Topical therapies for management of chronic rhinosinusitis: steroid implants

Abstract

Background: Chronic rhinosinusitis (CRS) causes severe symptoms that lead to poor quality of life. When optimal medical therapy does not improve CRS symptoms, then endoscopic sinus surgery (ESS) can be used in patients with persistent symptoms and radiographic evidence of CRS to improve patients' symptoms and quality of life. Despite appropriate and complete sinus surgery, there can be issues a er sinus surgery such as synechiae formation and recurrence of polyps in certain CRS patients that can decrease long-term outcomes. Corticosteroids are used to decrease postoperative scarring and edema as well as prevent recurrence of nasal polyp formation a er sinus surgery. However, the use of oral or systemic steroid can lead to serious shortterm and long-term complications. Therefore, a safer alternative would be the topical delivery of steroid via steroideluting sinus implants. Methods:A literature review was performed to identify clinical studies evaluating steroid-eluting implants. Two forms of steroid-eluting implants were identified, Propel family products and Sinuva. The research findings from clinical studies using various steroid-eluting sinus implants are reviewed and discussed. Results:Four prospective randomized clinical studies were identified for the Propel family products. Two prospective randomized clinical studies were identified for Sinuva. The results from the clinical studies showed that the use of the various steroid-eluting sinus implants can improve postoperative results a er ESS as well as treat the recurrence of nasal polyps a er sinus surgery without the need for additional sinus surgery. Conclusion:The novel steroid-eluting implants appear to be beneficial for CRS patients immediately postoperatively as well as for nasal polyps patients. Interestingly, these implants could be used as a substitute for the beneficial effect of systemic steroid use for CRS patients. C 2019 ARS-AAOA, LLC.

Adult chronic rhinosinusitis

“…This device has not undergone direct comparison with standard sprays in clinical trials 190 but is FDA approved and available for use in the USA. Steroid-eluting stents have been developed for use before and after sinus surgery, with the aim of delivering higher local concentrations of steroids than other delivery methods 191 .…”

Current Perspective on Nasal Delivery Systems for Chronic Rhinosinusitis

“…The entry of local steroids to the nasal cavity and sinuses may be obstructed by different factors, and hence, novel modes of drug delivery into sinonasal cavities need to be studied. Steroid-eluting sinus implants ( Figure 1G) have been introduced as a new method to optimize surgical outcomes and to treat recurrent nasal polyposis after ESS by delivering locally sustained-release corticosteroids directly to inflammatory sinus tissues [122]. This can create an effective sinus drug delivery system, local use of corticosteroids to solve the problem of inflammation [123].…”

Guidance for contemporary use of biologics in management of chronic rhinosinusitis with nasal polyps: discussion from a National Institutes of Health–sponsored workshop

“…Appropriate treatment may include leukotriene modifiers, 37 allergy immunotherapy for documented sensitivities, 38 saline irrigations, topical steroids in various forms, 39 or aspirin desensitization in interested patients. If patients were not compliant with medical therapy following their initial surgery, oral steroids followed by topical steroids, which are available via various delivery mechanisms, 39,40 should be considered prior to a revision surgery. Additional surgical goals such as improved access to sinus cavities involving partial middle turbinectomy or an endoscopic modified Lothrop procedure are options for recurrent polyp patients and should be considered.…”