XHANCE Allows a Chronic Rhinosinusitis Patient to Avoid Surgery
Ken Kaltwasser was well on his way to surgery for chronic rhinosinusitis when Martin J. Citardi, MD, professor and chair of the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston, suggested a new medical treatment – an exhalation delivery system called XHANCE®, which delivers the nasal steroid fluticasone propionate to sinonasal areas above the inferior turbinate, a location not reached by standard-delivery nasal sprays.
After Kaltwasser tried “this and that” with his primary physician and later, with a pulmonologist and an allergist, his brother-in-law, a former patient, suggested that he see Dr. Citardi. “I’m 68, but I’m in good shape,” he says. “I run regularly, play a lot of golf, and work out with weights. When I started getting bad sinus infections, I also had asthma and wheezing. All the doctors I saw wanted to treat me when I had an actual infection, but I wanted to find the root cause. These infections came out of the blue and were continuous. I was afraid that something really bad had triggered them.”
When Dr. Citardi examined his patient’s nose and sinuses using in-office endoscopy, he found significant polyps in both nostrils. “He mentioned the possibility of surgery, but said that he wanted to try XHANCE first,” Kaltwasser says. “I was happy to avoid surgery.”
Kaltwasser started using XHANCE about a year and a half ago. “All of a sudden I stopped getting sinus infections,” he says. “A couple of visits later, Dr. Citardi told me my polyps looked like small dried-up, flattened grapes. At my most recent visit, he suggested that we continue using it for a while and observe the results.”
“Mr. Kaltwasser was approaching the need for traditional endoscopic sinus surgery,” Dr. Citardi says. “Although the procedure is minimally invasive, it is still a surgery. Exhalation delivery of fluticasone delivers the drug closer to the target and can offer dramatic results. Recent clinical data supports this observation.”
XHANCE is the first nonsurgical treatment demonstrated to reduce symptoms and chronic rhinosinusitis exacerbations in randomized clinical trials in patients who have chronic rhinosinusitis both with and without nasal polyps. “Mr. Kaltwasser responded well and no longer needs surgery. We hope that surgical intervention is postponed indefinitely,” Dr. Citardi says.