Patent Application
20120053567
The bones in the skull and face contain a series of air-filled cavities known as paranasal sinuses that are connected by passageways. The paranasal sinuses include frontal sinuses, sphenoid sinuses and maxillary sinuses. The paranasal sinuses are lined with mucus-producing epithelial tissue and are in communication with the nasal cavity. Normally, mucus produced by the epithelial tissue slowly drains out of each sinus through an opening known as an ostium. If the epithelial tissue of one of these passageways becomes inflamed for any reason, the cavities which drain through that passageway can become blocked. This blockage can be periodic (resulting in episodes of pain) or chronic. This interference with drainage of mucus (e.g., occlusion of a sinus ostium) can result in mucosal congestion within the paranasal sinuses. Chronic mucosal congestion of the sinuses can cause damage to the epithelium that lines the sinus with subsequent decreased oxygen tension and microbial growth (e.g., a sinus infection).
The term “sinusitis” refers generally to any inflammation or infection of the paranasal sinuses caused by bacteria, viruses, fungi (molds), allergies or combinations thereof. It has been estimated that chronic sinusitis (e.g., lasting more than 3 months) results in 18 million to 22 million physician office visits per year in the United States. Patients who suffer from sinusitis typically experience at least some of the following symptoms: headaches or facial pain, nasal congestion or post-nasal drainage, difficulty breathing through one or both nostrils, bad breath and/or pain in the upper teeth. Thus, one of the ways to treat sinusitis is by restoring the lost mucus flow.
Medical devices which are adapted to be implanted into a patient for a limited period of time using minimally invasive insertion procedures for dilating a stenotic opening, such as a stenotic sinus opening, are provided. The devices and methods can be used for treating sinusitis and other nasal and/or sinus disorders.
Aspects of the present disclosure include a method of dilating a stenotic opening of a paranasal sinus in a subject. In certain embodiments, the method includes positioning a device in the stenotic opening, where the device includes an expandable portion configured to expand from a non-expanded configuration to an expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening, and a driver configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more, where the expanded configuration dilates the stenotic opening.
In certain embodiments, the method includes removing the device from the stenotic opening at a point in time after the device has expanded to the expanded configuration.
In some instances, the paranasal sinus is a frontal sinus, a sphenoid sinus or a maxillary sinus.
In some cases, the device includes at least one anchor configured to maintain the device within the stenotic opening.
In certain instances, the method includes anchoring the device within the stenotic opening.
In certain embodiments, the driver is configured to expand the expandable portion by at least one of osmosis, a shape memory metal, a spring, a swellable polymer, a thermal expansion of a gas, a thermal expansion of a liquid, a gas-generating chemical reaction and a phase change expansion of a material.
In some cases, the device includes a conduit defining an interior lumen, where the conduit includes a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject and a proximal end configured to be in fluid communication with a nasal cavity in the subject, and where the conduit is configured to allow fluid flow between the interior lumen of the paranasal sinus and the nasal cavity when the device is positioned within the stenotic opening.
In certain embodiments, the expandable portion includes a semipermeable membrane.
In some instances, the conduit includes a semipermeable membrane.
In some cases, the conduit includes an impermeable material.
In certain instances, the expandable portion includes an impermeable membrane.
In certain cases, the conduit includes a semipermeable membrane.
In certain embodiments, the method includes delivering a drug from the device while the device is positioned within the stenotic opening.
In some instances, the drug includes an antibiotic, an anti-inflammatory drug, a local anesthetic, an analgesic or a combination thereof.
In some cases, the drug is an antibiotic selected from the group consisting of levofloxacin, moxifloxacin, amoxicillin, clavulanic acid, clarithromycin, azithromycin, cefuroxime, ciprofloxacin, salts thereof and combinations thereof.
In certain cases, the drug is an anti-inflammatory drug selected from the group consisting of methylprednisolone, dexamethasone, salts thereof and combinations thereof.
In certain instances, the method is for the treatment of a subject having sinusitis. For example, certain embodiments include the device as described herein for use in the treatment of sinusitis.
In some instances, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours to 14 days.
In some embodiments, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 1 day to 10 days.
In certain cases, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 2 days to 8 days.
In some instances, the device includes a bioerodible material.
In certain cases, the non-expanded configuration has a diameter of 5 mm or less.
In certain embodiments, the paranasal sinus is a maxillary sinus and the expanded configuration has a diameter ranging from 5 mm to 10 mm.
In certain instances, the paranasal sinus is a frontal sinus and the expanded configuration has a diameter ranging from 3 mm to 5 mm.
In some instances, the paranasal sinus is a sphenoid sinus and the expanded configuration has a diameter ranging from 2 mm to 3 mm.
Aspects of the present disclosure also include a device for dilating a stenotic opening of a paranasal sinus in a subject. The device includes an expandable portion configured to expand from a non-expanded configuration to an expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening, and a driver configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more, where the expanded configuration dilates the stenotic opening.
In certain embodiments, the paranasal sinus is a frontal sinus, a sphenoid sinus or a maxillary sinus.
In some instances, the device includes at least one anchor configured to maintain the device within the stenotic opening.
In certain cases, the driver is configured to expand the expandable portion by at least one of osmosis, a shape memory metal, a spring, a swellable polymer, a thermal expansion of a gas, a thermal expansion of a liquid, a gas-generating chemical reaction and a phase change expansion of a material.
In some instances, the device includes a conduit defining an interior lumen, where the conduit comprises a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject and a proximal end configured to be in fluid communication with a nasal cavity in the subject, and where the conduit is configured to allow fluid flow between the interior lumen of the paranasal sinus and the nasal cavity when the device is positioned within the stenotic opening.
In some cases, the expandable portion includes a semipermeable membrane.
In some instances, the conduit includes a semipermeable membrane.
In certain cases, the conduit includes an impermeable material.
In some embodiments, the expandable portion includes an impermeable membrane.
In certain cases, the conduit includes a semipermeable membrane.
In some instances, the device includes a drug reservoir configured to deliver a drug while the device is positioned within the stenotic opening.
In certain embodiments, the drug comprises an antibiotic, an anti-inflammatory drug, a local anesthetic, an analgesic or a combination thereof.
In some cases, the drug is an antibiotic selected from the group consisting of levofloxacin, moxifloxacin, amoxicillin, clavulanic acid, clarithromycin, azithromycin, cefuroxime, ciprofloxacin, salts thereof and combinations thereof.
In certain cases, the drug is an anti-inflammatory drug selected from the group consisting of methylprednisolone, dexamethasone, salts thereof and combinations thereof.
In some cases, the device is configured for the treatment of a subject having sinusitis.
In some instances, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours to 14 days.
In some embodiments, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 1 day to 10 days.
In certain embodiments, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 2 days to 8 days.
In some instances, the device includes a bioerodible material.
In some cases, the device consists essentially of the bioerodible material.
In certain instances, the non-expanded configuration has a diameter of 5 mm or less.
In some cases, the paranasal sinus is a maxillary sinus and the expanded configuration has a diameter ranging from 5 mm to 10 mm.
In certain embodiments, the paranasal sinus is a frontal sinus and the expanded configuration has a diameter ranging from 3 mm to 5 mm.
In certain cases, the paranasal sinus is a sphenoid sinus and the expanded configuration has a diameter ranging from 2 mm to 3 mm.
Aspects of the present disclosure also include a device for dilating a stenotic opening of a paranasal sinus in a subject, where the device includes a self-expanding driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration, and the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening.
In certain cases, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 0.5 hours or more.
In some instances, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more.
In some cases, the driver is configured to expand the expandable portion by at least one of osmosis, a shape memory metal, a spring, a swellable polymer, a thermal expansion of a gas, a thermal expansion of a liquid, a gas-generating chemical reaction and a phase change expansion of a material.
In certain cases, the driver includes an osmotically active agent.
In some cases, the expandable portion is configured to dilate the stenotic opening such that a greater amount of drainage is allowed through the stenotic opening as compared to the undilated stenotic opening.
In some instances, the device includes a conduit defining an interior lumen, where the conduit comprises a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject and a proximal end configured to be in fluid communication with a nasal cavity in the subject, and where the conduit is configured to allow fluid flow between the interior lumen of the paranasal sinus and the nasal cavity when the device is positioned within the stenotic opening.
In certain instances, the expandable portion includes a semipermeable membrane.
In certain cases, the conduit includes a semipermeable membrane.
In some cases, the conduit includes an impermeable material.
In some instances, the expandable portion includes an impermeable membrane.
In some embodiments, the conduit includes a semipermeable membrane.
In certain embodiments, the device includes at least one of (i) a distal anchor proximate to the distal end of the device, and (ii) a proximal anchor proximate to the proximal end of the device, where the distal and proximal anchors are each configured to maintain the device within the stenotic opening.
In some instances, the device includes a drug reservoir configured to deliver a drug while the device is positioned within the stenotic opening.
In some cases, the drug includes an antibiotic, an anti-inflammatory drug, a local anesthetic, an analgesic or a combination thereof.
Aspects of the present disclosure also include a device for dilating a stenotic opening of a paranasal sinus in a subject, where the device includes: (a) an osmotic driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration; and (b) the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening.
In certain embodiments, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 0.5 hours or more.
In certain cases, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more.
In some instances, the osmotic driver includes an osmotically active agent.
In some cases, the device includes a conduit defining an interior lumen, where the conduit comprises a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject and a proximal end configured to be in fluid communication with a nasal cavity in the subject, and where the conduit is configured to allow fluid flow between the interior lumen of the paranasal sinus and the nasal cavity when the device is positioned within the stenotic opening.
In certain instances, the expandable portion includes a semipermeable membrane.
In some cases, the conduit includes a semipermeable membrane.
In certain embodiments, the conduit includes an impermeable material.
In certain cases, the expandable portion includes an impermeable membrane.
In some instances, the conduit includes a semipermeable membrane.
In some cases, the device includes at least one of (i) a distal anchor proximate to the distal end of the device, and (ii) a proximal anchor proximate to the proximal end of the device, where the distal and proximal anchors are each configured to maintain the device within the stenotic opening.
In certain cases, the device includes a drug reservoir configured to deliver a drug while the device is positioned within the stenotic opening.
In certain embodiments, the drug includes an antibiotic, an anti-inflammatory drug, a local anesthetic, an analgesic or a combination thereof.
Aspects of the present disclosure also include a device for dilating a stenotic opening of a paranasal sinus in a subject, where the device includes: (a) a conduit defining an interior lumen, where the conduit includes a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject and a proximal end configured to be in fluid communication with a nasal cavity in the subject, and where the conduit is configured to allow fluid flow between the interior lumen of the paranasal sinus and the nasal cavity when the device is positioned within the stenotic opening; (b) a self-expanding driver disposed on an exterior surface of the conduit and configured to expand an expandable portion from a non-expanded configuration to an expanded configuration; and (c) the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening.
In certain embodiments, the device includes at least one of (i) a distal anchor proximate to the distal end of the conduit and (ii) a proximal anchor proximate to the proximal end of the conduit, where the distal and proximal anchors are each configured to maintain the device within the stenotic opening.
In certain instances, the device includes a drug reservoir configured to deliver a drug while the device is positioned within the stenotic opening.
In some cases, the expandable portion includes a semipermeable membrane.
In some embodiments, the conduit includes a semipermeable membrane.
In certain instances, the conduit includes an impermeable material.
In some cases, the expandable portion includes an impermeable membrane.
In certain cases, the conduit includes a semipermeable membrane.
In some instances, the driver is configured to expand radially outward from the conduit.
In some embodiments, the driver includes an osmotically active agent.
In certain instances, the conduit is substantially non-collapsible.
