Does Acoustic Overlay of Music Improve Aerosol Penetration into Maxillary Sinuses?

Abstract

Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses. Recent years have seen numbers of findings and improvements in CRS treatment using nebulization process. Targeting delivery of nebulized antibiotics into the maxillary sinuses, the sites of infection, could improve clinical outcomes in patients with CRS. Thus, nasal drug delivery by nebulization is widely used in sinus disorders, because of its safety and convenience and due to its advantages as a painless therapy. However, the nebulization conditions to facilitate penetration of aerosols into the sinus cavities are not well established. The practice of aerosol therapy to treat CRS has not been studied thoroughly, despite few works have shown clinical benefit. This paper demonstrates that the music signal superimposed to aerosol provides a considerable innovative solution for the treatment of CRS patients. It encompasses frequency values among which the resonance frequency of the maxillary sinuses of patients regardless the initial sinus anatomy of the patient and the pathology stage and is thus more efficient to deliver the aerosol into the maxillary sinuses. "Music heals". This adage is generally studied by neuropsychologists and music therapists based on psychological approaches [1]. Unfortunately, one knows that it is difficult to prove since it is hardly measurable [2]. Moreover, in these studies, music is used traditionally through speakers or headphones as it was designed for. In the meantime, it is well known that music has complex features in terms of signal properties, especially if regarded as a random signal. In short, music belongs to the class of pseudo-stationarity signals which implies some statistical randomness but also some stationarity. In addition, music has a large frequency spectrum which is mainly linked to the human ear's response of 20Hz to 20kHz. Most of the musical information lies in the 40Hz-16kHz range, and this range depends a lot on the musical style. These characteristics can be exploited when such frequency ranges must be used for medical treatments like nebulization process. Instead of using ear-fatiguing signals like sinusoidal, or sum of sinusoidal, signals. Then, music can be used for its characteristics as a signal. Patients are more likely to accept the presence and the hearing of a signal if it is music. Chronic rhinosinusitis (CRS) is a disorder characterized by mucosal inflammation of the nose and paranasal sinuses. This common disease is marked by chronic sinonasal symptoms persisting for greater than 12 weeks that above all diminish patients' quality of life. It is a significant and increasing health problem which results in a large financial burden on society. CRS reportedly affects 5% to 13% of the general population in the United States, Europe and China [3]. Recent years have seen numbers of findings and improvements in CRS treatment using nebulization process [4-5]. Targeting delivery of nebulized antibiotics into the maxillary sinuses, the sites of infection, could improve clinical outcomes in patients with CRS. Thus, nasal drug delivery by nebulization is widely used in sinus disorders, because of its safety and convenience and due to its advantages as a painless therapy. Topical delivery of antimicrobial drugs for treatment of CRS also brings intuitive advantages over systemic therapy. It minimizes the risk of systemic side effects, the development of antibiotic resistance in non-targeted areas and allows a high topical drug concentration deposition with a minimal systemic adsorption. However, the nebulization conditions to facilitate penetration of aerosols into the sinus cavities are not well-established. The practice of aerosol therapy to treat CRS has not been studied thoroughly, despite few works have shown clinical benefit. To enhance the penetration of nebulized particles into badly ventilated areas (i.e. sinuses in healthy subject) or non-ventilated areas (i.e. sinuses in patients with sinus diseases), a pressure gradient generated by an acoustic airflow can be added to a usual nebulizer.