Preliminary application of a 3D-printed track-guided precise drug delivery device for the sinuses after endoscopic sinus surgery

Abstract

Background

Conventional treatment for eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is usually limited; consequently, relapses occur frequently, accurate local drug delivery is currently a research area of major interest.

Methods

Based on postoperative nasal sinus computed tomography (CT) images, the 3D printing technique was used to design and fabricate a precise track-guided sinus drug delivery device. The control group was treated with glucocorticoids by nasal spray for 1 year according to the conventional method, while the experimental group received topical nasal glucocorticoids using the 3D-printed track-guided precise sinus drug delivery device for 1 year. Scores on the Sino-Nasal Outcome Test (SNOT-22) scale and the Lund-Kennedy nasal endoscopic scale during reexamination at 1 month, 3 months, 6 months, and 1 year after the operation were used as the basis for evaluation.

Results

The follow-up duration was 12 months or more following endoscopic sinus surgery (ESS) with neosinus cavity formation. The two groups showed significant differences in SNOT-22 scores and nasal polyp Lund-Kennedy subscores at 3 months, 6 months, and 1 year (p < 0.001) and no differences in plasma cortisol at 6 months and 1 year (p > 0.05).

Conclusion

Local drug administration using our 3D-printed precise sinus drug delivery device is superior to conventional nasal cavity administration in controlling eCRS recurrence.

Keywords

3D-printed drug delivery device sinuses eosinophilic nasal polyps application

Get full access to this article

View all access options for this article.

References

Subspecialty Group of Rhinology . Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis (2018). Chin J Otorhinolaryngol Head Neck Surg 2019; 54(2): 81–100.

Fokkens

Lund

Mullol

, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl 2012; 23: 3–298.

Snidvongs

Lam

Sacks

, et al. Structured histopathology profiling of chronic rhinosinusitis in routine practice. Int Forum Allergy Rhinol 2012; 2(5): 376–385.

Fokkens

Lund

Hopkins

, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020; 58(Suppl S29):1–464.

Yang

Sun

, et al. Interpretation of 2020 European Position Paper on Rhinosinusitis and Nasal Polyps. Chin J Otorhinolaryngol Head Neck Surg 2020; 55(3): 304–308.

Wen

Liu

Zhang

, et al. Increased neutrophilia in nasal polyps reduces the response to oral corticosteroid therapy. J Allergy Clin Immunol 2012; 129(6): 1522–1528.

Kirtsreesakul

Atchariyasathian

. Nasal polyposis: role of allergy on therapeutic response of eosinophil- and noneosinophil-dominated inflammation. Am J Rhinol 2006; 20(1): 95–100.

Moller

Schuschnig

Meyer

, et al. Ventilation and aerosolized drug delivery to the paranasal sinuses using pulsating airflow-a preliminary study. Rhinology 2009; 47(4): 405–412.

Nabi

Rotenberg

Vukin

, et al. Nasal spray adherence after sinus surgery: problems and predictors. J Otolaryngol Head Neck Surg 2012; 41: S49–S55.

10.

Rudmik

Soler

. Medical therapies for adult chronic sinusitis: a systematic review. JAMA 2015; 314(9): 926–939.

11.

Poetker

Reh

. A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngol Clin North Am 2010; 43(4): 753–768.

12.

Grayson

, et al. Evaluation of diffuse type 2 dominant or eosinophilic chronic rhinosinusitis with corticosteroid irrigation after surgical neosinus cavity formation. JAMA Otolaryngol Head Neck Surg. 2021; 147(4): 360–367.

13.

Lou

Meng

Piao

, et al. Predictive significance of tissue eosinophilia for nasal polyp recurrence in the Chinese population. Am J Rhinol Allergy 2015; 29(5): 350–356.

14.

Weber

Keerl

Radziwill

, et al. Videoendoscopic analysis of nasal steroid distribution. Rhinology 1999; 37(2): 69–73.

15.

Leopold

Elkayam

Messina

, et al. NAVIGATE II: Randomized, double-blind trial of the exhalation delivery system with fluticasone for nasal polyposis. J Allergy Clin Immunol 2019; 143(1): 126–134.

16.

Wang

Lou

Wang XD , et al. Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2015; 135(4): 922–929.

17.

Demirel

Orhan

Keleş

, et al. Comparison of the efficacy of nasal drop and nasal spray applications of fluticasone propionate in nasal polyps. Kulak Burun Bogaz Ihtis Derg 2008; 18(1): 1–6.

18.

Tait

Kallogjeri

Suko

, et al. Effect of budesonide added to large-volume, low-pressure saline sinus irrigation for chronic rhinosinusitis: A randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2018; 144(7): 605–612.

19.

Kern

Stolovitzky

Silvers

, et al. A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps. Int Forum Allergy Rhinol 2018; 8(4): 471–481.

20.

Han

Forwith

Smith

, et al. RESOLVE: a randomized, controlled, blinded study of bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis. Int Forum Allergy Rhinol 2014; 4(11): 861–870.

21.

Forwith

Han

Stolovitzky

, et al. RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study. Int Forum Allergy Rhinol 2016; 6(6): 573–581.