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Richard J Harvey - One of the best experts on this subject based on the ideXlab platform.
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corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis
International Forum of Allergy & Rhinology, 2012Co-Authors: Richard J Harvey, Kornkiat Snidvongs, Eleanor Pratt, David Chin, Raymond Sacks, Peter EarlsAbstract:Background: Inflammatory dysfunction is considered an important part of chronic rhinosinusitis (CRS). Corticosteroid therapy has been widely used in CRS. Effective topical delivery has been previously problematic. The post–endoscopic sinus surgery (ESS) corridor is essential for adequate topical drug access. Devices delivering large volume with positive pressure allow better distribution to sinus mucosa. The objective of this study is to evaluate the efficacy of postoperative topical sinonasal steroid irrigations for CRS. Methods: Patients with CRS undergoing ESS after failing previous medical therapy were recruited. Structured histopathology including markers of eosinophilia was performed. After surgery, patients received either budesonide 1 mg or betamethasone 1 mg delivered in a 240-mL Squeeze Bottle daily. Outcomes of the symptom score, Sino-Nasal Outcome Test 22 (SNOT-22) score, and endoscopy score were recorded. Results: A total of 111 patients (mean 50.1 ± 13.5 standard deviation [SD] years, 40.5% female) were included. Mean follow-up was 55.5 ± 33.9 weeks. Baseline and posttreatment symptom scores (2.6 ± 1.1 vs 1.2 ± 1.0), SNOT-22 scores (2.2 ± 1.1 vs 1.0 ± 0.8), and endoscopy scores (6.7 ± 3.0 vs 2.5 ± 2.0) revealed significant improvement (all, p 10/high power field [HPF]) had significantly more improvement on symptom score (1.9 ± 1.4 vs 1.1 ± 1.0, p = 0.04), SNOT-22 score (1.6 ± 1.3 vs 1.0 ± 0.8, p = 0.03), and endoscopy score (5.12 ± 3.4 vs 3.06 ± 3.0, p = 0.01) than those without. Conclusion: The philosophical approach to ESS in CRS is evolving. Topical therapies, when used appropriately, are highly effective for the most challenging eosinophilic patients. Although corticosteroid is a nonspecific therapy, it is effective when appropriately delivered. ©2012 ARSAAOA, LLC.
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effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Richard J Harvey, John C Goddard, Sarah K Wise, Rodney J SchlosserAbstract:Objective Assess paranasal sinus distribution of topical solutions following endoscopic sinus surgery (ESS) using various delivery devices. Study design Experimental prospective study. Subjects and methods Ten cadaver sinus systems were irrigated with Gastroview before surgery, after ESS, and after medial maxillectomy. Delivery was via pressurized spray (NasaMist), neti pot (NasaFlo), and Squeeze Bottle (Sinus Rinse). Scans were performed before and after each delivery with a portable CT machine (Xoran xCAT), and blinded assessments were made for distribution to individual sinuses. Results Total sinus distribution was greater post-ESS (P Squeeze Bottle > pressurized spray (P Conclusion ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Pressurized spray solutions in un-operated sinuses provide little more than nasal cavity distribution. Use of Squeeze Bottle/neti pot post-ESS offers a greatly enhanced ability to deliver solutions to the paranasal sinuses.
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effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Richard J Harvey, John C Goddard, Sarah K Wise, Rodney J SchlosserAbstract:OBJECTIVE: Assess paranasal sinus distribution of topical solutions following endoscopic sinus surgery (ESS) using various delivery devices. STUDY DESIGN: Experimental prospective study. SUBJECTS AND METHODS: Ten cadaver sinus systems were irrigated with Gastroview before surgery, after ESS, and after medial maxillectomy. Delivery was via pressurized spray (NasaMist), neti pot (NasaFlo), and Squeeze Bottle (Sinus Rinse). Scans were performed before and after each delivery with a portable CT machine (Xoran xCAT), and blinded assessments were made for distribution to individual sinuses. RESULTS: Total sinus distribution was greater post-ESS (P Squeeze Bottle > pressurized spray (P < 0.001). Frontal sinus penetration was greatest after surgery (P = 0.001). CONCLUSION: ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Pressurized spray solutions in un-operated sinuses provide little more than nasal cavity distribution. Use of Squeeze Bottle/neti pot post-ESS offers a greatly enhanced ability to deliver solutions to the paranasal sinuses.
