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Drug delivery systems

Drug delivery systems . Michael G. Stewart, MD, MPH Professor and Chairman Department of Otorhinolaryngology. Paranasal sinuses & middle ear. Frequent sites of infection, inflammation Lined by mucous membrane (mucosa) with good capacity for absorption Current surgical management

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Drug delivery systems

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  1. Drug delivery systems Michael G. Stewart, MD, MPH Professor and Chairman Department of Otorhinolaryngology

  2. Paranasal sinuses & middle ear • Frequent sites of infection, inflammation • Lined by mucous membrane (mucosa) with good capacity for absorption • Current surgical management • Opening, ventilation, irrigation • Potential problems & issues • Access to cavity • Maintenance of medication dose

  3. Other potential locations • Into abdominal cavity • Into chest cavity • Intra-vascular • Directly into tissue, joint, muscle

  4. Sinus: clinical diseases • Chronic inflammatory sinus disease • Chronic infection • Nasal polyps • Fungal sinusitis • Cystic fibrosis • Other diseases of mucus and cilia transport

  5. Paranasal sinus anatomy

  6. Normal sinus CT

  7. Normal middle turbinate, left side

  8. Nasal polyps

  9. Large nasal polyp

  10. Endoscopic sinus surgery

  11. Endoscopic sinus surgery

  12. Endoscopic sinus surgery video

  13. Problems – sinus disease • Access to sinus cavities • Mucosa is source of inflammation, polyp regrowth • Inhaled solutions go directly to back of nose • Irrigated solutions go partially into some sinuses • Oral or intravenous meds go to mucosa • Problems with long-term use of steroids and antibiotics, antifungal meds

  14. Problems – sinus disease 2 • Fungal particles trapped in sinus cavity • “inside the sinus, outside the body” • Surgery to ventilate sinus is only part of solution • Bacterial overgrowth in sinus cavity • Impairment in mucus, cilia function

  15. Potential solutions - sinuses • Topical delivery system • Implantable delivery system • Slow-dissolving “gel” into sinus? • Positive pressure aerosol? • Other method of delivery • Long-term dosing directly to area • High topical dose, limited systemic absorption • Constant dosing

  16. Ear anatomy

  17. Ear disease • Middle ear • Persistent effusion • Recurrent infection or effusion • Eustachian tube block

  18. Ear disease • Inner ear – middle ear could be source of drug delivery • Meniere’s disease (recurrent vertigo) • Autoimmune inner ear disease • Sudden hearing loss • Ototoxic systemic medications • Noise trauma

  19. Normal eardrum

  20. Middle ear effusion

  21. Issues – ear disease • Easier access • Problems • requires puncturing eardrum • requires multiple procedures, doses • long-term problems, want preventative treatment in some cases

  22. Delivery system • Prolonged release • Steady dosing (not bolus) • Remain in situ • Not interfere with hearing

  23. Summary • Paranasal sinus and ear disease are very common problems • Can get access to site of disease • Need better long-term delivery and distribution of medication doses

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