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What almost all current guidelines on chronic rhinosinusitis have in common is the importance of intranasal steroid (INCS) use. However, it is increasingly understood that the efficacy of INCS depends on their efficient delivery to the point of need, i.e. the area of inflamed mucosa. Extended surgery, as well as novel methods of delivery (such as nasal douching) are vital in this regard. The authors of this study are proposing another method of local delivery, using a patented novel delivery device, an exhalation delivery system, which has been shown to deliver medication higher and deeper in the nasal cavity. From a total of 21 centres in the US, 223 patients who fulfilled the clinical and endoscopic criteria for CRS with or without nasal polyps, were recruited and were followed up with clinical examinations, including endoscopy over the course of 12 months. SNOT 22 decreased significantly by about 21 points for both the CRSwNP and the CRSsNP patients and remained low, while on endoscopy, patients also showed significant objective improvement. This was a non-randomised study and it demonstrates safety and basic efficacy. We are missing effective medical treatments for CRS, so, the potential for a novel delivery system is certainly something to look forward to. Watch this space!

EXHANCE-12: 1-year study of the exhalation delivery system with fluticasone (EDS-FLU) in chronic rhinosinusitis.
Palmer JN, Jacobson KW, Messina JC, et al.
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Christos Georgalas

Academic Medical Center, The Netherlands.

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