Peterjohn Wormald - One of the best experts on this subject based on the ideXlab platform.
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sinus penetration of a pulsating device versus the classic Squeeze Bottle in cadavers undergoing sinus surgery
Annals of Otology Rhinology and Laryngology, 2017Co-Authors: Philip G Chen, Jae Murphy, Les M Alloju, Sam Boase, Peterjohn WormaldAbstract:Objectives:Nasal irrigation is standard in the management of chronic rhinosinusitis both before and after surgical intervention. Numerous irrigation devices are commercially available. The aim of t...
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decreasing bacterial cross contamination with a pulsating nasal irrigation device
International Forum of Allergy & Rhinology, 2014Co-Authors: Mark Keen, Philip G Chen, Peterjohn WormaldAbstract:Background The use of nasal irrigation in the management of postoperative endoscopic sinus surgery (ESS) patients is commonplace; however, the potential contamination of these Bottles is concerning. The Sinugator® cordless pulsating nasal wash (NeilMed Pharmaceuticals, Inc., Santa Rosa, CA) is a battery-operated, positive pressure, pulsatile pump with a unidirectional flow. The principal aim of this study was to determine the incidence of cross-contamination using the pulsating nasal irrigation device and compare it with the traditional Squeeze Bottle. Methods Eleven post-ESS patients were given a NeilMed Sinugator nasal wash to use 3 times per day. A sterile nasal swab was obtained at the initial and second postoperative visits. A swab of the plastic irrigation reservoir was collected at the second visit. Results The overall contamination rate of Bottles was found to be 45%. During the study several different organisms were cultured in the nose and Bottles. The most commonly isolated organisms were coliforms and Staphylococcus aureus. We did not observe concomitant organisms in the nasal cultures and Bottles in any subject. Conclusion Despite using a motorized irrigation device, patients and their Bottles grew positive cultures. However, no cross-contamination between the patients and Bottles was identified, which can be attributed to a design that minimizes backwash.
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pre and postoperative sinus penetration of nasal irrigation
Laryngoscope, 2008Co-Authors: Alethea Grobler, Erik K Weitzel, Achim Buele, Camille Jardeleza, Yew C Cheong, John R Field, Peterjohn WormaldAbstract:Objective/Hypothesis: Endoscopic sinus surgery is an accepted treatment for medically recalcitrant chronic rhinosinusitis. Effective saline douching may improve long-term outcomes of chronic rhinosinusitis but is often impaired by postoperative ostial stenosis. The aim of this study is to determine a critical ostial size at which douching solution reliably enters the sinus cavities. Study Design: Prospective study of consecutive patient cohort. Methods: Seventeen preoperative or well-healed postoperative endoscopic sinus surgery patients were irrigated with 5 mL blue food coloring mixed with 200 mL buffered saline from a Squeeze Bottle. The degree of sinus penetration, sinus ostial patency, and ostial size were endoscopically determined. Results: Sinuses penetrated by blue dye had a significantly larger minimal ostial dimension (7.31 mm; 95% confidence interval 5.54–9.08) than those that had no blue dye penetration (1.26 mm; 95% confidence interval 0.86–1.66) as determined by Student t test. Chi-square analysis showed that operated sinuses were more likely to be penetrated than nonoperated sinuses (P .0016) and obstructed sinuses (P .0325). Logistic regression showed a 95% probability of penetration when the minimum ostial dimension is 3.95 mm or greater. Conclusions: Unoperated sinuses or cases with gross sinus ostial obstruction will not be reliably penetrated by sinus irrigant. A 3.95-mm ostial diameter seems to be the minimum size to guarantee penetration in paranasal sinuses to maximize the potential for topical sinus treatment.
