Department of Otolaryngology Head and Neck Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236, USA.
Am J Rhinol Allergy. 2012 May-Jun;26(3):197-200. doi: 10.2500/ajra.2012.26.3761.
Saline irrigations are proving to be a valuable intervention in the treatment of chronic sinusitis. The use of surfactants is a well established additive to topical treatments known to reduce surface tension and may prove to be a simple, nonoperative intervention to improve intrasinus douching penetration.
Six 30-mL, flat-bottomed medicine cups with circular holes cut through the bottom center and varying in diameter from 1 to 6 mm were created with punch biopsies. Water, saline, saline/dye, and saline/dye/surfactant were compared for maximum holding pressure via these modeled ostia. Holding pressures also were determined for cups with septal mucosa fused to the bottom with holes ranging from 1 to 6 mm. In addition, analysis was carried out with blood and blood/surfactant. Finally, five thawed, fresh-frozen cadaver heads were evaluated before any sinus surgery with water/dye and water/dye/surfactant for intrasinus penetration.
Surfactant significantly improved the ability of all solutions to penetrate ostia in both the plastic cup and fused septal mucosa model. All nonsurfactant-containing solutions were not statistically different from one another, nor did surfactant change the ostial penetration of blood. Surfactant significantly improved the ability of sinus irrigant to penetrate unoperated sinus cavities (3.12 vs 3.5, p = .021).
The addition of surfactant to saline irrigation improves ostial penetration in undissected and undiseased cadavers. This has practical implications for unoperated patients seeking care for sinus-related symptoms in that we have now described a method for improving topical treatment of target sinus mucosa prior to surgical intervention.
盐水冲洗被证明是治疗慢性鼻窦炎的一种有价值的干预措施。表面活性剂的使用是一种成熟的添加剂，用于局部治疗，可以降低表面张力，并可能成为一种简单的非手术干预措施，以改善窦内冲洗的穿透性。
用活检穿孔器制作了 6 个 30 毫升平底药杯，底部中心有圆形孔，直径从 1 毫米到 6 毫米不等。通过这些模拟的窦口比较了水、盐水、盐水/染料和盐水/染料/表面活性剂的最大保持压力。还测定了底部有孔的融合隔粘膜的杯的保持压力，孔的直径从 1 毫米到 6 毫米不等。此外，还对血液和血液/表面活性剂进行了分析。最后，在任何鼻窦手术之前，对五个解冻的新鲜冷冻尸体头部进行了水/染料和水/染料/表面活性剂的窦内穿透分析。
表面活性剂显著提高了所有溶液在塑料杯和融合隔粘膜模型中穿透窦口的能力。所有不含表面活性剂的溶液彼此之间没有统计学差异，表面活性剂也没有改变血液的窦口穿透性。表面活性剂显著提高了窦冲洗液穿透未手术窦腔的能力（3.12 对 3.5，p =.021）。
在未解剖和未患病的尸体中，向盐水冲洗液中添加表面活性剂可改善窦口穿透性。这对寻求鼻窦相关症状治疗的未手术患者具有实际意义，因为我们现在已经描述了一种在手术干预前改善目标窦粘膜局部治疗的方法。
