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Bioabsorbable steroid-releasing sinus implants in the frontal and maxillary sinuses: 2-year follow-up.

Matheny KE - Allergy Rhinol (Providence) (2015)

Bottom Line: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively.To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations.Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

View Article: PubMed Central - PubMed

Affiliation: Collin County Ear Nose and Throat, Dallas, Texas, USA.

ABSTRACT

Background: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS.

Objective: To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS.

Methods: 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years.

Results: Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

Conclusions: The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15-20 years.

No MeSH data available.


Related in: MedlinePlus

Postoperative coronal computed tomography (CT) of left frontal recess 2 years after revision ESS.
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Figure 4: Postoperative coronal computed tomography (CT) of left frontal recess 2 years after revision ESS.

Mentions: Ninety days after surgery, as the patient moved from the convalescent period to a prophylaxis and maintenance period, he was initially prescribed daily nasal nebulized therapy, which consisted of tobramycin and fluticasone. Both implants were absent at the 30-day endoscopy, so there was no overlap in topical steroid. This inhalational therapy was changed to mupirocin, fluticasone, and itraconazole 9 months later (1-year postoperatively), when daily mucus production subjectively increased. Symptom control has continued to be excellent overall since initiation of nasal nebulized therapy, with only mild occasional epistaxis from a posterior pinpoint septal perforation present since the patient's initial septoplasty 15–20 years ago. In October 2014, limited CT of the sinuses (Figs. 4 and 5) and nasal endoscopy of the left frontal recess (Fig. 6) and the right maxillary antrostomy (Fig. 7) were performed to objectively confirm the long-term positive postoperative outcome from ESS with deployment of the mometasone-eluting implants compared with the previous postoperative courses and periods of long-term medical management.


Bioabsorbable steroid-releasing sinus implants in the frontal and maxillary sinuses: 2-year follow-up.

Matheny KE - Allergy Rhinol (Providence) (2015)

Postoperative coronal computed tomography (CT) of left frontal recess 2 years after revision ESS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541632&req=5

Figure 4: Postoperative coronal computed tomography (CT) of left frontal recess 2 years after revision ESS.
Mentions: Ninety days after surgery, as the patient moved from the convalescent period to a prophylaxis and maintenance period, he was initially prescribed daily nasal nebulized therapy, which consisted of tobramycin and fluticasone. Both implants were absent at the 30-day endoscopy, so there was no overlap in topical steroid. This inhalational therapy was changed to mupirocin, fluticasone, and itraconazole 9 months later (1-year postoperatively), when daily mucus production subjectively increased. Symptom control has continued to be excellent overall since initiation of nasal nebulized therapy, with only mild occasional epistaxis from a posterior pinpoint septal perforation present since the patient's initial septoplasty 15–20 years ago. In October 2014, limited CT of the sinuses (Figs. 4 and 5) and nasal endoscopy of the left frontal recess (Fig. 6) and the right maxillary antrostomy (Fig. 7) were performed to objectively confirm the long-term positive postoperative outcome from ESS with deployment of the mometasone-eluting implants compared with the previous postoperative courses and periods of long-term medical management.

Bottom Line: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively.To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations.Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

View Article: PubMed Central - PubMed

Affiliation: Collin County Ear Nose and Throat, Dallas, Texas, USA.

ABSTRACT

Background: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS.

Objective: To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS.

Methods: 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years.

Results: Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

Conclusions: The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15-20 years.

No MeSH data available.


Related in: MedlinePlus