Raewyn G Campbell1, David W Kennedy. 1. aDepartment of Otorhinolaryngology-Head and Neck Surgery bDepartment of Rhinology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
PURPOSE OF REVIEW: In the surgical management of chronic rhinosinusitis, medical therapy is often used to prevent postoperative complications such as adhesions. These complications often require painful debridements in the clinic or revision surgery. Systemic steroids are not without risk and topical steroids are not ideal, as the duration of mucosal contact and exact dosage are unknown and penetration into gravity-dependent sinuses is suboptimal. Therefore, we reviewed the literature assessing the use of drug-eluting stents in the management of chronic rhinosinusitis. RECENT FINDINGS: Three randomized controlled trials and a meta-analysis support the efficacy and safety of the use of steroid-eluting implants in chronic rhinosinusitis. Implants placed in the ethmoid sinuses at the time of surgery have been found to significantly reduce postoperative adhesions, recurrence of polyposis, middle turbinate lateralization, the need for postoperative oral steroids and the need for postoperative interventions. Studies also support the ocular safety of steroid-eluting implants. SUMMARY: Steroid-eluting implants are well tolerated and an effective addition to the armamentarium utilized in the management of chronic rhinosinusitis. Future developments for the use of drug-eluting implants in chronic rhinosinusitis are discussed.
PURPOSE OF REVIEW: In the surgical management of chronic rhinosinusitis, medical therapy is often used to prevent postoperative complications such as adhesions. These complications often require painful debridements in the clinic or revision surgery. Systemic steroids are not without risk and topical steroids are not ideal, as the duration of mucosal contact and exact dosage are unknown and penetration into gravity-dependent sinuses is suboptimal. Therefore, we reviewed the literature assessing the use of drug-eluting stents in the management of chronic rhinosinusitis. RECENT FINDINGS: Three randomized controlled trials and a meta-analysis support the efficacy and safety of the use of steroid-eluting implants in chronic rhinosinusitis. Implants placed in the ethmoid sinuses at the time of surgery have been found to significantly reduce postoperative adhesions, recurrence of polyposis, middle turbinate lateralization, the need for postoperative oral steroids and the need for postoperative interventions. Studies also support the ocular safety of steroid-eluting implants. SUMMARY:Steroid-eluting implants are well tolerated and an effective addition to the armamentarium utilized in the management of chronic rhinosinusitis. Future developments for the use of drug-eluting implants in chronic rhinosinusitis are discussed.
Authors: Khodayar Goshtasbi; Mehdi Abouzari; Arash Abiri; Tyler Yasaka; Ronald Sahyouni; Benjamin Bitner; Bobby A Tajudeen; Edward C Kuan Journal: Int Forum Allergy Rhinol Date: 2019-09-20 Impact factor: 3.858