Hwang Peter H, Woo Rachel J, Fong Karen J
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Am J Rhinol. 2006 May-Jun;20(3):255-61. doi: 10.2500/ajr.2006.20.2861.
Despite the popularity of various nasal sprays and nebulizers, there are limited data regarding the anatomic distribution of particles generated by these devices. This pilot study sought to characterize distribution patterns of nebulized and sprayed saline particles in normal subjects and postsurgical sinus patients.
Fifteen subjects were studied in three trials: metered-dose nasal spray bottle versus vortex-propelled nebulizer in normal subjects, passive-diffusion nebulizer versus vortex nebulizer in normal subjects, and passive nebulizer versus vortex nebulizer in postsurgical sinus patients. Radiolabeled saline was administered, and nose, lungs, and stomach were imaged. Images were scored by four blinded reviewers for degree of penetration at nine anatomic subsites.
Compared with spray bottle, the vortex nebulizer showed more focal intranasal distribution with reduced nasopharyngeal, pharyngeal, and gastric penetration in normal subjects. Three of five subjects showed probable frontal sinus penetration by vortex nebulizer, but no other sinus penetration was noted. No patients showed sinus penetration with the spray bottle. In a separate trial against the passive nebulizer, the vortex nebulizer again showed a greater tendency for sinus penetration in normal subjects, with three of five showing some degree of sphenoid penetration and one of five showing slight maxillary penetration. In contrast, no sinus penetration was observed with the passive nebulizer. In the postsurgical patient cohort, minimal sinus penetration was noted with either the vortex nebulizer or the passive nebulizer. Despite surgically patent sinuses, only one of five subjects showed any type of sinus penetration.
The nebulizer and nasal spray devices tested in general showed limited penetration of the sinuses in both normal and postoperative patients. The device showing greatest promise for sinus penetration in normal patients was the vortex nebulizer, with an overall penetration rate in normal patients of 30% in the frontal, 30% in the sphenoid, and 10% in the maxillary. Understanding delivery patterns of topical therapies may be important in evaluating the efficacy of various topical treatment modalities.
尽管各种鼻喷雾剂和雾化器很受欢迎，但关于这些设备产生的颗粒在解剖学上的分布数据有限。这项初步研究旨在描述雾化和喷雾生理盐水颗粒在正常受试者和鼻窦手术后患者中的分布模式。
在三项试验中对15名受试者进行了研究：正常受试者中定量喷雾鼻瓶与涡旋推进式雾化器的比较、正常受试者中被动扩散雾化器与涡旋雾化器的比较，以及鼻窦手术后患者中被动雾化器与涡旋雾化器的比较。给予放射性标记的生理盐水，并对鼻子、肺部和胃部进行成像。由四名不知情的评审人员对图像在九个解剖亚部位的渗透程度进行评分。
与喷雾瓶相比，涡旋雾化器在正常受试者中显示出更集中的鼻内分布，鼻咽、咽部和胃部的渗透减少。五名受试者中有三名显示涡旋雾化器可能进入额窦，但未观察到其他鼻窦有渗透。没有患者显示喷雾瓶能进入鼻窦。在与被动雾化器的单独试验中，涡旋雾化器在正常受试者中再次显示出更大的鼻窦渗透倾向，五名中有三名显示一定程度的蝶窦渗透，五名中有一名显示轻微的上颌窦渗透。相比之下，被动雾化器未观察到鼻窦渗透。在手术后患者队列中，涡旋雾化器和被动雾化器的鼻窦渗透都很少。尽管鼻窦手术使其通畅，但五名受试者中只有一名显示出任何类型的鼻窦渗透。
总体而言，所测试的雾化器和鼻喷雾装置在正常患者和术后患者中对鼻窦的渗透都有限。在正常患者中最有希望实现鼻窦渗透的装置是涡旋雾化器，正常患者中总体渗透率为额窦30%、蝶窦30%、上颌窦10%。了解局部治疗的递送模式对于评估各种局部治疗方式的疗效可能很重要。