Aspects of the present disclosure also include a kit including: (a) a device for dilating a stenotic opening of a paranasal sinus in a subject; and (b) instructions for using the device to dilate the stenotic opening. The device includes: (1) an expandable portion configured to expand from a non-expanded configuration to an expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening; and (2) an osmotic driver configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 0.5 hours or more, where the expanded configuration dilates the stenotic opening; and
In certain instances, the kit includes two or more devices.
In some instances, the kit includes a first device and a second device, where the expanded configuration of the second device has a diameter that is greater than the diameter of the expanded configuration of the first device.
In some cases, the kit includes one or more sinus ostium sizing probes for sizing the stenotic opening.
Aspects of the present disclosure also include a device for dilating a stenotic opening in a subject, where the device includes: (a) an osmotic driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration; and (b) the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening.
In certain instances, the driver is self-expanding when in contact with tissue of the subject.
In some cases, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 0.5 hours or more.
In certain instances, the driver is configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more.
In certain embodiments, the device includes a conduit defining an interior lumen, where the conduit is configured to allow fluid flow therethrough when the device is positioned within the stenotic opening.
In certain cases, the driver is disposed on an exterior surface of the conduit.
Aspects of the present disclosure also include a method of dilating a stenotic opening in a subject, where the method includes positioning a device in the stenotic opening. In certain embodiments, the device includes: (a) an osmotic driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration; and (b) the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening, and where expansion of the device after said positioning facilitates dilation of the stenotic opening of the subject.
Aspects of the present disclosure include a device for dilating a stenotic opening in a subject. The term “stenotic opening” refers to an abnormal narrowing of a biological passageway. In certain embodiments, the device includes an osmotic driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration, and the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening. In certain embodiments, the driver is self-expanding when in contact with tissue of the subject. The driver may be configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 0.5 hours or more, or the driver may be configured to expand the expandable portion from the non-expanded configuration to the expanded configuration over a period of 4 hours or more. In certain embodiments, the device includes a conduit defining an interior lumen, where the conduit is configured to allow fluid flow therethrough when the device is positioned within the stenotic opening. In some instances, the driver is disposed on an exterior surface of the conduit.
According to embodiments of the present disclosure, devices (also referred to as a sinus dilator) for dilating a stenotic opening of a paranasal sinus in a subject include an expandable portion and a driver. In certain embodiments, the driver is configured to expand from a non-expanded configuration to an expanded configuration. The driver may be configured to expand in volume from a non-expanded configuration to an expanded configuration. The non-expanded configuration of the device may be sized to be positioned within the stenotic opening. During use, the driver is configured to expand in size to an expanded configuration, where the expanded configuration dilates the stenotic opening.
In certain embodiments, the driver is configured to be a self-expanding driver. By “self-expanding” is meant that the driver may expand from the non-expanded configuration to the expanded configuration without external intervention from a user or a health care practitioner. For example, the self-expanding driver may be self-contained, such that the driver is configured to expand without connection to an external pressure source. As such, self-expanding drivers as described herein function without the need for an external pressure source or a pressure monitoring device. In some cases, the self-expanding driver expands from the non-expanded configuration to the expanded configuration upon absorbing fluid from the surrounding environment when the device is in use. For instance, the self-expanding driver may expand from the non-expanded configuration to the expanded configuration upon absorbing water from the surrounding tissues of the stenotic opening when the device is in use. Self-expanding drivers may be configured to expand the expandable portion of the device by various ways, such as, but not limited to, an osmotic agent, a swellable agent (e.g., a swellable polymer), combinations thereof, and the like.
In certain embodiments, the driver is configured to begin expanding upon insertion of the device into the stenotic opening of the subject. The terms “insert” or “insertion” and “implant” or “implantation” are used herein interchangeably to describe the positioning of a device in a stenotic opening of a subject for a period of time. In some instances, the driver is configured to begin expanding within seconds or minutes after insertion of the device into the stenotic opening. In some cases, the driver is configured to begin expanding in 60 min or less, such as 45 min or less, or 30 min or less, including 10 min or less, or 5 min or less, such as 1 min or less, after insertion of the device into the stenotic opening.
In some instances, the driver is configured to begin expanding after a period of time has elapsed after the device has been inserted into the stenotic opening of the subject. For example, the driver may be configured to begin expanding 30 min or more, such as 45 min or more, including 60 min or more, or 90 min or more, 120 min or more, or 180 min or more after the device has been inserted into the stenotic opening of the subject.
In certain embodiments, the driver includes a swellable agent. In some cases, the swellable agent may be configured to expand upon absorption of fluid from the surrounding tissues after insertion of the device into the stenotic opening of the subject. For example, the swellable agent may be configured to absorb water from the surrounding tissues and expand.
Swellable agents suitable for use in the driver include, but are not limited to, water swellable polymers such as thermo-plastic urethane (TPU), poly ethylene oxide (PEO), hydroxypropylmethyl cellulose, polyvinyl alcohol, carboxymethylcellulose, sodium carboxymethylcellulose, poloxamer, polyethylene glycol, carbomer, methylcellulose, gelatin, xanthan gum, guar gum, amylose starches, alginates, and combinations thereof. In certain embodiments, the swellable agent may include, but is not limited to, the following: chemically cross-linked organic polymers, such as cross-linked sodium carboxymethyl cellulose (Ac-di-Sol; FMC Corp., Philadelphia, Pa.), and cross-linked polyvinyl pyrrolidone (PVP-XL; International Specialty Products, Wayne, N.J.); physically cross-linked organic polymers, such as low substituted hydroxypropyl cellulose (LHPC; Shin-Etsu Chemical Co., Ltd., New York, N.Y.), microcrystalline cellulose (FMC Corp., Philadelphia, Pa.), and powdered cellulose (Solka-Floc; International Fiber Corp., North Tonawanda, N.Y.); inorganic swelling agents, such as bentonite clay; combinations thereof; and the like.
In certain embodiments, the driver includes an osmotic agent. As used herein, the terms “osmotic agent,” “osmotically active agent” and “osmoagent” are used interchangeably and refer to an agent that facilitates the imbibition of water from a region of high water potential (e.g., low solute concentration) through a semipermeable membrane to a region of low water potential (e.g., high solute concentration) until a state of dynamic equilibrium is reached. In some instances, the osmotically active agent may be configured to absorb water flowing through a semipermeable membrane from the surrounding tissues after insertion of the device into the stenotic opening of the subject and expand. Suitable osmotically active agents are described in more detail below. In certain embodiments, the osmotic agent is configured to have a zero order rate of expansion. By “zero order” is meant that the rate of volume expansion of the osmotic agent is approximately constant and is independent of the surrounding solute concentration.
Embodiments of the presently disclosed devices include an expandable portion. The expandable portion is configured to expand from a non-expanded configuration to an expanded configuration. In certain embodiments, the expandable portion is configured to expand in size from a non-expanded configuration to an expanded configuration. The expandable portion may be configured to expand in size without significantly increasing in volume, such as by stretching in one or more dimensions from the non-expanded configuration. The expandable portion may be positioned peripherally around the driver. For instance, the expandable portion may be disposed on an exterior surface of the driver. In these embodiments, expansion of the underlying driver expands the expandable portion from its non-expanded configuration to its expanded configuration.
Aspects of the present disclosure include devices that have an expandable portion, where the expandable portion includes a membrane. The membrane may be an elastic membrane, such that the membrane is configured to expand from the non-expanded configuration to the expanded configuration, as described herein. In certain instances, the membrane is a semipermeable membrane. By “semipermeable” is meant a membrane that is permeable to solvent but not significantly permeable to solute across a concentration gradient, such as a membrane that allows solvent (e.g., water) molecules to pass through the membrane by osmosis from a region of low solute concentration to a region of high solute concentration until a state of dynamic equilibrium is reached. For instance, a semipermeable membrane may be configured to allow water to pass through the membrane by osmosis from a region of low solute concentration (e.g., high water potential) to a region of high solute concentration (e.g., low water potential) until a state of dynamic equilibrium is reached.
In certain embodiments, the expandable portion includes a membrane, where the membrane is an impermeable membrane. By “impermeable” is meant a membrane that is not significantly permeable to solvent or solute. Impermeable membranes do not allow significant amounts of solvent (e.g., water) or solute molecules to pass through the membrane by osmosis even in the presence of a solute concentration gradient across the membrane.
In certain embodiments, the device includes a conduit that defines an interior lumen of the device. The conduit includes a distal end configured to be in fluid communication with an interior lumen of the paranasal sinus in the subject. As used herein, the term “distal” refers to the end of the device that is inserted through a paranasal sinus opening of the subject and remains within the sinus cavity during use. The conduit also includes a proximal end configured to be in fluid communication with a nasal cavity in the subject. As used herein, the term “proximal” refers to the end of the device that remains on the nasal cavity side of the stenotic opening when the device is positioned in the stenotic opening during use.
In some cases, the conduit may be configured to allow fluid flow between the paranasal sinus in the subject and the nasal cavity when the device is positioned within the stenotic opening. In some instances, the conduit is configured to allow fluid and/or air to flow from the paranasal sinus to the nasal cavity of the subject. For example, the conduit may be configured to facilitate drainage of fluid from the paranasal sinus in the subject to the nasal cavity when the device is positioned within the stenotic opening. In some cases, the conduit may be configured to facilitate the flow of air into and out of the paranasal sinus in the subject.
In certain embodiments, the driver is disposed on an exterior surface of the conduit. The driver may be disposed on the exterior surface of the conduit at a position between the distal end and the proximal end of the conduit. For example, the driver may be positioned between a distal anchor at the distal end of the conduit and a proximal anchor at the proximal end of the conduit. As described herein, the expandable portion may be positioned peripherally around the driver. Thus, in these embodiments, the driver is disposed between the exterior surface of the conduit and the overlying expandable portion. Expansion of the driver expands the overlying expandable portion from its non-expanded configuration to its expanded configuration.
Aspects of the driver further include embodiments where the driver completely surrounds the conduit. The driver may be disposed on the exterior surface of the conduit around the entire periphery of the conduit. In certain embodiments, the driver surrounds the conduit around the central portion of the conduit, where the distal end of the conduit may have a distal anchor and the proximal end of the conduit may have a proximal anchor, as described in more detail herein. In some instances, the driver includes one or more subunits, where each subunit is disposed on the exterior surface of the conduit. The one or more driver subunits may be positioned such that they are in contact with the adjacent one or more driver subunits. Alternatively, the one or more driver subunits may be positioned such that there is a channel between the driver subunits (see e.g.,
In certain embodiments, the walls of the conduit are substantially rigid. The walls of the conduit may be substantially rigid, such that the conduit maintains substantially the same shape and size during use of the device. For instance, the conduit may maintain substantially the same interior diameter during use of the device. In some instances, the walls of the conduit are substantially rigid, such that pressure exerted on the exterior surface of the conduit by the driver does not significantly decrease the interior diameter of the conduit. For example, the walls of the conduit may be substantially rigid, such that the conduit is not crushed by the driver during use of the device. In some instances, the driver is configured to expand radially outward from the conduit. As discussed above, the walls of the conduit may be substantially rigid, thus expansion of the driver may be directed radially outward away from the substantially rigid walls of the conduit. Expansion of the driver radially outward from the conduit may facilitate dilation of the stenotic opening.
