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Does endoscopic balloon dilatation improve intranasal drug delivery to the olfactory cleft? A pre-clinical cadaver feasibility study

Published online by Cambridge University Press:  14 February 2022

D Gershnabel Milk Open the ORCID record for D Gershnabel Milk [Opens in a new window] ,
G C Khong ,
O H Çam ,
A Fernando ,
C Tierney ,
F Kassem  and
S C Leong Open the ORCID record for S C Leong [Opens in a new window]
D Gershnabel Milk
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, UK Department of Otolaryngology – Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel
G C Khong
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, UK
O H Çam
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, UK Faculty of Medicine, Başkent University, Ankara, Turkey
A Fernando
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, UK Department of Otolaryngology, Hospital Central Militar, Mexico City, Mexico
C Tierney
Affiliation:
Human Anatomy Resource Centre, University of Liverpool, UK
F Kassem
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel
S C Leong*
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr Samuel C Leong, Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK E-mail: [email protected]
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Abstract

Background

Although systemic steroids have been shown to improve olfactory function, topical steroids have not demonstrated the same efficacy. This could a result of limited drug delivery to the narrow, superiorly placed olfactory cleft. This study aimed to examine the penetration of intranasal drugs to the olfactory cleft following endonasal balloon dilatation.

Methods

Balloon dilatation was performed in 12 thawed, fresh-frozen cadaver specimens. In the Mygind position, nasal drops mixed with blue food dye were administered into the nostril before and after the dilatation procedure. Endoscopic videos were recorded to assess dye staining of the olfactory cleft and osteo-meatal complex using a 4-point Likert scale.

Results

Prior to balloon dilatation, the mean penetration of nasal drops into the olfactory cleft was 1.34, which improved significantly (p < 0.05) to 2.66 following the procedure. There was no change in dye penetration into the osteo-meatal complex after balloon dilatation.

Conclusion

The results of this exploratory study suggest that balloon dilatation may improve the delivery of nasal drops to the olfactory cleft area. The clinical applicability and impact on olfactory function will require further assessment.

Keywords

Paranasal SinusesDilatationSmell
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 10 , October 2022 , pp. 970 - 974
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Mr S Leong takes responsibility for the integrity of the content of the paper

References

Lund, VJ, Stammberger, H, Fokkens, WJ, Beale, T, Bernal-Sprekelsen, M, Eloy, P et al. European position paper on the anatomical terminology of the internal nose and paranasal sinuses. Rhinol Suppl 2014;24:1–34Google ScholarPubMed
Weiss, T, Secundo, L, Sobel, N. Human olfaction: a typical yet special mammalian olfactory system. In: Mori, K.. The Olfactory System: From Odor Molecules to Motivational Behaviors. Tokyo: Springer, 2014;177–202CrossRefGoogle Scholar
Murphy, C, Schubert, CR, Cruickshanks, KJ, Klein, BEK, Klein, R, Nondahl, DM. Prevalence of olfactory impairment in older adults. JAMA 2002;288:2307–12CrossRefGoogle ScholarPubMed
Brämerson, A, Johansson, L, Ek, L, Nordin, S, Bende, M. Prevalence of olfactory dysfunction: the Skövde population-based study. Laryngoscope 2004;114:733–7CrossRefGoogle ScholarPubMed
Smeets, MAM, Veldhuizen, MG, Galle, S, Gouweloos, J, de Haan, AMJA., Vernooij, J et al. Sense of smell disorder and health-related quality of life. Rehabil Psychol 2009;54:404–12CrossRefGoogle ScholarPubMed
Vento, SI, Simola, M, Ertama, LO, Malmberg, CH. Sense of smell in long-standing nasal polyposis. Am J Rhinol 2001;15:159–63CrossRefGoogle ScholarPubMed
Heilmann, S, Huettenbrink, K-B, Hummel, T. Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol 2004;18:29–33CrossRefGoogle ScholarPubMed
Jankowski, R, Nguyen, DT, Gallet, P, Rumeau, C. Olfactory cleft dilatation. Eur Ann Otorhinolaryngol Head Neck Dis 2018;135:437–41CrossRefGoogle ScholarPubMed
Piccirillo, JF, Payne, SC, Rosenfeld, RM, Baroody, FM, Batra, PS, DelGaudio, JM et al. Clinical consensus statement: balloon dilation of the sinuses. Otolaryngol Head Neck Surg 2018;158:203–14CrossRefGoogle ScholarPubMed
Cam, OH, Gershnabel Milk, D, Alfaro-Iraheta, F, Khong, GC, Tierney, C, Leong, SC. Endoscopic balloon dilatation of the olfactory cleft - a feasibility study of a novel technique in cadavers. Acta Otorhinolaryngol Ital 2021;41:168–72CrossRefGoogle ScholarPubMed
Kidwai, SM, Parasher, AK, Khan, MN, Eloy, JA, Del Signore, A, Iloreta, AM. Improved delivery of sinus irrigations after middle turbinate resection during endoscopic sinus surgery. Int Forum Allergy Rhinol 2017;7:338–42CrossRefGoogle ScholarPubMed
Bassiouni, A, Chen, PG, Naidoo, Y, Wormald, PJ. Clinical significance of middle turbinate lateralization after endoscopic sinus surgery. Laryngoscope 2015;125:36–41CrossRefGoogle ScholarPubMed
Ference, EH, Graber, M, Conley, D, Chandra, RK, Tan, BK, Evans, C et al. Operative utilization of balloon versus traditional endoscopic sinus surgery. Laryngoscope 2015;125:49–56CrossRefGoogle ScholarPubMed
Ross, PD, Joice, P, Nassif, RG, White, PS. Surgical instrument force exerted during endoscopic sinus surgery: differences within the ethmoid sinus complex. Am J Rhinol Allergy 2010;24:76–80CrossRefGoogle ScholarPubMed
Merkus, P, Ebbens, FA, Muller, B, Fokkens, WJ. Influence of anatomy and head position on intranasal drug deposition. Eur Arch Otorhinolaryngol 2006;263:827–32CrossRefGoogle ScholarPubMed
Charlton, S, Jones, NS, Davis, SS, Illum, L. Distribution and clearance of bioadhesive formulations from the olfactory region in man: effect of polymer type and nasal delivery device. Eur J Pharm Sci 2007;30:295–302Google ScholarPubMed
Lechner, M, Chandrasekharan, D, Jumani, K, Liu, J, Gane, S, Lund, VJ. Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers - a systematic review of the literature, case series, and recommendations for clinical assessment and management. Rhinology 2020;58:394–9Google ScholarPubMed
Hopkins, C, Surda, P, Whitehead, E, Nirmal Kumar, B. Early recovery following new onset anosmia during the COVID-19 pandemic--an observational cohort study. Otolaryngol Head Neck Surg 2020;49:26CrossRefGoogle ScholarPubMed