Rhinologists from the Texas Sinus Institute of the Department of Otorhinolaryngology—Head and Neck Surgery at The University of Texas Medical School at Houston reported their results on a novel topical therapy for the treatment of refractory chronic rhinosinusitis (CRS) in patients who have undergone endoscopic sinus surgery (ESS). The report was presented at the spring meeting of American Rhinologic Society in Las Vegas on April 29, 2010.
Symptomatic post-ESS patients received a gel formulation of high-dose mometasone furoate (MF) that was applied in the office under endoscopic visualization to sinus mucosa showing signs of inflammation. Prior to gel application and at each follow-up visit (2 and 3 weeks) sinus mucosa was graded as normal, edematous, polypoid or with frank polyps, and the presence or absence of eosinophilic mucin was noted.
Sixteen patients were evaluated and treated. The results were encouraging and showed a significant reduction of mucosal inflammation. At the initial visit, 94% had polypoid mucosa or polyps, and 6% had normal or edematous mucosa. At follow-up visits 1 and 2, 50% had polypoid mucosa or polyps, and 50% had normal or edematous mucosa.
“The ideal medication to control inflammation following surgery for CRS would be one we can deliver topically with minimal systemic effect and side effects,” says Amber Luong, MD, PhD, an assistant professor of otorhinolaryngology—head and neck surgery at the UT Medical School. “Currently, only nebulizers, sprays and lavages are available for topical use, none of which adhere to the sinonasal mucosa long enough to have sustained effect. Mometasone furoate gel appears to adhere to the mucosa longer, allowing for greater uptake and efficacy.”
“A second important finding involves patients taking prednisone following surgery,” says Samer Fakhri, MD, an associate professor at the UT Medical School. “When we applied the gel intranasally in these patients, 50 percent were able to get off systemic steroids while maintaining good control of their symptoms and mucosal stage. Initially, 50 percent of patients were on systemic steroid therapy but by follow-up visit 3 the number had decreased to 25 percent. There were no complications and this in-office therapy was easily tolerated by patients.”
The rhinologists concluded that in-office endoscopic intranasal application of MF gel is a useful adjunct to treat mucosal inflammation in postoperative patients with CRS, and that it may help reduce the need for systemic steroid therapy.