In certain embodiments, the walls of the conduit are substantially non-collapsible. The walls of the conduit may be substantially non-collapsible, such that the conduit is configured to maintain an opening in the conduit during use of the device. For example, the walls of the conduit may be substantially non-collapsible, such that the conduit is not crushed by the driver during use of the device. In some cases, a non-collapsible conduit maintains substantially the same shape and size during use of the device. For instance, the conduit may maintain substantially the same interior diameter during use of the device. In some instances, the walls of the conduit are substantially non-collapsible, such that pressure exerted on the exterior surface of the conduit by the driver does not significantly decrease the interior diameter of the conduit. As discussed above, the driver may be configured to expand radially outward from the conduit and, as such, the walls of the conduit may be substantially non-collapsible, such that expansion of the driver is directed radially outward away from the substantially non-collapsible walls of the conduit. Expansion of the driver radially outward from the conduit may facilitate dilation of the stenotic opening. A substantially non-collapsible conduit may be rigid, as described above, or may be flexible and adapted to bend from its original shape. In some instances, a flexible conduit facilitates insertion of the sinus dilator in a sinus ostium.
In certain instances, the conduit includes a membrane. The conduit membrane may be a semipermeable membrane. In certain instances, the conduit membrane is a non-collapsible semipermeable membrane. In some cases, the conduit membrane is a rigid semipermeable membrane. The membrane may be configured to be permeable to solvent but not significantly permeable to solute across a concentration gradient, such that the membrane allows solvent (e.g., water) molecules to pass through the membrane by osmosis from a region of low solute concentration to a region of high solute concentration until a state of dynamic equilibrium is reached. For instance, the membrane may be configured to allow water to pass through the membrane by osmosis from an interior lumen of the conduit to the surrounding driver until a state of dynamic equilibrium is reached.
In some embodiments, the device includes a conduit that includes a semipermeable membrane, a surrounding driver, and an overlying expandable portion that includes a semipermeable membrane. In these embodiments, the device may be configured to allow solvent (e.g., water) to pass through both the semipermeable expandable portion membrane by osmosis and through the semipermeable conduit membrane by osmosis. For example, the device may be configured to allow solvent to pass through the semipermeable expandable membrane from the surrounding tissues to the underlying driver, and also allow solvent to pass through the semipermeable conduit membrane from an interior lumen of the conduit to the surrounding driver.
In other embodiments, the device includes a conduit that includes a semipermeable membrane, a surrounding driver, and an overlying expandable portion that includes an impermeable membrane. In these embodiments, the device may be configured to allow solvent (e.g., water) to pass through the semipermeable conduit membrane by osmosis but not allow significant amounts of solvent (e.g., water) to pass through the impermeable expandable portion membrane. For example, the device may be configured to allow solvent to pass through the semipermeable conduit membrane from an interior lumen of the conduit to the surrounding driver, but not allow significant amount of solvent to pass through the impermeable expandable portion membrane to the driver.
In yet other embodiments, the conduit includes an impermeable material. In some cases, the impermeable material is an impermeable membrane. For instance, the device may include a conduit that includes an impermeable membrane, a surrounding driver, and an overlying expandable portion that includes a semipermeable membrane. In these embodiments, the device may be configured to allow solvent (e.g., water) to pass through the semipermeable expandable membrane by osmosis but not allow significant amounts of solvent (e.g., water) to pass through the impermeable conduit membrane. For example, the device may be configured to allow solvent to pass through the semipermeable expandable portion membrane from the surrounding tissues to the underlying driver, but not allow significant amount of solvent to pass through the impermeable conduit membrane from the interior lumen of the conduit to the surrounding driver.
Aspects of the device may include a distal anchor configured to maintain the device within the stenotic opening during use of the device. The distal anchor may be connected to the device proximate to the distal end of the device. For example, the distal anchor may be connected to the device proximate to the distal end of the conduit. In some cases, the distal anchor is configured to prevent the device from premature explantation from the stenotic opening. The distal anchor may facilitate maintaining the device within the stenotic opening for a desired period of time until the device is removed from the stenotic opening by the user or a health care professional. In certain embodiments, the distal anchor is a mechanical anchor, such as, but not limited to, a hook, a barb, a clamp, a tether and the like. In certain cases, the distal anchor is configured to maintain the device within the stenotic opening by having a diameter that is greater than the diameter of the stenotic opening.
In some instances, the device has a frictional surface on an exterior surface of the device. The frictional surface may be configured to increase the friction between the exterior surface of the device and the surrounding tissues when the device is in use. Increasing the friction between the exterior surface of the device and the surrounding tissues may facilitate retention of the device in the stenotic opening of the subject during use. For example, the frictional surface may have a rough topography that includes an exterior surface shaped as, for example, washboard, rings, waffle pattern, snow tire pattern, pebble finish, shark skin texture, combinations thereof, and the like.
In certain cases, the device includes an adhesive disposed on an exterior surface of the device. In some cases, the membrane includes an adhesive. The membrane may be configured such that the adhesive elutes to the external surface of the device during use. The adhesive may facilitate retention of the device in the stenotic opening of the patient during use. Examples of suitable adhesives include, but are not limited to, carbomer, low molecular weight hydroxypropyl methylcellulose, combinations thereof, and the like.
In some cases, the distal anchor is configured to allow the device to be inserted into the stenotic opening. The distal anchor may have an outside diameter that is substantially the same as the outside diameter of the device when the device is in a non-expanded configuration. In some instances, the distal anchor has an outside diameter that is greater than the diameter of the conduit. In certain embodiments, the distal anchor has a tapered shape, such that the distal end of the distal anchor has a diameter that is less than the diameter of the proximal end of the distal anchor (see e.g.,
In certain embodiments, the distal anchor is a flexible anchor. In some cases, the flexible distal anchor is configured to have a configuration that has a smaller diameter during insertion of the device into the stenotic opening as compared to the diameter of the flexible distal anchor after the anchor portion of the device has been inserted into the paranasal sinus. For instance, the flexible distal anchor may be configured to fold into a configuration that has a smaller diameter during insertion of the device into the stenotic opening as compared to the diameter of the flexible distal anchor after the anchor portion of the device has been inserted into the paranasal sinus. An example of an embodiment having flexible anchors is shown in
Aspects of the device may include a proximal anchor configured to maintain the device within the stenotic opening during use of the device (see e.g.,
In some embodiments, the device includes an attachment portion configured to facilitate removal of the device from the stenotic opening. The attachment portion may be configured to allow a removal device to be attached to the device. For example, the attachment portion of the device may include a structure, such as, but not limited to, a loop, a tether or a hook. The removal device may include a corresponding structure that allows for attachment of the removal device to the attachment portion of the device. In some instances, the device includes a loop and the removal device includes a hook. In other embodiments, the device includes a hook and the removal device includes a loop. In either embodiment, insertion of the hook into the loop connects the device to the removal device and may facilitate removal of the device from the stenotic opening.
In some cases, the attachment portion may protrude from the device to facilitate connection of the removal device to the attachment portion of the device. The attachment portion may be disposed at or near the proximal end of the device to facilitate removal of the device from the stenotic opening. For example, the attachment portion may be disposed on the proximal anchor at the proximal end of the device. In certain cases, the attachment portion may be connected to the conduit proximate to the proximal end of the device.
In certain embodiments, the device includes one or more drug reservoirs configured to deliver a drug to the subject while the device is positioned within the stenotic opening. The drug reservoir may be configured to deliver the drug locally to the tissues surrounding the device while the device is in use. For example, the drug reservoir may be configured to deliver the drug to one or more of the interior tissues of the stenotic opening, the interior lumen of the paranasal sinus, the tissues of the stenotic opening, the exterior tissues of the stenotic opening, and the nasal cavity.
The one or more drug reservoirs may have a variety of different configurations. In some instances, the one or more drug reservoirs are disposed on the exterior surface of the conduit. In certain cases, the one or more drug reservoirs are disposed on the exterior surface of the expandable portion of the device. The one or more drug reservoirs may be positioned between the expandable portion and the driver. The one or more drug reservoirs may be within the driver. Various combinations of the above described drug reservoir configurations are also possible and may depend of the type of drug to be delivered, the desired site of activity for the drug, the patient, the size of the stenotic opening, the desired configuration for the device, and the like. For example, in some embodiments, the device includes a first drug reservoir near the distal end of the device and a second drug reservoir near the proximal end of the device. The first drug reservoir may be disposed between the distal anchor and the driver, and the second drug reservoir may be disposed between the proximal anchor and the driver. In some instances, the drug reservoir is disposed distal to the distal anchor of the device. In these instances, positioning of the drug reservoir distal to the distal anchor of the device may facilitate delivery of the drug to one or more of the interior tissues of the stenotic opening, the interior lumen of the paranasal sinus, and the like.
In certain embodiments, the drug reservoir is configured to deliver the drug from the drug reservoir to the surrounding tissue. In some embodiments, the drug reservoir is configured to allow the drug to passively diffuse from the drug reservoir. In other embodiments, the drug reservoir is configured to actively deliver the drug to the surrounding tissue. For example, the drug reservoir may include an osmotically active agent and may be configured to deliver the drug from the drug reservoir through the action of the osmotically active agent after the device has been positioned in the stenotic opening of the subject. In certain embodiments, the device may be configured to deliver the drug from the drug reservoir through the action of the driver. In embodiments where the driver includes a swellable polymer or an osmotically active agent, expansion of the driver may apply external pressure on the drug reservoir and push the drug out of the drug reservoir. For example, as discussed above, the drug reservoir may be positioned between the proximal anchor and the driver (or between the distal anchor and the driver). Expansion of the driver may compress the drug reservoir against the proximal anchor (or the distal anchor) and thus force the drug out of the drug reservoir.
Referring now to
Referring now to
An embodiment of an implantable dilation device 100 is shown in
Positioned at the distal opening 102 is a flexible distal anchor 104. As used herein, the term “distal” refers to the end of the device that is inserted through a paranasal sinus opening of the subject and remains within the sinus cavity during use. Distal anchor 104 can have a daisy configuration as shown in
Similarly, attached to the proximal end 103 of conduit 101 is a proximal anchor 105 having a central passageway 106 which aligns with the hollow interior of conduit 101. As used herein, the term “proximal” refers to the end of the device that remains on the nasal cavity side of the stenotic opening when the device is positioned in the stenotic opening during use. Proximal anchor 105 has an expanded diameter compared to the diameter of conduit 101 and thereby acts as a second anchor for preventing the device 100 from entering into the nasal sinus cavity during use. In certain embodiments, the opening 102, leading to the hollow interior of conduit 101 and the aligned opening 106 create a conduit or passageway for fluid in the sinus cavity, such as mucus, puss and/or blood, to drain through the device 100 while the device 100 is positioned within the sinus opening.
Positioned along a central portion of conduit 101 (e.g., between the distal anchor 104 and the proximal anchor 105) is an osmotic driver 110 that includes an elastic semipermeable membrane 111 surrounding an osmotic core 112. The osmotic core 112 may include one or more osmotically active agents such as water soluble salts or sugars, such as sodium chloride, lactose, etc., and optionally binders, lubricants and mold release agents. The osmotic core additionally may include osmopolymers such as polyethylene oxide, sodium carboxymethyl cellulose, and the like. Once inserted into a paranasal sinus opening, water from the patient's body permeates through the membrane 111 by osmosis and forms a solution of the salt or sugar and hydrates the osmopolymer in the osmotic core 112, thereby causing the osmotic core 112 to expand. As water imbibes in, the volume of the core 112 increases. In addition, due to its elastic nature, the membrane 111 also expands to accommodate the increased volume of the osmotic core 112. The rate of water permeation can be controlled by controlling the composition, thickness and porosity of the membrane 111, in combination with the osmotic activity of the core 112. In certain embodiments of the devices disclosed herein, the membrane 111 composition, thickness and porosity are controlled to achieve expansion of the core 112 over a period of 0.5 hours or more, such as 1 hour or more, including 2 hours or more, or 3 hours or more, or 4 hours or more. In other embodiments of the devices disclosed herein, the membrane 111 composition, thickness and porosity are controlled to achieve expansion of the core 112 over a period of 4 hours or more. In some cases, the expansion will occur gradually over a period of 4 hours to 14 days, such as over a period of 6 hours to 12 days, including over a period of 1 to 10 days, for example, the expansion may occur gradually over a period of 2 to 8 days. In this way the rapid expansion and the resulting pain experienced by the patient during conventional balloon sinuplasty may be substantially avoided.
