Steroid-Eluting Stents May Not Add Post-Operative Benefit Over Irrigation in Patients with Chronic Sinusitis with Nasal Polyps

CLINICAL QUESTION

Do steroid-eluting stents offer added benefit over steroid rinses alone in post-operative healing and long-term front sinus patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)?

BOTTOM LINE

For CRSwNP, with or without asthma, without other underlying systemic disease factors, steroid-eluting stents may not add benefit over steroid rinses.

BACKGROUND: While frontal chronic rhinosinusitis can be treated with endoscopic sinus surgery (ESS), the frontal sinus tends to stenose post-operatively without proper anti-inflammatory treatment. Steroid rinses and steroid-eluting stents are both options for preventing post-operative stenosis, and there is currently no standardization in intra- and post-operative care regimens.

STUDY DESIGN: Prospective study

SETTING: Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif.

SYNOPSIS: In this 1:1 randomized, single-blinded, intrapatient controlled, single-center study that ran from January 2017 to December 2023, adult patients diagnosed with CRSwNP underwent successful frontal sinus surgery resulting in >5 mm opening on both sides. No pre-operative steroids or antibiotics were administered within one month of surgery, nor post-operative oral steroids, antibiotics, or biologics. Patients were encouraged to use steroid irrigation bilaterally starting on day one post-operatively. The group of 62 patients (42.4% women, mean age 55.7 years) was randomized to receive one steroid-eluting stent in either the right or left frontal sinus ostium; thus, each patient served as their own control. Scarring/adhesion, edema, patency, and the need for additional treatments were assessed at one, three, 12, and 24 weeks post-operatively. A scoring system was used to grade each frontal sinus opening at each visit based on the endoscopic evaluation. Findings showed a similarity in all scoring areas in both groups at all time points. Authors note that there is general agreement that the use of steroid-eluting stents in ESS could be considered for certain patients, such as those with recurrent stenosis, diabetes, or oral steroid intolerance. Study limitations included a small sample size.

CITATION: Fieux M, et al. Comparing efficacy of steroid irrigation + steroid-eluting sinus stent versus steroid irrigation alone for maintaining frontal sinus patency after sinus surgery: a randomized controlled trial. Int Forum Allergy Rhinol. 2025. doi:10.1002/alr.23524.