Emerging treatments

Topical antibiotics

Topical application delivers the antibiotic directly to the area (by dissolving it in solution or administering via nebulizer). This is not Food and Drug Administration-approved, and early results do not show a clear benefit over oral antibiotics. The majority of studies have shown that antifungals are not beneficial.[49] However, good-quality evidence shows topical antibiotics have a clear role in postsurgical patients with culture-directed therapy. Topical antibiotics should not be first-line management, but may be attempted in patients refractory to the traditional topical corticosteroids and oral antibiotics.[50]

Balloon catheter technology for sinus dilatation

In addition to existing technological advances, such as image guidance systems, new tools are being developed. One such tool is the use of balloon catheters to dilate sinus ostia.[51][52] The flexible balloon catheters are used to dilate the ostia (openings) without the need for extensive tissue removal or trauma. Fluoroscopy or transillumination is used to confirm location of the catheter. Further studies are warranted and in progress to determine whether this tool improves surgical outcomes.[53]

Drug eluting implants

Bioabsorbable stents eluting the corticosteroid mometasone have shown promise as an adjunct treatment in the setting of endoscopic sinus surgery. These implants may be placed into surgically opened sinus cavities and may reduce inflammation and scarring and promote wound healing.[54][55][56]​ These adjuncts may also reduce the need for additional postoperative oral corticosteroids and their potential complications.[57] More recently, corticosteroid eluting implants have been developed for placement in the office, providing up to 24 weeks of symptomatic benefit.[58] Given these findings, the American Academy of Otolaryngology-Head and Neck Surgery considers corticosteroid eluting implants as a proven and therapeutic option for mucosal inflammation.[59]​​​​

Exhalational delivery system with fluticasone

While topical corticosteroids are a mainstay in the medical management of chronic rhinosinusitis, with and without nasal polyposis, there are some concerns regarding the ability of traditional nasal sprays to adequately deliver medications to the sinus cavities. A recently developed exhalational delivery system for intranasal application of high-dose fluticasone is showing promising early evidence of benefit in patients, with and without nasal polyposis, who have not responded to traditional topical corticosteroids.[60][61][62]

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