STUDY OBJECTIVES: The primary objective of this study was to determine whether vortical pulsating airflow can achieve therapeutic pharyngeal pressure levels without requiring a tight-sealing mask. METHODS: A pilot study included 12 nasal-breathing adults who are currently using positive airway pressure (PAP) for therapy. Patients were awake, and pharyngeal pressures were measured using a miniature pressure probe inserted through their nares. Vortical pulsating airflow was applied via a nasal cannula with a customized valve. The inspiratory flow rate was increased until the pharyngeal pressure matched or exceeded the participant's prescribed PAP level. The expiratory flow rate was maintained at a constant low level of continuous airflow. RESULTS: The study demonstrated that vortical pulsating airflow could generate pharyngeal pressures equivalent to or higher than those achieved with PAP therapy in all participants. The peak inspiratory pressures with vortical pulsating airflow followed an oscillatory pattern matching the pulsation frequency. The mean peak pressure increased linearly with the pulsating flow rate. Compared to a high-flow nasal cannula, vortical pulsating airflow produced significantly higher inspiratory pharyngeal pressures, reaching nearly 20 cmH CONCLUSIONS: Vortical pulsating airflow could be a viable method for delivering PAP therapy to patients with respiratory or sleep disorders without needing a tight-sealing mask. Further research is required to establish whether this method can improve patients' adherence to PAP therapy, assess long-term safety and efficacy, and explore the impact of varying pulsation parameters on treatment outcomes. CITATION: Oren L, Gutmark E, Romaker A. A novel method for positive airway pressure delivery: vortical pulsating airflow.