Certain embodiments of the osmotic core include ring (e.g., donut) shaped salt- and polymer-containing tablets having an inner opening that is large enough to slide over conduit 101. In some instances, the tablets have an outer diameter of 5 mm or less, such as 4 mm or less, or 3 mm or less, or 2 mm or less, or 1 mm or less. For instance, the tablets may have an outer diameter of 3 mm. In some instances, the tablets are composed of a salt (e.g., NaCl). In certain cases, the tablets are composed of a polymer, such as a high molecular weight hydrogel-forming polymer, for example polyethylene oxide (e.g., Polyox™, Dow Chemical Company, Midland, Mich.). In certain cases, the tablets include tableting excipients and/or lubricants. In some embodiments, the tablets include 10 to 95 wt % salt, such as 20 to 90 wt % salt, including 30 to 80 wt % salt, or 40 to 70 wt % salt. For example, the tablets may include 10 to 95 wt % NaCl, such as 20 to 90 wt % NaCl, including 30 to 80 wt % NaCl, or 40 to 70 wt % NaCl. In some cases, the tablets include 30 to 80 wt % NaCl. In certain embodiments, the tablets include 5 to 90 wt % polymer, such as 10 to 80 wt % polymer, including 20 to 70 wt % polymer, or 30 to 60 wt % polymer. For example, the tablets may include 5 to 90 wt % Polyox, such as 10 to 80 wt % Polyox, including 20 to 70 wt % Polyox, or 30 to 60 wt % Polyox. In certain cases, the tablets include 20 to 70 wt % Polyox. In some embodiments, the tablets are composed of a salt and a polymer, as described above. For example, the tablets may include 30 to 80 wt % NaCl and 20 to 70 wt % Polyox. In certain instances, the NaCl gives a quicker rate of expansion than does the Polyox, though both materials are osmotically active and cause water to be imbibed into the interior of the dilator. Because of its low molecular weight, there may be some leakage of NaCl out through the semipermeable membrane, whereas because of its high molecular weight, there is substantially no leakage of the Polyox out through the semipermeable membrane. A higher NaCl loading (e.g., 80 wt %) gives a longer duration of dilator expansion than a lower NaCl loading (e.g., 20 wt %).
Referring now to
Also shown in
In certain embodiments, reservoirs 107 and 108 are composed of substantially rigid materials. In these embodiments, the reservoirs assist in directing the expansion of osmotic driver 110 in a radially outward direction, rather than in a direction that is parallel to the longitudinal axis of device 100.
An alternate configuration of an insertable dilation device, similar to device 100 shown in
Reference is now made to
In place of the distal anchor 104 in device 100, device 200 has an osmotic anchor 220 including an elastic semipermeable membrane 221 surrounding an osmotic core 222. The operation of the osmotic anchor 220 is similar to the operation of osmotic driver 210 in that osmotic core 222 may be configured to expand upon absorption of water from the patient's body. In certain embodiments, osmotic core 222 expands in volume at a rate greater than the rate of expansion of osmotic core 212. For example, osmotic core 222 may become fully expanded within several hours of insertion into the paranasal sinus opening, such as within 1 hour of insertion into the paranasal sinus opening. Driver 220 is shown in a fully expanded configuration in
Referring now to
Referring now to
Surrounding conduit 401 is an expandable driver 410 that includes an expandable polymer matrix. Suitable expandable polymers for use as the driver 410 include water swellable polymers such as poly ethylene oxide (PEO), hydroxypropylmethyl cellulose, polyvinyl alcohol, carboxymethylcellulose, sodium carboxymethylcellulose, poloxamer, polyethylene glycol, carbomer, methylcellulose, gelatin, xanthan gum, guar gum and amylose starches. In some cases, the polymer is a hydrophilic polymer that is capable of absorbing 100% or more, such as 200% or more, including 500% or more, or 1,000% or more, or 1,500% or more, for instance 2,000% or more of its dry weight in water. In certain embodiments, the polymer absorbs water and swells in volume in an isotropic fashion, although non-isotropic expansions are possible and may be used in certain embodiments. One example of a hydrophilic polymer is aliphatic, polyether-based thermo-plastic urethane (TPU). This material is an injection moldable thermo-plastic, and may be molded in various shapes, as desired.
In use, the device 400 is positioned within a sinus opening in a non-expanded configuration. Water from the patient's body is absorbed into the polymer matrix of driver 410, causing it to gradually expand to the configuration shown in
Conduit 401 may be made from a metal, a metallic alloy, a polymer, a ceramic or other rigid or non-collapsible material and may be configured to constrain the expansion of driver 410 in a direction that is parallel to the axis of device 400, ensuring that driver 410 expands in an outward radial direction. For example, the ends of conduit 401 may be flared, creating flanges 403 and 404, which help direct expansion of the driver 410 in an outward radial direction from the conduit 401. Conduit 401 may be rigid or non-collapsible, such that conduit 401 reinforces the inner diameter of the device so that the device is capable of exerting force radially outward without collapsing.
Device 400 may be fabricated by an insert molding operation wherein the expandable polymer is molded onto the rigid or non-collapsible conduit 401. Additionally, device 400 may be fabricated as two separate parts and joined in a mechanical assembly process to form the final as-assembled configuration.
Referring now to
In certain embodiments, the entire device 500 is composed of an expandable polymer matrix 510. The ends of matrix 510 are flared, creating anchoring flanges 503 and 504 which help keep device 500 anchored within the sinus opening during use. A suitable expandable polymer for use as matrix 510 is aliphatic, polyether-based thermo-plastic urethane (TPU). In certain embodiments, the polymer expands by 100% or more in each linear dimension. The linear expansion may be equivalent to a 700% or more volume expansion. In some instances, the polymer has a specific gravity of between 1.10 and 1.15, which equates to a water absorption of approximately 620% by mass. The matrix material may be an injection moldable thermo-plastic, and may be molded in various shapes, as desired. In some instances, the polymer matrix 510 is a homogeneous polymer matrix. In other cases, the polymer matrix 510 is a heterogeneous polymer matrix. For example, the heterogeneous polymer matrix may be configured to have a region of higher rigidity near the interior surface of the device that forms the inner conduit 502. The polymer matrix may also be configured to have regions of higher rigidity at the distal end and the proximal end of the device, such as at the anchoring flanges 503 and 504, respectively. The regions of higher rigidity may facilitate directing the expansion of the polymer matrix radially outward from the inner conduit 502.
In use, the device 500 is positioned within a sinus opening in a non-expanded configuration. Water from the surrounding tissues of the patient's body is absorbed into the polymer matrix, causing it to gradually expand to the configuration shown in
In general, hydrophilic polymeric materials may be manufactured into the configurations shown in
Referring now to
As shown in
While
Another embodiment of an osmotic dilator insertion device 900 is shown in
In certain embodiments, device 900 includes a light source 911, which in some instances is a directional light source, such as a low energy laser. The light source 911 emits light into the lumen of hollow member 901. When the light source 911 is positioned as shown in
As shown in
Referring now to the osmotically driven devices 100, 200 and 300, once inserted, the dilation devices 100, 200, and 300 begin to expand by reason of their osmotic drivers 110, 210 and 310, respectively. Referring now specifically to dilation device 100, water from the patient's body begins to permeate through the semipermeable membrane 111 by reason of the osmotically active agents contained within core 112. Similarly, for dilation device 200, water from the patient's body begins to permeate through the semipermeable membrane 211 by reason of the osmotically active agents contained within core 212. Similarly, for dilation device 300, water from the patient's body begins to permeate through the semipermeable membranes 311a and 311b by reason of the osmotically active agents contained within core 312 (e.g., cores 312a and 312b).
Referring now to
Another embodiment of an osmotic dilator 150 is shown in a non-expanded configuration in
As described herein, the distal anchor 156 may be sized such that upon initial insertion the anchor is small enough so that it can be easily pushed through the stenotic ostium during dilator 150 placement and yet expands to a size that keeps the dilator from being pushed out of the ostium and into the nasal passageway during dilator expansion. Two in situ expanding distal anchor designs are illustrated in
In other embodiments, a similar flaring distal anchor may be attached to the dilator 150 with the sections of the anchor arranged in the opposite direction from that shown in
As a further alternative for anchoring dilator 150, the distal anchor 156 may be eliminated and the thickness of the proximal anchor 157 can be increased over what is shown in
The dimensions, both initial and after dilation, of the osmotic drivers may vary depending on the particular sinus opening to be dilated. In the case of a device for dilating the opening of a maxillary sinus, the initial (e.g., before expansion/dilation) diameter of the osmotic driver may be 5 mm or less, such as 4 mm or less, including 3 mm or less, or 2 mm or less, or 1 mm or less. For example, the initial diameter of the osmotic driver may range from 1 mm to 5 mm, such as 2 mm to 4 mm, including 2 mm to 3 mm. In some cases, the final (e.g., after expansion/dilation) diameter of the osmotic driver is 5 mm or more, such as 6 mm or more, including 7 mm or more, or 8 mm or more, 9 mm or more, or 10 mm or more. For example, the final diameter of the osmotic driver may range from 1 mm to 10 mm, such as 2 mm to 10 mm, including 5 mm to 10 mm. In certain embodiments, the length of the osmotic driver is 20 mm or less, or 15 mm or less, such as 10 mm or less, including 5 mm or less, or 2 mm or less, or 1 mm or less. For instance, the length of the osmotic driver may range from 1 mm to 20 mm, such as 2 mm to 15 mm, including 2 mm to 10 mm.
In the case of a device for dilating the opening of a sphenoid sinus, the initial (e.g., before expansion/dilation) diameter of the osmotic driver may be 5 mm or less, such as 4 mm or less, including 3 mm or less, or 2 mm or less, or 1 mm or less. For example, the initial diameter of the osmotic driver may range from 1 mm to 5 mm, such as 2 mm to 4 mm, including 2 mm to 3 mm. In some cases, the final (e.g., after expansion/dilation) diameter of the osmotic driver is 2 mm or more, such as 3 mm or more, or 5 mm or more, such as 6 mm or more, including 7 mm or more, or 8 mm or more, 9 mm or more, or 10 mm or more. For example, the final diameter of the osmotic driver may range from 1 mm to 10 mm, such as 2 mm to 10 mm, including 3 mm to 5 mm. In certain embodiments, the length of the osmotic driver is 20 mm or less, or 15 mm or less, such as 10 mm or less, including 5 mm or less, or 2 mm or less, or 1 mm or less. For instance, the length of the osmotic driver may range from 1 mm to 20 mm, such as 2 mm to 15 mm, including 2 mm to 10 mm.
In the case of a device for dilating the opening of a frontal sinus, the initial (e.g., before expansion/dilation) diameter of the osmotic driver may be 5 mm or less, such as 4 mm or less, including 3 mm or less, or 2 mm or less, or 1 mm or less. For example, the initial diameter of the osmotic driver may range from 1 mm to 5 mm, such as 2 mm to 4 mm, including 2 mm to 3 mm. In some cases, the final (e.g., after expansion/dilation) diameter of the osmotic driver is 2 mm or more, such as 3 mm or more, or 5 mm or more, such as 6 mm or more, including 7 mm or more, or 8 mm or more, 9 mm or more, or 10 mm or more. For example, the final diameter of the osmotic driver may range from 1 mm to 10 mm, such as 2 mm to 10 mm, including 3 mm to 5 mm. In certain embodiments, the length of the osmotic driver is 30 mm or less, such as 25 mm or less, or 20 mm or less, or 15 mm or less, such as 10 mm or less, including 5 mm or less, or 2 mm or less, or 1 mm or less. For instance, the length of the osmotic driver may range from 1 mm to 30 mm, such as 1 mm to 25 mm, including 2 mm to 25 mm.
