Sundström Elias, Talat Rehab, Sedaghat Ahmad R, Khosla Sid, Oren Liran
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267.
J Eng Sci Med Diagn Ther. 2022 Aug 1;5(3):031103. doi: 10.1115/1.4053907. Epub 2022 Mar 11.
Eustachian tube dysfunction (ETD) is a common otolaryngologic condition associated with decreased quality of life. The first-line treatment of ETD is intranasal corticosteroid sprays (INCS). Computational fluid dynamics (CFD) was used to study particle deposition on the Eustachian tube (ET) using two commercial INCS (Flonase and Sensimist). Simulations also considered the effects of nostril side, insertion depth, insertion angle, cone spray angle, inhaling rates, wall impingement treatment, and fluid film. Flonase and Sensimist produced different particle size distributions and sizes. Sensimist droplets are smaller, less sensitive to asymmetry in nostrils anatomy and variation in insertion angle, and therefore can reach the posterior nasopharynx more readily. Flonase produces larger particles with greater inertia. Its particles deposition is more sensitive to intrasubject variation in nasal anatomy and insertion angles. The particle deposition on the ET was sensitive to the wall impingement model. The deposition on the ET was insignificant with adherence only <0.15% but increased up to 1-4% when including additional outcomes rebound and splash effects when droplets impact with the wall. The dose redistribution with the fluid film is significant but plays a secondary effect on the ET deposition. Flonase aligned parallel with the hard palate produced 4% deposition efficiency on the ET, but this decreased <0.14% at the higher insertion angle. INCS with larger droplet sizes with a small insertion angle may be more effective at targeting droplet deposition on the ET opening.
咽鼓管功能障碍（ETD）是一种常见的耳鼻喉科疾病，与生活质量下降有关。ETD的一线治疗方法是鼻内使用皮质类固醇喷雾剂（INCS）。利用计算流体动力学（CFD），使用两种市售的INCS（辅舒良和仙特明）研究了颗粒在咽鼓管（ET）上的沉积情况。模拟还考虑了鼻孔侧、插入深度、插入角度、锥形喷雾角度、吸入速率、壁面撞击处理和液膜的影响。辅舒良和仙特明产生了不同的粒径分布和尺寸。仙特明的液滴较小，对鼻孔解剖结构的不对称性和插入角度的变化不太敏感，因此更容易到达鼻咽后部。辅舒良产生的颗粒较大，惯性也更大。其颗粒沉积对鼻腔解剖结构和插入角度的个体差异更为敏感。颗粒在ET上的沉积对壁面撞击模型很敏感。颗粒在ET上的沉积量微不足道，粘附率仅<0.15%，但当包括液滴撞击壁面时的额外结果反弹和飞溅效应时，沉积量增加至1-4%。液膜导致的剂量重新分布很显著，但对ET沉积起次要作用。与硬腭平行排列的辅舒良在ET上产生4%的沉积效率，但在较高插入角度时，沉积效率降至<0.14%。液滴尺寸较大且插入角度较小的INCS可能在将液滴沉积靶向于ET开口处时更有效。
