research-article
Authors: Oveis Pourmehran, Alkis Psaltis, Sarah Vreugde, Kavan Zarei, + 3, Yidan Shang, Kiao Inthavong, Peter-John Wormald (Less)
Volume 264, Issue C
Published: 08 May 2025 Publication History
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Highlights
•
Nebuliser is better than nasal irrigation for sinus drug delivery post-Partial-MT.
•
Nasal irrigation is more effective for drug delivery to the frontal sinuses.
•
Larger size of ostia improve airflow and nebuliser drug delivery efficiency.
•
Anatomical variations and surgeries are crucial in selecting drug delivery methods.
Abstract
Background and Objective
Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition that substantially affects patients’ quality of life. Functional endoscopic sinus surgery (FESS) is commonly performed in cases where medical therapy fails. Effective post-operative drug delivery is crucial for improving outcomes. This study uses computational fluid dynamics (CFD) to compare nebulisation and nasal irrigation (bottle wash) in post-operative sinonasal models and to evaluate how anatomical alterations affect drug deposition across various paranasal sinuses.
Methods
Eight post-FESS models were generated from the CT scans of a 29-year-old female CRS patient. These models included variations in maxillary ostium sizes, both with and without partial middle turbinectomy. Using 3D Slicer®, images were segmented, and Ansys SpaceClaim® prepared the final geometries. CFD simulations then examined drug delivery efficiency for both nebulisation and nasal irrigation.
Results
Nebulisation faces considerable challenges due to sinus complexity; however, surgical modifications improved nebuliser deposition in the maxillary and sphenoid sinuses. In contrast, nasal irrigation showed higher efficiency in delivering drugs to the frontal sinuses. The residual liquid layer on sinus walls after irrigation significantly impacts comparative evaluations of these methods.
Conclusions
These findings emphasise the importance of adapting drug delivery strategies to specific surgical and anatomical factors. Tailored post-operative protocols may enhance outcomes in CRS, potentially improving patient comfort and compliance, and reducing recurrence rates. Further investigations are warranted to precisely quantify the liquid layer thickness remaining after irrigation, particularly as head movements can result in medication flowing back from sinuses into the nasal cavity.
Graphical abstract
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References
[1]
E. Lourijsen, et al., Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps, Rhinology 58 (3) (2020) 213–217.
[2]
N.W. Wahid, et al., The socioeconomic cost of chronic rhinosinusitis study, Rhinology 58 (2) (2020) 112–125.
[3]
S.F. Seys, et al., Real-life assessment of chronic rhinosinusitis patients using mobile technology: the mySinusitisCoach project by EUFOREA, Allergy 75 (11) (2020) 2867–2878.
[4]
J. Van der Veen, et al., Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre, Allergy 72 (2) (2017) 282–290.
[5]
L. Rudmik, et al., Economic evaluation of endoscopic sinus surgery versus continued medical therapy for refractory chronic rhinosinusitis, Laryngoscope 125 (1) (2015) 25–32.
[6]
H. Salati, et al., Nasal irrigation delivery in three post-FESS models from a squeeze-bottle using CFD, Pharm. Res. 39 (10) (2022) 2569–2584.
[7]
R. Jain, et al., The impact of endoscopic sinus surgery on paranasal physiology in simulated sinus cavities, Int. Forum. Allergy Rhinol 7 (3) (2017) 248–255.
[8]
S.H. de Paiva Leite, R.G. Douglas, How does sinus surgery affect topical irrigation distribution?, Curr. Opin. Otolaryngol. Head Neck Surg. 26 (1) (2018) 21–26.
[9]
X.B. Chen, et al., Drug delivery in the nasal cavity after functional endoscopic sinus surgery: a computational fluid dynamics study, J. Laryngol. Otol. 126 (5) (2012) 487–494.
[10]
W. Möller, et al., Topical drug delivery in chronic rhinosinusitis patients before and after sinus surgery using pulsating aerosols, PLoS One 8 (9) (2013) e74991.
[11]
M.R. Wofford, et al., A computational study of functional endoscopic sinus surgery and maxillary sinus drug delivery, Rhinology 53 (1) (2015) 41–48.
[12]
H.Y. Yoon, et al., Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis, Clin. Otolaryngol. 43 (2) (2018) 525–532.
[13]
J. Siu, et al., Quantification of airflow in the sinuses following functional endoscopic sinus surgery, Rhinology 58 (3) (2020) 257–265.
[14]
K.B. Lee, et al., Effects of partial middle turbinectomy with varying resection volume and location on nasal functions and airflow characteristics by CFD, Comput. Biol. Med. 77 (2016) 214–221.
[15]
A.A. Halderman, et al., The effect of middle turbinate resection on topical drug distribution into the paranasal sinuses, International Forum of Allergy & Rhinology, Wiley Online Library, 2016.
[16]
R. Ma, et al., Numerical and experimental analysis of pollen inhalation exposure in nasal airways following various middle turbinectomy, Sci. Total Environ. 907 (2024).
