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Rhinology/Allergy

(279) Intranasal Medication Distribution Utilizing EDS After Limited FESS in Cadavers

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Brandon J. Vilarello, BA

    Medical Student
    Columbia University Vagelos College of Physicians and Surgeons
    New York, NY, United States

    • Co-Author(s)

  • Patricia T. Jacobson, BSN

    Medical Student
    Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center; University of Rochester School of Medicine and Dentistry
    New York, New York, United States

  • LA

    Lucas G. Axiotakis, Jr., MD

    Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, USA

  • David A. Gudis, MD

    Associate Professor of Rhinology, Skull Base Surgery, and Pediatric Otolaryngology
    Division of Rhinology & Anterior Skull Base Surgery, Department of Otolaryngology–Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
    New York, New York, USA

  • Daniel B. Spielman, MD

    Assistant Professor
    Department of Otolaryngology-Head and Neck Surgery, MedStar Health, Georgetown University Hospital
    20007, Washington, United States

  • NY

    Nathan Yang, MD

    Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center, USA

    • Senior Author(s)

  • Jonathan B. Overdevest, MD, PhD

    Assistant Professor of Otolaryngology
    Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian/Columbia University Irving Medical Center
    New York, NY, United States

Disclosure(s):
Brandon J. Vilarello, BA: No relevant relationships to disclose.
Patricia T. Jacobson, BSN: No relevant relationships to disclose.
Daniel B. Spielman, MD: No relevant relationships to disclose.
Jonathan B. Overdevest, MD, PhD: No relevant relationships to disclose.


Introduction: One goal of endoscopic sinus surgery (ESS) is to facilitate medication delivery to the sinuses, optimizing chronic rhinosinusitis (CRS) management. Limited ESS may achieve this without the need for more comprehensive surgical approaches. Exhalation delivery systems (EDS) have shown safety and efficacy for topical steroid delivery in CRS patients. This study seeks to evaluate sinonasal topical penetration by EDS compared to conventional nasal sprays (NS) after limited ESS in cadavers.

Methods: Eight cadavers underwent limited ESS, including uncinectomy, maxillary antrostomy, and anterior ethmoidectomy. Fluorescein dye was delivered via EDS and NS. Images of middle turbinate (MT), maxillary sinus (MS), and anterior ethmoid (AE) subsites were captured endoscopically and rated from 0 (no staining) to 3 (heavy staining) by 7 rhinologists. Ratings were averaged for each subsite. Differences in staining between EDS and NS were assessed using Wilcoxon signed-rank tests.

Results: Average AE staining was greater in EDS specimens compared to NS (1.438±0.785 vs. 0.911±0.843, p=0.012). In a summed composite measure of post-ESS staining in MT, MS, and AE subsites, staining score was greater in EDS specimens compared to NS (3.589±1.560 vs. 2.813±1.680, p=0.044). Inter-rater reliability was excellent with an ICC of 0.956 (95% CI: 0.931, 0.972).

Conclusions: These findings demonstrate a significant increase in EDS medication delivery to anatomic subsites following limited ESS. This increase is reflected in the composite score, with the main contribution from staining in the AE region. Patients who undergo limited ESS for CRS treatment may benefit clinically more from EDS than NS medication delivery, where additional research would provide requisite insight into true clinical implications in this population.