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a prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers
American Journal of Roentgenology, 2008Co-Authors: Rowan Valentine, Theo Athanasiadis, May Thwin, Deepti Singhal, Erik K Weitzel, Peterjohn WormaldAbstract:BACKGROUND Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model. METHODS Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized Squeeze bilaterally of a 200-mL nasal irrigation Bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols. RESULTS Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p < 0.001), percentage of stain (49.96% versus 4.19%, p < 0.001), and circumference stained (76.59% versus 12.7%, p < 0.001) with the plastic nasal irrigation Squeeze Bottle versus PARI device. Analysis of individual sinuses consistently showed significant increases in indices of nasal douching relative to nebulization. The PARI sinus nebulizer was noted to reach the ethmoids regularly (92% incidence), whereas the other sinuses were not reached as regularly with incidences noted at frontal (43%), maxillary (46%), and sphenoid (54%). This compares to 96% of all sinuses being stained by the Squeeze Bottle. CONCLUSION In all measured indices, the nasal douching method with the Squeeze Bottle was superior to the PARI sinus nebulizer in highly dissected sinonasal cadaver models.
Rodney J Schlosser - One of the best experts on this subject based on the ideXlab platform.
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Identification of microbial contaminants in sinus rinse Squeeze Bottles used by allergic rhinitis patients
'Elsevier BV', 2019Co-Authors: Shaun A. Nguyen, Marc P. Camilon, Rodney J SchlosserAbstract:Objective: To identify whether irrigation devices become contaminated when used by patients with allergic rhinitis (AR). Methods: Ten AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus rinse system and instructed on its proper use, cleaning, and storage. Two Squeeze Bottles (Bottle A and Bottle B) were given to each patient for twice-a-day rinsing. Bottle A was used in the morning and analyzed after four weeks. Bottle B was used in the evening and analyzed after 8 weeks of use. Microbial contaminants were cultured from the nose pieces and the inner surface of the Bottles obtained from patients. Results: Seventeen sinus rinse devices (17/20) from all individuals in this study grew bacteria commonly in the nozzles. Twenty-four bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus. In addition, no correlation was apparent between the length of Bottle use and the degree of contamination (r = 0.13, p = 0.76). During the study period, no patient developed acute sinus infections. Conclusion: Microbial contamination of the sinus rinse system occurs commonly, even in uninfected AR patients; however no evidence exists linking this to clinically relevant sinus infections. Trial Registration: clinicaltrials.gov Identifier: NCT01030146. Keywords: Allergic rhinitis, Microbial contaminants, Sinus irrigation, Sinus rinse, Squeeze Bottle
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effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Richard J Harvey, John C Goddard, Sarah K Wise, Rodney J SchlosserAbstract:Objective Assess paranasal sinus distribution of topical solutions following endoscopic sinus surgery (ESS) using various delivery devices. Study design Experimental prospective study. Subjects and methods Ten cadaver sinus systems were irrigated with Gastroview before surgery, after ESS, and after medial maxillectomy. Delivery was via pressurized spray (NasaMist), neti pot (NasaFlo), and Squeeze Bottle (Sinus Rinse). Scans were performed before and after each delivery with a portable CT machine (Xoran xCAT), and blinded assessments were made for distribution to individual sinuses. Results Total sinus distribution was greater post-ESS (P Squeeze Bottle > pressurized spray (P Conclusion ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Pressurized spray solutions in un-operated sinuses provide little more than nasal cavity distribution. Use of Squeeze Bottle/neti pot post-ESS offers a greatly enhanced ability to deliver solutions to the paranasal sinuses.
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effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Richard J Harvey, John C Goddard, Sarah K Wise, Rodney J SchlosserAbstract:OBJECTIVE: Assess paranasal sinus distribution of topical solutions following endoscopic sinus surgery (ESS) using various delivery devices. STUDY DESIGN: Experimental prospective study. SUBJECTS AND METHODS: Ten cadaver sinus systems were irrigated with Gastroview before surgery, after ESS, and after medial maxillectomy. Delivery was via pressurized spray (NasaMist), neti pot (NasaFlo), and Squeeze Bottle (Sinus Rinse). Scans were performed before and after each delivery with a portable CT machine (Xoran xCAT), and blinded assessments were made for distribution to individual sinuses. RESULTS: Total sinus distribution was greater post-ESS (P Squeeze Bottle > pressurized spray (P < 0.001). Frontal sinus penetration was greatest after surgery (P = 0.001). CONCLUSION: ESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Pressurized spray solutions in un-operated sinuses provide little more than nasal cavity distribution. Use of Squeeze Bottle/neti pot post-ESS offers a greatly enhanced ability to deliver solutions to the paranasal sinuses.