For instance, referring back to
As disclosed herein, in certain embodiments, the rate of expansion of the osmotic driver is such that the driver expands over a period of 0.5 hours or more, and in other embodiments over a period of 4 hours or more. Thus, the rate of water imbibition may be such that the dilator expands to the desired size over the desired period of time, e.g., 0.5 hours or more, or 4 hours or more. The rate of volume increase of the osmotic drivers can be approximated by the following equation:
dv/dt=A(k)(Δπ)/L
where:
k is the osmotic water permeability of the semipermeable membrane;
A is the surface area of the semipermeable membrane;
L is the semipermeable membrane thickness; and
Δπ is the osmotic pressure difference across the membrane.
Using this equation, embodiments of the present disclosure may have a rate of volume increase, for example, according to the following: assuming k=9.7×10−6 cm2/hr atm (3.8×10−3 cm mil/hr atm); A=0.55 cm2; L=0.038 cm (15 mils); Δπ=356 atm (using NaCl as the osmotic core material) gives an osmotic driver volume increase rate of 0.05 cm3/hour. In certain embodiments, the device has a rate of volume increase ranging from 0.01 cm3/hour to 0.5 cm3/hour, such as 0.05 cm3/hour to 0.45 cm3/hour, including 0.1 cm3/hour to 0.4 cm3/hour, or 0.15 cm3/hour to 0.35 cm3/hour, for example 0.2 cm3/hour to 0.3 cm3/hour.
In some instances, the volumetric imbibition rate is gradually decreased by the buildup of hydrostatic pressure within the osmotic driver as the semipermeable membrane stretches and as the membrane exerts pressure against tissues of the ostium. When the hydrostatic pressure in the osmotic driver reaches the osmotic pressure of the osmoagent within the core, the driver reaches equilibrium and substantially stops expanding. In certain embodiments, the osmotic driver is configured such that the driver reaches equilibrium when the device has expanded to its desired size. In some instances, this provides a safety feature for preventing overexpansion of the surrounding tissues of the patient.
In the above equation, Δπ represents the gradient in osmotic pressure across the semipermeable membrane. The osmotic driving force may depend on the osmotic activity of the mucous layer and other fluids surrounding the ostium. For example, the π value for normal saline is 8 atm. Therefore, if the osmotic core of the driver contains saturated lactose having a π value equal to 18 atm, and assuming the surrounding mucus has similar activity as saline, then Δπ is 10 atm (18 atm−8 atm=10 atm).
Various semipermeable membranes suitable for human use may be included in embodiments of the osmotic dilators. The polymeric materials from which the semipermeable membranes may be made vary based on the pumping rates and device configuration requirements and include, but are not limited to, plasticized cellulosic materials, enhanced polymethylmethacrylate such as hydroxyethylmethacrylate (HEMA) and elastomeric materials such as polyurethanes and polyamides, polyether-polyamide copolymers, thermoplastic copolyesters and the like. Further semipermeable compositions are described in U.S. Pat. Nos. 5,413,572 and 6,270,787, the disclosures of which are incorporated herein by reference in their entirety. In certain embodiments, the semipermeable membrane material includes cellulose acetate CA398 (Eastman Chemical Co., Kingsport, Tenn.).
In certain embodiments, the semipermeable membranes used in embodiments of the present disclosure also include a plasticizer and/or a rubber-like polymer such as a pharmaceutical grade polyacrylate. One suitable polyacrylate is Eudragit NE30D (Evonik Cyro LLC, Piscataway, N.J.). This material is rubbery and has an elongation at break of 600%, meaning it can be stretched about 6-fold before breaking. Eudragit E30D serves as a polymeric plasticizer and mixtures of Eudragit E30D and cellulose acetate CA398 may provide elongation at break (Eb) values that can be tailored to any particular sinus opening, with higher Eb values being associated with blends having a higher fraction of NE30D. Elastomers such as silicones can also be used.
The degree of elastic membrane expansion under pressure may depend on membrane thickness, membrane composition, salt tablet composition and the shape, configuration and number of the salt tablets used. In some instances, the elastic semipermeable membranes exhibit non-uniform expansion. Without being bound to any particular theory, this non-uniformity in membrane expansion may be due to variability in membrane thickness. In other embodiments, the elastic semipermeable membrane expands uniformly. In these embodiments, the elastic semipermeable membrane may have a substantially uniform thickness. When the membranes are applied as multiple coatings of a liquid membrane solution, the membranes may be moved during drying so that thicker coated regions do not develop. For example, an osmotic driver that swells uniformly may include 2 to 4 donut-shaped salt tablets formulated with Polyox™ 303 (Dow Chemical Company, Midland, Mich.) and 50 wt % NaCl, together with an expandable semipermeable membrane composed of Tecophilic® HP93A-100 (Lubrizol Corp., Wickliffe, Ohio) coated to a thickness of 15 mils. These drivers may swell evenly and symmetrically over a period of 4 hours, at which time they reach osmotic equilibrium and substantially stop further swelling, and the symmetry is maintained for 30 hours or more.
As an alternative to a stretchable semipermeable membrane, the membrane may also be composed of a low elongation material that is folded back on itself in the pre-insertion state. For example, the membrane may include materials such as Mylar or polyvinylidene chloride (PVdC). In some cases, the membrane is made to the proper fully expanded size, and then folded upon itself around the osmotic core. In this manner, the membrane unfolds to accommodate the osmotic core as the volume of the osmotic core expands.
Osmotic cores according to embodiments of the present disclosure can include any suitable osmotic agent, examples of which include, but are not limited to, a non-volatile water soluble osmoagent, an osmopolymer which swells on contact with water, or a mixture thereof. Representative osmoagents or osmopolymers are described, for example, in U.S. Pat. Nos. 5,413,572 and 6,270,787, the disclosures of which are incorporated herein by reference in their entirety. Osmotic agents, such as sodium chloride may be used. Sodium chloride in compressed form is an osmotic agent as described, for example, in U.S. Pat. No. 5,728,396, the disclosure of which is incorporated herein by reference in its entirety. The osmotic cores may further include appropriate lubricants, binders, and viscosity modifying agents, such as sodium carboxymethylcellulose or sodium polyacrylate. In certain embodiments, the osmotic agent is capable of generating a pressure ranging from 1 atm to 50 atm, such as 5 atm to 25 atm, including 10 to 20 atm. A summary of suitable osmotic agents (also referred to herein as osmoagents) is listed in Table 1 below. The osmoagents listed in the left column are at saturated concentration in water. The column on the right represents values calculated at one tenth saturated concentration.
The osmotic agent as disclosed in embodiments herein can also be in the form of a polymer. A general description of suitable osmotically active polymers (also referred to herein as osmopolymers) is provided in U.S. Pat. No. 5,160,743, the disclosure of which is incorporated herein by reference in its entirety. Some suitable osmopolymers include, but are not limited to, polyethylene oxide (Polyox® Coagulant Grade, Polyox® 303 low ethylene oxide, Colorcon, Harleysville, Pa.), cellulose gum (Sodium Carboxymethyl Cellulose Grade 7H4F, Aqualon, Wilmington, Del.), and polyacrylic acids (Carbopol Grades 974 NF, EDT2020 NF, Ultrez 10 NF, and ETD 2020NF, Lubrizol Corporation, Wickliffe, Ohio).
In certain embodiments, at least portions of the dilation devices as disclosed herein are formed of bioerodible (also referred to herein as bioabsorbable) materials that are capable of breaking down and either being absorbed by, or expelled by, the patient's body. Such bioerodible or bioabsorbable materials include metals, polymers, and bioactive glasses. Suitable bioerodible/bioabsorbable metals include magnesium alloys, including formulations such as the magnesium alloys disclosed in U.S. Patent Application No. 2002/0004060, the disclosure of which is incorporated herein by reference in its entirety. In some instances, the bioerodible/bioabsorbable alloy includes 50-98% magnesium, 0-40% lithium, 0-5% iron and 5% or less of other metals. Other suitable formulations include a magnesium alloy having 90% or more magnesium, 3.7%-5.5% yttrium, and 1.5%-4.4% rare earths. Additional formulations are disclosed in U.S. Patent Application No. 2004/0098108, the disclosure of which is incorporated herein by reference in its entirety. Suitable bioerodible/bioabsorbable polymers include polyactic acid, polyglycolic acid, collagen, polycaprolactone, hylauric acid, adhesive protein, co-polymers of these materials, as well as composites and combinations thereof.
In certain embodiments the entire dilation device is formed of bioerodible/bioabsorbable materials. In these embodiments, no active removal of the device is required, e.g., the device is passively removed through the process of bioerosion/bioabsorption. In some instances, only a portion of the device is composed of bioerodible materials. For example, the drug reservoirs may include bioerodible/bioabsorbable material. In these embodiments, drug releasing bioerodible/bioabsorbable polymers can be used, including those disclosed in U.S. Pat. Nos. 5,464,450; 6,387,124; and 5,500,013, the disclosures of which are incorporated herein by reference in their entirety.
Aspects of the present disclosure include a method of dilating a stenotic opening in a subject. In certain embodiments, the method includes positioning a device for dilating the stenotic opening in the stenotic opening. In some cases, the device includes an osmotic driver configured to expand an expandable portion from a non-expanded configuration to an expanded configuration, and the expandable portion disposed peripherally around the driver and configured to expand from the non-expanded configuration to the expanded configuration, where the non-expanded configuration is sized to be positioned within the stenotic opening.
When a patient's opening to any of the maxillary, frontal or sphenoid sinuses becomes occluded or partially occluded (e.g., stenotic), the sinus is unable to properly drain and ventilate resulting in a tendency to develop infections, e.g., sinusitis. The implantable dilation devices disclosed herein are adapted to be inserted into these occluded or partially occluded sinus openings by way of the nostril opening (NO) and nasal cavity (NC).
Aspects of the present disclosure include a method of dilating a stenotic opening of a paranasal sinus in a subject. In certain embodiments, the method includes positioning a device in the stenotic opening, where the device is a device for dilating the stenotic opening as described herein. As described above, the device is configured to expand from a non-expanded configuration to an expanded configuration, where the expanded configuration dilates the stenotic opening. By “dilate” is meant that the average diameter of the stenotic opening is greater after the device has expanded to its expanded configuration as compared to the average diameter of the stenotic opening before the device has expanded.
In some cases, the method further includes removing the device from the stenotic opening. The device may be removed from the stenotic opening at a point in time after insertion of the device into the stenotic opening. For instance, the device may be removed from the stenotic opening at a point in time after the device has expanded to the expanded configuration. The device may be removed by contacting a removal device to the device and extracting the device from the stenotic opening. In some cases, the removal device may be attached to the device using a hook, a loop, a clamp, a suction device, a tether and the like. For instance, the removal device may include a hook configured to attach to a loop on the device. Removal of the device may be achieved by pulling the device from the stenotic opening. In certain embodiments, removal of the device may be facilitated by reducing the pressure exerted by the driver against the surrounding tissues before removing the device from the stenotic opening. In some cases, the internal pressure of the driver may be reduced by puncturing the driver. For example, the removal device may include a needle or blade configured to create a hole in the driver allowing the internal pressure of the driver to equalize with the pressure in the nasal cavity. In some cases, the removal device may include a suction device configured to remove the internal contents of the driver from the device, thus reducing the pressure the device is exerting on the surrounding stenotic opening.
In certain embodiments, the device can include a bioerodible or bioabsorbable material where the device removal occurs by bioerosion or bioabsorption of the device. The device may be left in the stenotic opening of the subject and the device gradually erodes and may be absorbed by or expelled by the patient's body over a period of time.
