Evaluation of the penetration ability into perinasal sinuses of particles using the PARI LC SPRINT® SINUS nebulizer with a modified technique in healthy individuals and in cystic fibrosis patients with chronic rhinosinusitis with endoscopic sinus surgery

Abstract

Introduction: In cystic fibrosis patients with chronic rhinosinusitis, the same microorganisms that colonize the upper airway are the ones who damage the lung. Local treatments by nebulization of perinasal sinuses would be helpful in these cases. Aim: To evaluate the penetration ability of nebulized particles into perinasal sin­uses. Material and method: Healthy volunteers and cystic fibrosis patients with chronic rhinosinusitis with endoscopic sinus surgery had nasal nebulization using the pulsating nebulizer PARI LC Sprint® SINUS. Fusion of scintigraphic SPECT and CT images was used to evaluate the particles penetration ability into perinasal sinuses. Results: Five volunteers and 2 patients with CF were evaluated. It was not possible to perform the nebulization procedure as indicated by the manufacturer. A continous nebulization was done instead. 9% of the nebulized material was deposited in the perinasal sinuses in volunteers and 4% in patients with CF, while the rest of the particles were distributed in the body, specially in lungs and digestive tract. Conclusions: The main deposition of the nasal nebulized solution was outside the perinasal sinuses. These results led to discontinuation of the study because it would be difficult to prove a difference in the effectiveness of nebulized particles among patients with and without surgery. It also seems impossible to define the real value of local peri- nasal sinus therapies considering a probable systemic effect.