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Characterizing Nasal Delivery in 3D Models Before and After Sinus Surgery

Kimbell JS, Basu S, Farzal Z, Senior BA.

Respiratory Drug Delivery 2018. Volume 1, 2018: 181-188.

Abstract:

Chronic rhinosinusitis (CRS) is a prevalent disease characterized by inflammation of the nasal and sinus mucosa and significantly decreases quality of life for those who suffer from it. If maximal medical therapy does not resolve symptoms, surgical treatment may be indicated. Nasal sprays are an important component of treatment both before and after sinus surgery, yet use of such sprays according to package insert instructions has not been studied in a CRS population. A preliminary computational study was conducted to establish methods for simulating patient instructions for use, and to characterize and compare simulated fluticasone propionate (FP) nasal spray droplet distribution before and after sinus surgery in two CRS patients, using droplet size distribution and plume geometry measured for FP nasal spray. Total nasal deposition exceeded 96% of spray mass in all cases but penetration past the nasal valve did not surpass 23%, and while sinus deposition did increase after surgery, increases were no larger than 1.1%. Droplets less than 20 μm in diameter penetrated deeper and were more widely distributed throughout both the pre- and post-operative nasal cavities than larger droplets, and showed better penetration and distribution after surgery than before, but accounted for less than 16% of total spray mass and did not change mass deposited in sinuses substantially. This study highlights the importance of droplet size distribution, and when coupled with model refinements from comparison with experimental measurements and extended to a larger cohort of CRS patients, will help guide the development of improved delivery of topical medications for improved treatment outcomes in CRS patients.