Corticosteroid-eluting implants for the management of chronic rhinosinusitis with or without nasal polyps

ABSTRACT

Introduction

Topical corticosteroid therapies are the most popular prescribed medications for patients with chronic rhinosinusitis (CRS). While topical corticosteroids effectively reduce the inflammatory burden associated with CRS, their distribution inside the nasal cavity is limited and primarily dependent on their delivery device. Corticosteroid-eluting implants serve as relatively novel technology, allowing targeted, sustained release of a high concentration of corticosteroids directly onto the sinus mucosa. Three types of corticosteroid-eluting implants can be characterized: 1. intraoperatively inserted corticosteroid-eluting sinus implants, 2. postoperatively inserted, office-based corticosteroid-eluting sinus implants, and 3. office-based corticosteroid-eluting implants for naïve paranasal sinuses.

Areas covered

The review summarizes the different steroid-eluting sinus implants, their indications for use in CRS patients, and the existing evidence regarding their clinical efficacy. We also highlight potential areas for improvement and development.

Expert opinion

Corticosteroid-eluting sinus implants highlight an evolving field that is constantly investigating and adding new treatment options to the market. Presently, corticosteroid-eluting implants for CRS are most commonly applied intraoperatively and postoperatively with endoscopic sinus surgery, providing significant improvements in mucosal healing and reducing the amount of surgical failures. Future development around corticosteroid-eluting implants should focus on strategies to reduce the amount of crusting around the implants.

KEYWORDS:

• chronic rhinosinusitis
• nasal polyps
• topical corticosteroids
• drug-eluting implants
• bioresorbable implants

Article highlights

• Intranasal corticosteroids are the mainstay treatment of chronic sinusitis with and without nasal polyps

• The distribution of the topical steroids inside the nasal cavities and paranasal sinuses is limited and highly dependent on the delivery device

• Corticosteroid-eluting sinus implants serve as relatively novel technology, allowing targeted, sustained release of a high concentration of corticosteroids directly onto the sinus mucosa

• Corticosteroid-eluting sinus implants can be classified into :1. intraoperatively inserted corticosteroid-eluting sinus implant, 2. postoperatively inserted, office-based corticosteroid-eluting sinus implants, and 3. office-based corticosteroid-eluting implants for naïve paranasal sinuses

• The efficacy and safety of the devices are supported by well-designed clinical trials. Nonetheless, more international, high-volume studies are required to assess the prevalence of side effects, stent failures, and the implants’ place in the CRS treatment algorithm.

Declaration of interest

J Han is a research consultant for Medtronic. K Lam is a research consultant for LYRA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.