Aspects of the present disclosure include inserting the device through a nostril of a patient into a stenotic opening of a frontal sinus, a sphenoid sinus or a maxillary sinus of the patient. After insertion, the device is left in place in the stenotic opening for an extended period of time during which the size of the device slowly expands exerting pressure on the stenotic opening to gradually dilate the opening. In order to minimize patient discomfort, the expansion of the device may occur over a period of 0.5 hour, 1 hour 2 hours, 3 hours or 4 hours or more. In certain embodiments, the device expansion occurs over a period of 4 hours to 14 days and is then removed from the opening. In other embodiments, the device expansion occurs over a period of 1 to 10 days and is then removed from the opening. In still other embodiments, the device expansion occurs over a period of 2 to 8 days and is then removed from the opening. The device can be left in place in the opening for 3 weeks or more before it is removed from the opening.
In certain embodiments, the method includes contacting the device with a fluid prior to positioning the device in the stenotic opening. Contacting the device with a fluid prior to positioning the device in the stenotic opening may initiate expansion of the device prior to insertion of the device in the stenotic opening. For embodiments of the device that include a swellable polymer or an osmotic agent, contacting the device with a fluid prior to insertion into the stenotic opening may facilitate expansion of the device after positioning the device in the stenotic opening. For example, embodiments of the device may be configured to begin expanding 30 min or more, such as 45 min or more, including 60 min or more, or 90 min or more, 120 min or more, or 180 min or more after the device has been contacted with a fluid. In these embodiments, contacting the device with a fluid prior to insertion of the device into the stenotic opening may facilitate the onset of expansion of the device at a point in time sooner after insertion of the device into the stenotic opening. In some instances, the fluid may include water, saline, sterile water, sterile saline, and the like.
In certain embodiments, the method includes delivering a drug from the device while the device is positioned within the stenotic opening. For example, the drug may include, but is not limited to, an antibiotic, an anti-inflammatory drug, anesthetics (e.g., local anesthetics), analgesics (e.g., locally acting analgesics), vasoconstrictors, combinations thereof, and the like, as discussed above. The drug may be delivered to the tissues of the stenotic opening that surround the device when the device is positioned within the stenotic opening. In some cases, the drug may be delivered to the tissues at the interior end of the stenotic opening or into the paranasal sinus. In certain instances, the drug may be delivered to the tissues at the exterior end of the stenotic opening or into the nasal cavity.
Aspects of the present disclosure include a system for dilating a stenotic opening of a paranasal sinus in a subject. The systems include a device for dilating the stenotic opening and an implantation device configured to position the device in the stenotic opening. The device may include an expandable portion configured to expand from a non-expanded configuration to an expanded configuration, and a driver configured to expand the expandable portion from the non-expanded configuration to the expanded configuration, as described herein.
Suitable implantation devices are described herein and also in U.S. Provisional Application No. 61/378,368, filed on Aug. 30, 2010, U.S. Provisional Application No. 61/416,240, filed Nov. 22, 2010, and in a U.S. Non-Provisional Application filed concurrently with the present U.S. Application entitled “DEVICES AND METHODS FOR INSERTING A SINUS DILATOR”, the disclosures of each of which are hereby incorporated by reference in their entirety.
In certain embodiments, the system includes a device for dilating a stenotic opening of a paranasal sinus and a stent. The stent may be configured such that the device fits within the stent when the device is in a non-expanded configuration, as described herein. For example, the stent may have a cylindrical shape with a diameter that is slightly greater than the diameter of the device when the device is in a non-expanded configuration. In some cases, the stent is an expandable stent. The expandable stent may be configured to expand in size as the device expands from a non-expanded configuration to an expanded configuration. In certain embodiments, the stent is configured to maintain its expanded configuration after it has been expanded from the non-expanded configuration to the expanded configuration. For example, the stent may be configured, such that the stent is able to expand from a non-expanded configuration to an expanded configuration, but upon application of a force to the exterior surface of the stent, may maintain substantially the same interior diameter or deform under application of the force and then return to substantially the same interior diameter after removal of the external force. In some cases, the stent may be configured such that pressure exerted on the exterior surface of the stent by the surrounding tissues during use does not significantly decrease the interior diameter of the stent. In certain embodiments, the stent is configured, such that the interior diameter of the stent does not significantly decrease even if the dilation device is removed. A stent that is configured to maintain its expanded configuration may facilitate dilation of the stenotic opening. The stent may be made of any suitable material know by those of ordinary skill in the art to be useful for a stent, such as a shape-memory alloy, including but not limited to nitinol, stainless steel, titanium, cobalt-chromium alloy, combinations thereof, and the like.
The subject devices, systems and methods find use in a variety of different applications where the dilation of a stenotic opening of a paranasal sinus in a subject is desired. In certain embodiments, the methods are directed to the treatment of a patient having sinusitis. As described above, the method may include positioning a device in the stenotic opening, where the device is a device for dilating the stenotic opening as described herein. Dilation of the stenotic opening of the paranasal sinus may facilitate an alleviation of the symptoms associated with sinusitis. For instance, dilation of the stenotic opening may allow a greater amount of drainage through the stenotic opening as compared to the undilated stenotic opening. Dilation of the stenotic opening may also facilitate the flow of air into and out of the paranasal sinus, which may help alleviate the symptoms associated with sinusitis.
The subject devices, systems and methods may also facilitate the treatment of a patient having sinusitis by delivering a drug for the treatment of sinusitis from the device while the device is positioned within the stenotic opening. As described herein, the device may include drug reservoirs and may be configured to deliver the drug to the tissues near the stenotic opening and/or the tissues surrounding the stenotic opening, including, but not limited to, the interior tissues of the stenotic opening, the interior lumen of the paranasal sinus, the tissues of the stenotic opening, the exterior tissues of the stenotic opening, and the nasal cavity. Delivery of a drug for the treatment of sinusitis from the device may facilitate the alleviation of symptoms associated with sinusitis.
Aspects of the present disclosure additionally include kits that have a device for dilating a stenotic opening of a paranasal sinus in a subject, as described in detail herein. The kits may include one or more devices, where the devices may be provided in a variety of different sizes. The size of the device may depend on the type of paranasal sinus to be treated (e.g., a frontal sinus, a sphenoid sinus or a maxillary sinus), the physiology of the subject to be treated, the severity of stenosis, etc. Additional embodiments of the kits may include a drug, such as, but not limited to an antibiotic, an anti-inflammatory drug, anesthetics (e.g., local anesthetics), analgesics (e.g., locally acting analgesics), vasoconstrictors, combinations thereof, and the like. The drug may be provided in a separate container, such as a syringe, vial, bottle, etc., such that the drug may be filled into the drug reservoir of the device prior to insertion of the device into the stenotic opening.
In certain embodiments, the kits include two or more devices for dilating a stenotic opening of a paranasal sinus in a subject. As described herein, the devices expand from a non-expanded configuration to an expanded configuration. In some instances, the devices have the same diameter when in their respective non-expanded configurations and different diameters when in their respective expanded configurations. For example, embodiments of the kits may include a first device and a second device. The first device and the second device may have substantially the same diameter when they are in their respective non-expanded configurations. In some cases, the devices expand to their respective expanded configurations as described herein, where the second device has an expanded configuration with a diameter that is greater than the diameter of the first device when the first device is in its expanded configuration. In other embodiments, the first device and the second device have different diameters when in their respective non-expanded configurations. For instance, the second device may have a non-expanded configuration with a diameter that is greater than the diameter of the first device when the first device is in its non-expanded configuration. Upon expansion of the first and second devices, the second device may have an expanded configuration with a diameter that is greater than the diameter of the first device when the first device is in its expanded configuration.
Initially, the first device may be positioned in a stenotic opening of a paranasal sinus as described herein and maintained in place for a desired period of time. Subsequently, the first device may be removed from the stenotic opening, and if desired the second device may be positioned in the stenotic opening. As described above, the second device may have an expanded configuration with a diameter that is greater than the diameter of the first device when the first device is in its expanded configuration. In some instances, a plurality of devices may be used sequentially, such that devices with progressively larger diameters are positioned in the stenotic opening. The sequential use of a plurality of devices with progressively larger diameters may facilitate dilation of the stenotic opening.
In certain embodiments, the kits include one or more sinus ostium sizing probes. In some instances, the probes are configured to be removably mountable onto the distal end of the dilator insertion/implanting devices (e.g., on the distal end of the hollow elongated member of the device). In certain cases, the probes are of varying diameters and adapted to be inserted into the dilated ostium to determine the diameter of the dilated ostium and assess whether further dilation is needed.
In addition to the above components, the subject kits may further include instructions for practicing the subject methods. These instructions may be present in the subject kits in a variety of forms, one or more of which may be present in the kit. One form in which these instructions may be present is as printed information on a suitable medium or substrate, e.g., one or more pieces of paper on which the information is printed, in the packaging of the kit, in a package insert, etc. Another form would be a computer readable medium, e.g., diskette, CD, DVD, Blu-Ray, computer-readable memory, etc., on which the information has been recorded or stored. Yet another form of providing instructions to a user may be a website address which may be used via the Internet to access the information at a removed site. Any convenient means of providing instructions may be present in the kits.
Three different designs of an osmotic dilator for dilating and remodeling the ostium of a maxillary sinus over a period of 3 to 4 hours were fabricated.
External Elastic Semipermeable Membrane Design
The osmotic driver was prepared by passing 11.0 g of ultrahigh molecular weight polyethylene oxide (Polyox™ Sentry Grade WSR 303 LEO National Formulary, having a viscosity in water at 1% solids of approximately 8,700 centipoise, and a molecular weight of approximately 7 million; Colorcon®, Inc., West Point, Pa.) through a 100-mesh sieve into a beaker. 12.5 g of sodium chloride was ground to a fine powder in a mortar with pestle and passed through the 100-mesh sieve. The polyethylene oxide and sodium chloride were mixed together in a beaker with a spatula. 1.25 g of hydroxypropyl methyl cellulose (Methocel™ E5 Premium LV having an aqueous viscosity at 2 weight percent solids of approximately 5 centipoise; Dow Chemical Company, Midland, Mich.) was sized through the 100-mesh sieve. The hydroxypropyl methylcellulose was added to the mixture and stirred with a spatula. 22 ml of denatured ethyl alcohol grade SDA3A was slowly stirred with a spatula into the powder mixture until a uniformly wet blend formed. The resulting damp mass was passed with a spatula through a 40-mesh sieve, forming elongated granules. The granules were air dried at room temperature for 3 hours, stirred with a spatula, and then dried overnight in a forced air oven set at 40° C. The dried granules were then passed again through the 40-mesh sieve and weighed. An amount of magnesium stearate tablet lubricant, equal to 1 weight percent of the weighed granules, was passed through an 80-mesh sieve and added to the granules. The lubricant was tumble mixed for 2 minutes into the blend. Portions of the resulting blend weighing 17 mg were filled into a core rod tooling punch and die set (Natoli Engineering, St. Charles, Mo.) having an inside diameter of 2.9 mm and a core rod outside diameter of 0.055 inch (0.14 cm). The punches were 2.9 mm round flat faced beveled tooling. The powders were compressed with a force of approximately 250 pounds (1110 Newtons) on a Carver press to form donut shaped tablets having a central hole of approximately 0.055 inch (0.14 cm) diameter, an outside diameter of approximately 2.9 mm, and height of approximately 2.5 mm.
