Introduction
While there is a growing trend to use corticosteroid nasal irrigation instead of spray in
postoperative care after endoscopic sinus surgery (ESS)(1-8) , there is some, albeit very limited evidence that supports this application as an initial treatment before sinus surgery as being the superior method. A few previous studies investigated the concept of sinus distribution on pre-surgical sinus cavities with the aim of determining the most effective methods to deliver the medicine into the sinus.(9-11) Unfortunately, the results from the studies could not show any significant benefit of nasal irrigation in sinus penetration. However, most studies were conducted in either healthy subjects or cadavers, which could not represent the actual status of pathological sinus cavities and dynamic physiology while rinsing the sinus.(9, 10) Furthermore, one study examining sinus penetration in unoperated chronic rhinosinusitis (CRS) patients used low-volume nasal irrigation, which could not represent the ideal volume to enhance sinus penetration even in the post-surgical sinus status.(11)
Therefore, according to such knowledge gap, this study aims to compare the sinus distribution of high-volume nasal irrigation and nasal spray to determine the effective route for drug administration before sinus surgery in CRS patients.