[17]
L.K. Dkhar, et al., Intranasal drug delivery devices and interventions associated with post-operative endoscopic sinus surgery, Pharm. Dev. Technol. 23 (3) (2018) 282–294.
[18]
R.R. Verma, R. Verma, Sinonasal irrigation after endoscopic sinus surgery–Past to present and future, Indian J. Otolaryngol. Head Neck Surg. 75 (3) (2023) 2694–2701.
[19]
P. Senanayake, et al., The impact of nasal adhesions on airflow and mucosal cooling–A computational fluid dynamics analysis, Respir. Physiol. Neurobiol. 293 (2021).
[20]
O. Pourmehran, et al., Acoustically-driven drug delivery to maxillary sinuses: aero-acoustic analysis, Eur. J. Pharm. Sci. 151 (2020).
[21]
M. Burgos, et al., New CFD tools to evaluate nasal airflow, Eur. Arch. Otorhinolaryngol. 274 (2017) 3121–3128.
[22]
M. Moniripiri, et al., Numerical simulation of unsteady airflow in a nasal cavity for various sizes of maxillary sinus opening in a virtual endoscopic surgery, Respir. Physiol. Neurobiol. 291 (2021).
[23]
K. Shrestha, et al., Effect of breathing profiles on nebuliser drug delivery targeting the paranasal sinuses in a post-operative nasal cavity, J. Aerosol Sci. 161 (2022).
[24]
R.J. Harvey, et al., Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation, Otolaryngol.—Head Neck Surg., 139 (1) (2008) 137–142.
[25]
K. Inthavong, et al., Characterization of nasal irrigation flow from a squeeze bottle using computational fluid dynamics, International Forum of Allergy & Rhinology, Wiley Online Library, 2020.
[26]
K. Zhao, et al., Sinus irrigations before and after surgery—Visualization through computational fluid dynamics simulations, Laryngoscope 126 (3) (2016) E90–E96. p.
[27]
Y. Liu, D. Wu, Bi-directional nasal drug delivery systems: a scoping review of nasal particle deposition patterns and clinical application, Laryngoscope Inv. Otolaryngol. 8 (6) (2023) 1484–1499.
[28]
M. Khamooshi, et al., Computational assessment of the nasal air conditioning and paranasal sinus ventilation from nasal assisted breathing therapy, Phys. Fluids 34 (5) (2022).
[29]
O. Pourmehran, et al., The effect of inlet flow profile and nozzle diameter on drug delivery to the maxillary sinus, Biomech. Model. Mechanobiol. 21 (3) (2022) 849–870.
[30]
S. Morsi, A. Alexander, An investigation of particle trajectories in two-phase flow systems, J. Fluid Mech. 55 (2) (1972) 193–208.
[31]
K. Shrestha, et al., Effects of head tilt on squeeze-bottle nasal irrigation – A computational fluid dynamics study, J. Biomech. 123 (2021).
[32]
J.U. Brackbill, et al., A continuum method for modeling surface tension, J. Comput. Phys. 100 (2) (1992) 335–354.
Digital Library
[33]
H. Salati, et al., N95 respirator mask breathing leads to excessive carbon dioxide inhalation and reduced heat transfer in a human nasal cavity, Phys. Fluids (8) (2021) 33.
[34]
H. Salati, Investigation Into Nasal Saline Irrigation Within a Healthy Human Nose, Auckland University of Technology, 2019.
[35]
D.O. Frank-Ito, et al., Influence of mesh density on airflow and particle deposition in sinonasal airway modeling, J. Aerosol. Med. Pulm. Drug. Deliv. 29 (1) (2016) 46–56.
[36]
K. Inthavong, et al., Examining mesh independence for flow dynamics in the human nasal cavity, Comput. Biol. Med. 102 (2018) 40–50.
[37]
M. Hazeri, et al., Regional deposition of the allergens and micro-aerosols in the healthy human nasal airways, J. Aerosol Sci. 152 (2021).
[38]
D.E.L. Olson, et al., Radiographic comparison of three methods for Nasal saline irrigation, Laryngoscope 112 (8) (2002) 1394–1398.
[39]
W.M. Abadie, et al., Irrigation penetration of nasal delivery systems: a cadaver study, Int. Forum. Allergy Rhinol. 1 (1) (2011) 46–49.
Index Terms
Evaluating nebulisation and nasal irrigation efficiency in post-operative chronic rhinosinusitis patients through computational fluid dynamics simulation
Applied computing
Life and medical sciences
Computational biology
Consumer health
Health care information systems
Health informatics
Computing methodologies
Modeling and simulation
Model development and analysis
Model verification and validation
Index terms have been assigned to the content through auto-classification.
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Published In
Computer Methods and Programs in Biomedicine Volume 264, Issue C
Jun 2025
297 pages
Issue’s Table of Contents
The Author(s).
Publisher
Elsevier North-Holland, Inc.
United States
Publication History
Published: 08 May 2025
Author Tags
- Chronic rhinosinusitis
- Functional endoscopic sinus surgery
- Computational fluid dynamics
- Nebulisation
- Nasal irrigation
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