Stainless steel hypodermic needle stock grade steel 304 was cut into lengths of 55 mm and ends were de-burred. The inside diameter of the tubes was 0.032 inch (0.081 cm) and the outside diameter was 0.042 inch (0.11 cm). The tubular sections were passivated by treating with nitric acid solution, then potassium hydroxide solution, rinsed with de-ionized water, and air dried. An elastomeric semipermeable membrane coating solution was prepared by tumble mixing 14.4 g of polyurethane (Tecophilic® grade HP-93A-100; Thermedics™ Polymer Products, Wilmington, Mass.). This polymer had nominal values for Shore Hardness of 83 A, for Flexural Modulus of 2,900 pounds per square inch (2000 Newtons/cm2) as measured by ASTM test D790, for Ultimate Elongation in the dry state of 1,040 percent and for Ultimate Elongation in the wet state of 620 percent as measured by ASTM method D412, and for equilibrium moisture content of 100%) in 65.6 g of n-methyl pyrrolidone solvent (Pharmasolve®, ISP Technologies, Inc., Wayne, N.J.) at room temperature for 2 days.
Osmotic dilators having a configuration as shown in
Distal and proximal anchors 156, 157 were fabricated. The proximal anchor 157 was punched from 1.7 mm sheet stock of black acrylonitrile butadiene rubber (Buna-n) in the outline shape of a dog bone. The length of the proximal anchor was 10.3 mm and the width, at the necked-down portion, was 6.5 mm. A hole was drilled through the center of the anchor using a 0.042 inch (0.11 cm) drill bit. The distal anchor 156 was made of molded black polyurethane (grade 60A) rubber having a central hole similar in size to the drilled hole of the proximal anchor 157. The distal anchor 156 had a daisy petal configuration with an outside diameter of 6.2 mm. The distal and proximal anchors 156, 157 were affixed to the stainless steel tube 151 by threading the ends of the tube 151 into the holes in the anchors 156, 157 and secured using a medical grade cyanoacrylate adhesive (Loctite 4013, Loctite Corp., Rocky Hill, Conn.).
Internal Semipermeable Membrane with External Non-Permeable Membrane Design without Wick
An aluminum mandrel was machined to a cylindrical shape having distal and proximal regions of differing diameters. The proximal region had a diameter of 7.6 mm and a length of 6.8 mm. The distal region had a diameter of 2.1 mm and length of 14.7 mm. The resulting mandrel was first coated with a release coating layer of poly(p-xylylene) polymer (Parylene, Para Tech Coating, Inc., Aliso Viejo, Calif.). Then a 7 mil (0.2 mm) thick semipermeable membrane comprising 60/40 cellulose acetate poloxamer 188 was spray coated onto the mandrel. The cellulose acetate membrane was cut along the edge of the proximal end of the mandrel and removed from the mandrel. Four osmotic salt tablets having the same composition as the salt tablets used in the external membrane design (see above) were compressed with core rod tooling having an outer diameter of 3.5 mm, inside diameter of 2.5 mm, and height 2.9 mm and were threaded onto the distal end of the cellulose acetate shell. The end section of a polyethylene terephthalate (PET) 8 mm×150 mm catheter balloon was cut. The resulting catheter balloon was crimped onto the tablets by wrapping the balloon with sutures. Once crimped, the PET balloon was glued to the cellulose acetate inner membrane at the distal and proximal ends of the device. The larger diameter cellulose acetate portion acted as a proximal anchor. The distal anchor was made of molded black polyurethane (grade 60A) rubber having a central hole and secured to the stainless steel tube by threading the ends of the tube into the hole and secured using a medical grade cyanoacrylate adhesive.
Internal Semipermeable Membrane with External Non-Permeable Membrane Design with Wick
This design was substantially the same as the internal rigid semipermeable membrane with external non-permeable membrane without wick design (see above), except that a 2.4 mm thick sheet of polyvinyl alcohol (PVA) open cell foam sponge (Expandacell™ sponge, Shippert Medical Technologies, Engelwood, Colo.) was positioned in the center lumen of the rigid cellulose acetate membrane at the proximal end of the device to serve as a water wicking material.
The performance of the external membrane design dilator 150 (see
Similar testing of six of the internal membrane design system indicated for 5 out of 6 of the dilators that enhanced sealing of the glued seal between the hydrophobic PET elastic membrane and the internal hydrophilic cellulose acetate membrane may be achieved using a different adhesive and/or sealing techniques (e.g., crimping, suturing, solvent welding, sonic welding, etc.).
The three osmotic dilator designs made in accordance with Example 1 were also tested in vivo in sheep since the sheep is a recognized model for the human sinus anatomy (Gardiner et al., Journal of Laryngology and Otology, May 1996, Vol. 110, 425-428). Each device was measured (outer diameter of the device), weighed and photographed prior to insertion. Under endoscopic examination using a 30 degree endoscope, a probe was first inserted into the nasal cavity of live anesthetized adult sheep and a 3 mm diameter opening was punctured through the thin wall separating the nasal cavity and maxillary sinus cavity in both maxillary sinuses of each animal. An osmotic dilator was inserted into each of the two maxillary sinus openings such that the distal anchor was located inside the maxillary sinus and the proximal anchor remained within the nasal cavity, thereby anchoring the dilators within the respective openings. After epistaxis was noted in the first few insertions, topical 0.5% oxymetazoline was applied to the lateral nasal wall before insertion. The external membrane dilators were inserted in 3 animals (6 devices), the internal membrane without wick dilators were inserted in 3 animals (6 devices) and the internal membrane with wick dilators were inserted in one animal (2 devices). After dilator insertion, the animals were awakened and returned to a holding area.
At the time of dilator extraction, the animals were sedated, the dilators removed under videoendoscopy, and the resulting ostium was measured. The extracted dilators were placed in a dry vial, measured and weighed.
The external membrane dilators were left in place for 4, 6 or 15 hrs before being removed. During that time, the dilators swelled by imbibing physiological water. Dilator diameters were measured at these sampling points and are shown in
As for the internal membrane design systems, those systems were left in place for 1, 2 or 3 days before being removed. The internal membrane designs without a wick exhibited approximately a 20% increase in diameter and an 80% weight gain after 24 hrs. The internal membrane systems with the PVA wick swelled substantially more slowly than the internal membrane systems without a wick. This slower rate of swelling may be due to dried mucous tending to form on the exposed portions of the wick, which may have inhibited water from being imbibed to the internal membranes.
Upon retrieval of the external membrane dilators, the diameter of the opening in the maxillary sinus wall formed by the expanded dilator was measured under endoscopic examination by comparing the opening size to reference probes of known diameters.
The diameters of the dilated ostia from these animals were monitored over a period of 4 weeks post treatment in order to assess the patency of the enlarged ostia. The ostia were measured at time zero immediately following dilation treatment, 13 days, and 27 days according to the same procedures described above.
All dilators that were inserted and remained in place demonstrated dilation. For the external membrane dilators, dilation appeared to be complete at the time of the first measurement time point (4 hours after placement) and did not increase with increased insertion time. This apparent equilibrium point may indicate a “safety valve” for the system. In other words, the system does not continue to enlarge endlessly which could damage surrounding structures. It was also shown that the diameter of the opening created correlated with the diameter of the expanded dilator. This indicated that the dilators were creating long term changes in the surrounding tissue and not just temporary stretching of the tissue. Also the amount of trauma to the tissue was minimal, therefore not causing damage or tearing leading to a larger than desired opening. Finally, 27 day patency was documented in all sinuses.
Observations of the enlarged ostia compared to previous work done using balloon catheter sinuplasties are as follows. The slowly expanding osmotic dilators kept in place for several hours produced more even (i.e., a round opening with smooth surfaces) remodeling of the tissue in the sinus opening compared to short time duration/high hydraulic pressures used to inflate sinuplasty balloons. The latter high short burst of pressure tends to produce ostial openings having uneven/jagged surfaces. This comparison shows that slow expansion due to slow dilation driven by osmotic pressure applied over a longer period of time gave better ostial tissue remodeling, and resulted in less tissue damage, than the short high pressure bursts used in balloon sinuplasty.
Osmotic dilators designed to dilate and remodel the ostium over a duration of about 20 to 24 hours were fabricated. Tubes having lengths of 55 mm were cut from 304 stainless steel hypodermic needle stock. The tubes were de-burred, then washed with an aqueous solution of Liquinox detergent, rinsed 5 times with de-ionized water, then washed with dry acetone, and air dried. An elastomeric membrane coating solution was prepared by mixing 8.0 g of polyurethane (Tecophilic® grade HP60D-20; Thermedics™ Polymer Products, Wilmington, Mass.). This elastomeric polymer had nominal values for Shore Hardness of 43D, for Flexural Modulus of 4,300 pounds per square inch (3000 Newtons/cm2) as measured by ASTM test D790, for Ultimate Elongation in the dry state of 430 percent and for Ultimate Elongation in the wet state of 390 percent as measured by ASTM method D412, and for equilibrium moisture content of 20%) in 72 g of n-methyl pyrrolidone solvent (Pharmasolve®, ISP Technologies, Inc., Wayne, N.J.). The blend was tumble mixed for 2 days at room temperature to form a clear, colorless, viscous solution. The tubes were dipped in the elastomeric membrane coating solution to a depth of 45 mm multiple times to build up a coating thickness of approximately 0.005 inch (0.013 cm). Between coatings, the tubes were hung vertically and dried in a current of air in a fume hood.
Osmotic salt-containing tablets were fabricated by passing 16.0 g of polyethylene oxide (Polyox™ Sentry Grade WSR 303 LEO; Colorcon®, Inc., West Point, Pa.) through a sizing screen having 40 wires per inch (16 wires per cm). Sodium chloride, 7.5 g, was then triturated in a mortar with pestle, passed through a 60-mesh sieve, and added to the polyethylene oxide. 1.3 g of hydroxypropyl methyl cellulose (Methocel™ E5 Premium LV, The Dow Chemical Company, Midland, Mich.) was passed through the 60-mesh sieve and added to the powders. The powders were stirred with a spatula to form a pre-blend. 25 ml of anhydrous ethanol grade SD3A was slowly stirred into the powders to form a uniform, damp mass. The damp mass was forced through a 40-mesh sieve with a spatula to form elongated granules. After drying overnight in at room temperature in a fume hood, the granules were passed again through a 40-mesh sieve, yielding 21.35 g of granules. Magnesium stearate tableting lubricant, 216 mg, was passed through an 80-mesh sieve and added to the dried, sized granules. The mixture was tumbled in a 120 cm3 screw-capped bottle for one minute to form the final osmotic engine blend composition. The resulting composition was compacted with 2.9 mm flat-faced round punches and dies to a nominal weight of 22.5 mg using an applied load of 250 pounds (1110 Newtons) with a Carver press to form compressed tablets. The nominal height of the tablets was 2.5 mm. A central hole was drilled in the middle of the face of the tablets using a 0.055 inch (0.14 cm) drill bit. After drilling, the nominal weight of the tablets was 16 mg.
Four osmotic salt tablets were threaded onto each of the coated stainless steel tubes. The tablets were positioned in the middle of the 55 mm tube length and in contact with each other to produce a continuous stack of tablets. The subassembly was then dipped into the same elastomeric membrane coating solution used to coat the stainless steel tubes. The subassemblies were dipped multiple times in order to build up a coating thickness on the tablets of approximately 0.014 inch (0.036 cm). Between coatings, the subassemblies were hung vertically and dried in a current of room temperature air. The excess membrane coatings over the tube ends were trimmed off with a razor following the same procedure described in Example 1. The ends of the tubes were then cut to an overall length of about 14 mm, leaving approximately 2 mm of bare metal exposed at each end of the tubes. Proximal and distal anchors were then attached to the metal tubes as described in Example 1 to complete fabrication of the osmotic dilators.
