A prospective, randomised study from Finland to compare a drug eluting stent (DES) and intranasal corticosteroids (INCS) in 63 patients as assessed by SNOT-22, VAS, endoscopy, CT and rhinometry pre-treatment, at three and six months post treatment. Recruitment was over 42 months with inclusion criteria being: CRS diagnosis as outlined by EPOS; adequate medical therapy for three months without satisfactory result; age 18-65; CT evidence of ethmoid disease with Lund-Mackay score of at least 2; and that the patient reaches the threshold for sinus surgery. Exclusion criteria were: previous sinonasal surgery; high ASA; systemic disease; glaucoma; pregnancy; a Lund-Mackay score of more than 1 for the maxillary, frontal or sphenoid sinus; distance from face of ethmoid bulla to face of sphenoid less than 20mm; and nasal polyps beyond the middle meatus. Fifty-seven patients were analysed, 28 in the drug eluting stent group and 29 in the intranasal steroid group, appropriately randomised. The stent is placed into ethmoid under image guidance under general anaesthesia and is loaded with triamcinolone 40mg/ml, if both sides are implanted 24mg of triamcinolone will leak through over a four-week period. The stent was removed in out-patients at four weeks. For the spray group, triamcinolone 55ug/dose, two sprays a day (Nasacort) was used for six months. No other steroids were allowed however saline irrigation was allowed as the patient saw fit. Statistical analysis demonstrated significant difference between the demographics of the groups and analysis of the results showed no significant difference between the groups as assessed by SNOT-22, VAS, endoscopy, LM score, total nasal volume or measurements of airway resistance. Of course, all of these assessments showed a statistically significant benefit during each treatment arm individually. Interestingly the patients who previously were taking INCS and were randomised to the group that continued taking the INCS, showed significant improvement after being instructed how to do this properly and maintaining their compliance over the six-month study period. The study does not recommend DES over INCS spray due to the significant cost difference between using a spray and having a stent surgically inserted under general anaesthesia.

A prospective, randomized clinical study comparing drug eluting stent therapy and intranasal corticoid steroid therapy in the treatment of patients with chronic rhinosinusitis.
Taulu R, Bizaki A, Numminen J, Rautiainen M.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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