Janda Monika - One of the best experts on this subject based on the ideXlab platform.
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The children and sunscreen study : a crossover trial investigating children's sunscreen application thickness and the influence of age and dispenser type.
American Medical Association, 2012Co-Authors: Diaz Abbey, Kimlin, Michael G., Jones Lee, Neale Rachel.e, Janda MonikaAbstract:Free to read \ud \ud OBJECTIVES\ud \ud To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm(2)) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL Squeeze Bottle, or 50-mL roll-on).\ud \ud DESIGN\ud \ud A crossover quasiexperimental study design comparing 3 sunscreen dispenser types.\ud \ud SETTING\ud \ud Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia.\ud \ud PARTICIPANTS\ud \ud Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258).\ud \ud INTERVENTION\ud \ud Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week.\ud \ud MAIN OUTCOME MEASURE\ud \ud Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen.\ud \ud RESULTS\ud \ud Children applied their sunscreen at a median thickness of 0.48 mg/cm(2). Children applied significantly more sunscreen when using the pump (0.75 mg/cm(2)) and the Squeeze Bottle (0.57 mg/cm(2)) compared with the roll-on (0.22 mg/cm(2)) (P
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The children and sunscreen study: a crossover trial investigating children's sunscreen application thickness and the influence of age and dispenser type
'American Medical Association (AMA)', 2012Co-Authors: Diaz Abbey, Neale, Rachel E., Kimlin, Michael G., Jones Lee, Janda MonikaAbstract:Objectives: To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm ) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL Squeeze Bottle, or 50-mL roll-on). Design:Acrossover quasiexperimental study design comparing 3 sunscreen dispenser types. Setting: Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia. Participants: Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258). Intervention: Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week. Main Outcome Measure: Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen. Results: Children applied their sunscreen at a median thickness of 0.48 mg/cm . Children applied significantly more sunscreen when using the pump (0.75 mg/cm ) and the Squeeze Bottle (0.57 mg/cm ) compared with the roll-on (0.22 mg/cm ) (
Diaz Abbey - One of the best experts on this subject based on the ideXlab platform.
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The children and sunscreen study : a crossover trial investigating children's sunscreen application thickness and the influence of age and dispenser type.
American Medical Association, 2012Co-Authors: Diaz Abbey, Kimlin, Michael G., Jones Lee, Neale Rachel.e, Janda MonikaAbstract:Free to read \ud \ud OBJECTIVES\ud \ud To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm(2)) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL Squeeze Bottle, or 50-mL roll-on).\ud \ud DESIGN\ud \ud A crossover quasiexperimental study design comparing 3 sunscreen dispenser types.\ud \ud SETTING\ud \ud Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia.\ud \ud PARTICIPANTS\ud \ud Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258).\ud \ud INTERVENTION\ud \ud Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week.\ud \ud MAIN OUTCOME MEASURE\ud \ud Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen.\ud \ud RESULTS\ud \ud Children applied their sunscreen at a median thickness of 0.48 mg/cm(2). Children applied significantly more sunscreen when using the pump (0.75 mg/cm(2)) and the Squeeze Bottle (0.57 mg/cm(2)) compared with the roll-on (0.22 mg/cm(2)) (P
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The children and sunscreen study: a crossover trial investigating children's sunscreen application thickness and the influence of age and dispenser type
'American Medical Association (AMA)', 2012Co-Authors: Diaz Abbey, Neale, Rachel E., Kimlin, Michael G., Jones Lee, Janda MonikaAbstract:Objectives: To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm ) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL Squeeze Bottle, or 50-mL roll-on). Design:Acrossover quasiexperimental study design comparing 3 sunscreen dispenser types. Setting: Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia. Participants: Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258). Intervention: Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week. Main Outcome Measure: Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen. Results: Children applied their sunscreen at a median thickness of 0.48 mg/cm . Children applied significantly more sunscreen when using the pump (0.75 mg/cm ) and the Squeeze Bottle (0.57 mg/cm ) compared with the roll-on (0.22 mg/cm ) (