Osmotic dilators made in accordance with Example 4 were tested in vitro in 50 ml of unstirred distilled water at 37° C. Diameter and weight gain of the dilators were monitored as a function of time in this media. The solid symbols illustrated in
Osmotic dilators made in accordance with Example 4 were tested in vivo in sheep by inserting the dilator in an opening connecting the nasal cavity and the maxillary sinus as described in Example 3. The dilators were retrieved at 4, 17, and 24 hours and thickness and weight gain were monitored. These in vivo data are plotted as open symbols in
A self-centering osmodilator is fabricated which is designed to nest within the sinus ostium. A non-collapsing tube is coated with elastomeric polyurethane according to the procedures and compositions described in Example 4. A single osmotic driver is threaded onto the middle of the 55 mm coated tube. The resulting subassembly is dip coated multiple times and dried until the elastomeric coating on the osmotic driver is built up to a nominal thickness of 0.003 inch (0.008 cm). Another osmotic driver is threaded onto each end of the coated tube such that a gap of about 1.5 mm is present between the first (middle) coated driver and the two end drivers which are not yet coated. The resulting subassembly is then dip coated such that the middle driver and an end driver are dip coated. After drying, the dilator is inverted 180° and dip coated such that the other end driver located at the opposite end of the tube and middle driver are coated. This process is repeated multiple times such that the coating on the end drivers is always less than the coating thickness of the middle driver. Each end of the tube is cut off and anchors are attached, according the procedures described in Example 4.
When placed in an ostium, the osmotic drivers located on the ends of the dilator, which have thinner membranes, imbibe physiological water faster than the middle driver, which has a thicker membrane coating. As the osmotic drivers continue to imbibe water, the dilator transforms into a barbell configuration, which configuration nests into the ostia and centers the dilator between the proximal and distal surfaces of the wall of the sinus (e.g., a maxillary sinus).
An osmodilator is made according to the procedures described in Example 1 except the subcoat elastomeric tube, the osmotic drivers, and the overcoat elastomeric tube are each formed by injection molding.
An osmotic dilator which forms rib elements which help retain the dilator within a sinus ostium is made. The osmotic dilator is made according to the compositions and procedures described in Example 4. Prior to the final applications of elastomeric coating, three equally-spaced hoops are placed around the stack of four osmotic drivers. The hoops can comprise stainless steel, high tensile strength wire, thread, suture, floss, or high tensile strength molded or machined ring material. After the hoops are installed, the final applications of membrane coating are applied, thereby embedding the three hoops within the membrane structure. When placed in an aqueous environment, such as the sinus ostium, water is imbibed by osmotic activity causing the stack of osmotic drivers to swell and distend the external elastomeric membrane. As the membrane and osmotic drivers enlarge, swelling is constrained and directed by the hoops such that ribbed elements form between the hoops. This directed swelling produces radial expansion between the hoops larger than would be present without the hoops. Additionally, the ribbed elements assist in retaining the device within the ostia by providing convoluted surfaces within which the ostia can reside during treatment.
An osmotic dilator is fabricated according to Example 9 except that a wire mesh cage is present instead of the hoops. The mesh cage provides the elastomeric membrane with a frictional surface that enhances retention of the dilator while it undergoes expansion within the sinus ostia.
An osmotic dilator is fabricated according to Example 9 except that a braided, knitted, non-woven, or woven polymeric tube is present instead of the hoops. The texture of the tube provides the elastomeric membrane with a frictional surface that enhances retention of the dilator while it undergoes expansion within the sinus ostia.
A self-positioning (e.g., self-centering) sinus ostium dilator 160 having spaced salt tablets 163, 164, 165 is shown in
When in an aqueous environment such as a sinus ostium (e.g., a maxillary sinus ostium), the osmotic dilators 160 imbibe physiological fluids causing radial distension of the outer elastomeric semipermeable membrane 167. The end salt tablets 163, 165 imbibe fluid at a faster rate than the middle salt tablet 164 which has a thicker coating of membrane 167. The net result of these different imbibition rates is that the dilator 160 forms a dumb bell configuration that helps to nest and position the dilator within the sinus ostium. The microwashers serve to direct swelling radially outwardly to further improve ostium dilation.
An osmotic dilator designed to dilate and remodel a sinus ostium (e.g., of a maxillary sinus) is fabricated according to the methods and materials described in Example 1 except the membrane comprises a blend of two water-insoluble polymers. The blend of polymers consists of 50 weight percent of Tecophilic® HP93A-100 (Thermedics™ Polymer Products, Wilmington, Mass.) and 50 weight percent Tecophilic® HP60D-20 (Thermedics™ Polymer Products, Wilmington, Mass.). When placed in the aqueous environment of the ostia, the dilator imbibes water, swells, and reaches osmotic equilibrium over duration of 8 to 16 hours.
An osmotic dilator for dilating and remodeling a sinus ostium (e.g., of a maxillary sinus) is fabricated according to the methods and materials described in Example 1 except the membrane comprises a blend of a water insoluble polymer and a water soluble flux enhancer. The blend of polymers consists of 90 weight percent of Tecophilic® HP93A-100 (Thermedics™ Polymer Products, Wilmington, Mass.) as the water insoluble polymer and 10 weight percent poloxamer 188. When placed in the aqueous environment of the ostia, the dilator imbibes water, swells, and reaches osmotic equilibrium over duration of about 2 hours.
An osmotic dilator for dilating and remodeling a sinus ostium (e.g., of a maxillary sinus) is fabricated according to the methods and materials described in Example 1 except the membrane comprises a blend of a water insoluble polymer and a water soluble flux enhancer. The blend of polymers consists of 70 weight percent of Tecophilic® HP93A-100 (Thermedics™ Polymer Products, Wilmington, Mass.) as the water insoluble polymer and 30 weight percent polyvinyl pyrrolidone 12 PF. When placed in the aqueous environment of the ostia, the dilator imbibes water, swells, and reaches osmotic equilibrium over duration of about 0.5 hours.
A phase 1, open-label study to assess the safety and performance of the osmotic dilator shown in
This study is a single-arm, open-label, prospective study and will involve the collection of demographic, image and clinical data. Up to 10 subjects are recruited using the following inclusion criteria: (1) age between 18 and 70 years; (2) both males and females are eligible; (3) subject has the ability to follow the study instructions, is willing to be available on the specific required study visit days, and is willing to complete all study visit procedures and assessments; (4) subject must understand the research nature of this study and sign an informed consent prior to the performance of any study specific procedure or assessment; and the following exclusion criteria: (1) subject is pregnant or breast feeding; (2) subject has one of the following diagnoses: cytic fibrosis, Sampter's Triad (aspirin sensitivity, asthma, sinonasal polyps), nasal polyposis, sinonasal tumors, allergic fungal sinusitis, ciliary disfunction, perforated septum, atrophic nasal mucosa, and/or excessive osteogenesis; (3) subject has any anatomic abnormality that precludes access to the maxillary sinus ostium (e.g., a deviated septum); (4) subject has a history of facial trauma that resulted in distortion of the nasal and/or sinus anatomy; (5) subject has had a previous antrostomy; (6) subject has clinical evidence of acute respiratory or sinus infection; (7) subject has a known infection with human immunodeficiency virus, other immune deficiency, insulin dependent diabetes or other serious systemic disease; (8) subject is currently participating in, or has participated in, any type of investigational study in the thirty days prior to screening visit; (9) subject has known sensitivity to the local anesthetic agent used in the study; (10) subject has a diagnosis of hematologic disease, bleeding diathesis or is taking anticoagulant medication; and (11) any other condition which in the investigator's opinion deems the subject an unsuitable candidate to receive study treatment or which may interfere with the study results. Enrolled subjects undergo local anaesthesia/decongestant followed by a nasal endoscopy. Standardized photographs/videos are taken at baseline (i.e., prior to any dilation treatment). Patency and if applicable diameter of the MSO prior to dilatation is recorded. The osmotic dilator is inserted, using the inserter illustrated in
An osmotic dilator designed to dilate and remodel the ostium of a maxillary sinus over a duration of minutes was fabricated according to the methods and materials described in Example 1, except the membrane had a nominal thickness of 348 microns (13.7 mils). When three stents were placed in deionized water at 37° C. for 120 minutes, the devices imbibed an average of 125 mg water and swelled from an initial diameter of 3.6 mm to an expanded diameter of 5.6 mm.
An osmotic dilator designed to dilate and remodel the ostium of a maxillary sinus over a duration of minutes was fabricated according to the methods and materials described in Example 1, except the membrane was formed by extrusion. A tube made of Tecophilic® HP93A-100 (Thermedics™ Polymer Products, Wilmington, Mass.) was extruded having a nominal inside diameter of 44 mils (1.12 mm) and nominal wall thickness of 5 mils (0.127 mm). The extruded tube was slipped onto the stainless steel tube described in Example 1. Then, two osmotic tablets as described in Example 1 were positioned over the extruded tube such that they were in contact with each other. A second tube of Tecophilic® HP93A-100 (Thermedics™ Polymer Products, Wilmington, Mass.) was extruded having a nominal inside diameter of 116 mils (2.95 mm) and a nominal wall thickness of 14 mils (0.356 mm). The second tube was then slipped over the osmotic tablets. The inner first tube and outer second tube were heated locally at each side of the pair of osmotic tablets using a hot iron such that the first and second tubes adjacent to the engines were melted and bonded to form a continuous seal between the inner and outer tubes, thereby fully encapsulating the osmotic tablets with the membrane material. The resulting device was placed in deionized water at 37° C. and the device imbibed water from the environment. The device swelled from an initial diameter of 3.7 mm to a final diameter of 5.25 mm over a period of 90 minutes.
An osmotic dilator designed to dilate and remodel the ostium of a maxillary sinus over a duration of minutes is fabricated according to the methods and materials described in Example 18, except the membrane is sealed by solvent welding.
An osmotic dilator designed to dilate and remodel the ostium of a maxillary sinus over a duration of minutes is fabricated according to the methods and materials described in Example 18, except the membrane is sealed by sonic welding.
Although the foregoing embodiments have been described in some detail by way of illustration and example for purposes of clarity of understanding, it is readily apparent to those of ordinary skill in the art in light of the teachings of the present disclosure that certain changes and modifications may be made thereto without departing from the spirit or scope of the appended claims. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be embodied only by the appended claims.
Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included in the smaller ranges and are also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.
All publications and patents cited in this specification are herein incorporated by reference as if each individual publication or patent were specifically and individually indicated to be incorporated by reference and are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. The citation of any publication is for its disclosure prior to the filing date and should not be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed.
It is noted that, as used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation.
As will be apparent to those of skill in the art upon reading this disclosure, each of the individual embodiments described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present invention. Any recited method can be carried out in the order of events recited or in any other order which is logically possible.
Accordingly, the preceding merely illustrates the principles of the invention. It will be appreciated that those skilled in the art will be able to devise various arrangements which, although not explicitly described or shown herein, embody the principles of the invention and are included within its spirit and scope. Furthermore, all examples and conditional language recited herein are principally intended to aid the reader in understanding the principles of the invention and the concepts contributed by the inventors to furthering the art, and are to be construed as being without limitation to such specifically recited examples and conditions. Moreover, all statements herein reciting principles, aspects, and embodiments of the invention as well as specific examples thereof, are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents and equivalents developed in the future, i.e., any elements developed that perform the same function, regardless of structure. The scope of the present invention, therefore, is not intended to be limited to the exemplary embodiments shown and described herein. Rather, the scope and spirit of the present invention is embodied by the appended claims.
This application claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Provisional Application Nos. 61/378,360 filed Aug. 30, 2010; 61/378,368 filed Aug. 30, 2010; 61/416,248 filed Nov. 22, 2010; and 61/416,240 filed Nov. 22, 2010, the disclosures of each of which are incorporated by reference herein in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 61378360 | Aug 2010 | US | |
| 61378368 | Aug 2010 | US | |
| 61416240 | Nov 2010 | US | |
| 61416248 | Nov 2010 | US |
