{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:01:01Z","timestamp":1779894061217,"version":"3.53.1"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0\u2010 to 3\u2010point scale, with ratings averaged for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19\u00a0\u00b1\u00a00.81\u00a0vs. 0.78\u00a0\u00b1\u00a01.06; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21\u201310.09; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.021) and post\u2010ESS (OR, 9.00; 95% CI, 1.95\u201341.5; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44\u2013104.85; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.23248","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T04:46:29Z","timestamp":1691037989000},"page":"660-667","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Accessing the Eustachian tube: Conventional nasal spray vs. exhalation delivery system and the impact of targeted endoscopic sinus surgery on topical distribution patterns"],"prefix":"10.1002","volume":"14","author":[{"suffix":"Jr","given":"Lucas G.","family":"Axiotakis","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2602-0416","authenticated-orcid":false,"given":"Daniel B.","family":"Spielman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-9349","authenticated-orcid":false,"given":"David A.","family":"Gudis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1934-4922","authenticated-orcid":false,"given":"Carol H.","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California San Diego School of Medicine  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary M.","family":"Soler","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Medical University of South Carolina  Mt. Pleasant South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5907-3421","authenticated-orcid":false,"given":"Joshua M.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R.","family":"Rowan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandria L.","family":"Irace","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University of Pennsylvania Health System  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon J.","family":"Vilarello","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia T.","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1152-2512","authenticated-orcid":false,"given":"Jonathan B.","family":"Overdevest","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons New York\u2013Presbyterian Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12475"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-020-00951-3"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200206000-00004"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22942"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.4193\/Rhin21.209"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22376"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/4602651"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000199741.08517.99"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145561320980194"},{"key":"e_1_2_9_11_1","article-title":"Efficacy of the exhalation delivery system with fluticasone in patients with chronic rhinosinusitis with nasal polyps whose symptoms recur after sinus surgery","author":"Ow RA","year":"2022","journal-title":"Int Forum Allergy Rhinol"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22728"},{"key":"e_1_2_9_13_1","unstructured":"Effect of Novel Exhalational Delivery System With Fluticasone (EDS\u2010FLU) on Eustachian Tube Dysfunction (ETD).U.S. National Library of Medicine ClinicalTrials.gov. 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