Ralph H. Johnson VA Medical Center and Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
Int Forum Allergy Rhinol. 2013 Sep;3(9):691-703. doi: 10.1002/alr.21172. Epub 2013 May 31.
The objective of this work was to review the literature concerning the distribution of topical therapeutics to the sinuses versus nasal cavity regarding: surgical state, delivery device, head position, and nasal anatomy and to provide evidence-based recommendations.
A systematic review was conducted using Medline, EMBASE, and Cochrane databases to perform a Medical Subject Heading search of the literature from 1946 until the last week of May 2012. Articles were independently reviewed and graded for level of evidence. All authors came to consensus on recommendations through an iterative process.
Recommendations were made for: improved sinus delivery with high-volume devices and after standard sinus surgery. Recommendations were made against low-volume delivery devices, such as drops, sprays, or simple nebulizers as they do not reliably reach the sinuses. If large-volume devices are not tolerated, low-volume devices are recommended using the lying head back or lateral head low positions to improve nasal cavity distribution to the middle meatus or olfactory cleft.
Surgery, volume of device, head position, and nasal anatomy were shown to impact distribution to the sinuses. Recommendations are made based upon this evidence as to how to best maximize therapeutic distribution to the sinuses.
本研究旨在回顾有关鼻腔鼻窦局部给药的文献，包括手术状态、给药装置、头部位置、鼻腔解剖结构等方面，旨在为临床提供基于循证医学的推荐意见。
本研究通过 Medline、EMBASE 和 Cochrane 数据库，对 1946 年至 2012 年 5 月最后一周的文献进行主题词检索，由两位独立的评价者对文献进行评价和分级，并对推荐意见进行了一致性检验。
研究推荐使用大剂量装置和标准鼻窦手术后改善鼻窦的给药效果。不推荐使用小剂量的给药装置，如滴剂、喷雾剂或简单的雾化器，因为它们不能可靠地到达鼻窦。如果不能耐受大剂量装置，则推荐使用仰卧或侧卧头部低位，以增加鼻腔至中鼻甲或嗅裂的分布，从而改善鼻腔的分布。
手术、装置容量、头部位置和鼻腔解剖结构均影响药物在鼻窦内的分布。本研究根据这些证据提出了如何最大限度地将药物输送到鼻窦的建议。
