There has been an explosion in the understanding of the mechanisms of chronic sinonasal inflammation. Multiple approaches to control and modify the inflammatory reaction in chronic rhinosinusitis have led to many new agents being introduced topically to the nose. This miniseminar aims to provide an evidence-based approach to the science behind topical management of sinonasal disease. Current research into irrigation dynamics and delivery device will be discussed. There are a range of products available to deliver solutions topically to nose. The scientific basis behind high and low volume along with negative and positive pressure delivery is presented. The general therapeutic goal of topical management often lies between, potentially competing actions of mechanical and pharmaceutical intervention. Distribution research behind nebulizers, sprays, irrigations and other delivery techniques is discussed within this framework. The over-the-counter (OTC) market for topical sinonasal treatments is likely to exponentially grow over the next few years. Increasingly, the pharmaceutical options have also grown. Antibiotics, such as mupriocin, and steroids are often added to solutions. The science behind the OTC agents and pharmaceutical additions to saline are presented. Potential adverse risks also need to balanced with greater local intervention. The influence of pre and post surgical distribution efficacy is an important factor that significantly changes how these solutions should be used. Saline, as the basis of all topicals, and its evidence base is briefly described. The miniseminar is presented by rhinologists actively involved in the topical management of chronic sinonasal conditions both clinically and in research. Presentations for delivery, device, saline and pharmaceutical additives will be given with video used to illustrate research.
Educational Objectives
1) Define the therapeutic goals of topical therapies. 2) Understand the influence of device and surgical state on topical delivery. 3) Learn about the science behind novel topical agents. 4) Be able to identify the inflammatory conditions under which to apply these new topical therapies.
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