pages 2078–2081, November 2008
How to Cite
Grobler, A., Weitzel, E. K., Buele, A., Jardeleza, C., Cheong, Y. C., Field, J. and Wormald, P.-J. (2008), Pre- and Postoperative Sinus Penetration of Nasal Irrigation. The Laryngoscope, 118: 2078–2081. doi: 10.1097/MLG.0b013e31818208c1
- Issue published online: 2 JAN 2009
- Article first published online: 2 JAN 2009
- Manuscript Accepted: 3 JUN 2008
- Endoscopic sinus surgery;
- nasal irrigation;
- sinus ostia stenosis;
- nasal douche
Objective/Hypothesis: Endoscopic sinus surgery is an accepted treatment for medically recalcitrant chronic rhinosinusitis. Effective saline douching may improve long-term outcomes of chronic rhinosinusitis but is often impaired by postoperative ostial stenosis. The aim of this study is to determine a critical ostial size at which douching solution reliably enters the sinus cavities.
Study Design: Prospective study of consecutive patient cohort.
Methods: Seventeen preoperative or well-healed postoperative endoscopic sinus surgery patients were irrigated with 5 mL blue food coloring mixed with 200 mL buffered saline from a squeeze bottle. The degree of sinus penetration, sinus ostial patency, and ostial size were endoscopically determined.
Results: Sinuses penetrated by blue dye had a significantly larger minimal ostial dimension (7.31 mm; 95% confidence interval 5.54–9.08) than those that had no blue dye penetration (1.26 mm; 95% confidence interval 0.86–1.66) as determined by Student t test. Chi-square analysis showed that operated sinuses were more likely to be penetrated than nonoperated sinuses (P = .0016) and obstructed sinuses (P = .0325). Logistic regression showed a 95% probability of penetration when the minimum ostial dimension is 3.95 mm or greater.
Conclusions: Unoperated sinuses or cases with gross sinus ostial obstruction will not be reliably penetrated by sinus irrigant. A 3.95-mm ostial diameter seems to be the minimum size to guarantee penetration in paranasal sinuses to maximize the potential for topical sinus treatment.