Comparing Efficacy of Steroid Irrigation, Steroid‐Eluting Sinus Stent, and Both Modalities on Endoscopic Outcomes After Endoscopic Sinus Surgery

CLINICAL QUESTION

What is the comparative efficacy of steroid irrigation, steroid-eluting sinus (SES) stents, and their combination in improving endoscopic outcomes following endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis?

BOTTOM LINE

Both steroid irrigation and SES independently improve post-operative endoscopic scores following ESS, with the combination therapy offering additional benefit. However, SES alone may not be superior to irrigation alone, highlighting the importance of personalized post-operative care.

BACKGROUND: Post-operative inflammation and scarring after ESS in patients with chronic rhinosinusitis (CRS) can compromise long-term outcomes. Topical steroids—delivered via irrigations or implantable stents—aim to reduce mucosal inflammation and polyp recurrence, yet their comparative effectiveness, particularly when used in combination, remains unclear.

STUDY DESIGN: Prospective, 1:1 randomized, single-blinded, intrapatient-controlled, single-center study of CRS with nasal polyps (CRSwNP) patients undergoing bilateral frontal sinus surgery after failed medical therapy.

SETTING: Academic tertiary referral center (University of Colorado), with surgeries performed by rhinology fellowship-trained surgeons

SYNOPSIS: This study randomized 62 CRSwNP patients (with or without asthma) using an intrapatient control design: Following bilateral frontal sinusotomies for medically refractory disease, one side was randomly assigned to receive a steroid-releasing implant, while the other served as a control. There was no added benefit of steroid-eluting stents over steroid irrigation alone in maintaining frontal sinus ostium (FSO) patency, preventing scarring or edema, or reducing the need for further treatment when adjusted for age, gender, and time. Male gender was associated with a higher risk of scarring/adhesion, while longer follow-up time increased the risk of FSO obstruction and scarring but reduced the risk of edema. No significant predictors were found for requiring additional medical or surgical treatment. The type of stent used (Propel Mini versus Contour) did not impact outcomes. No adverse events, whether related or unrelated to the SES, were reported in this study. This study indicates that in patients with CRSwNP who consistently and effectively use steroid rinses, SES may offer no additional advantage in minimizing post-operative scarring or edema, maintaining long-term frontal sinus patency, or reducing the need for further medical or surgical intervention.

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;15:513-523. doi:10.1002/alr.23524

COMMENT: This randomized controlled trial evaluates the potential benefit of steroid-eluting stents placed into the frontal sinusotomy after endoscopic sinus surgery in reducing stenosis, over the baseline use of topical steroid irrigations. The American Rhinologic Society has previously released a position statement supporting the clinical applicability of these stents, highlighting that they are not investigational. This study finds that with well-performed surgery and post-operative adherence to topical steroid irrigations, there is no significant difference in endoscopic or clinical outcomes. This calls into question how routinely these implants should be utilized, although ultimately such a decision should be left to individual surgeons’ discretion. Ashoke Khanwalkar, MD