The device has not yet been studied in pediatric patients, but according to Dr. Han, the drug-eluting stent would be safe for use in the pediatric population. “Mometasone has a typical bioabsorbtion rate that is very low, less than one percent,” he said.
Explore This IssueDecember 2011
According to Dr. Citardi, additional research is needed to determine which patients are most likely to benefit from implantation of drug-eluting stents after FESS. “The incremental benefit of the device in the study patient population, which was most likely a primary level of sinus surgery population, is probably different than in patients who have had multiple procedures,” he said. “You also have to weigh the benefit against the actual cost of the device.”
Some otolaryngologists are looking forward to applying the technology to clinical practice. “I think the most common question after our presentation at the [AAO-HNS Annual Meeting] was, ‘Where do we get it?’” Dr. Han said. “The next most common question was, ‘Can you put this in at the office?’”
To date, in-office use has not been studied. Dr. Han said in-office deployment of the drug-eluting stent is theoretically possible.
Dr. Freeman said that there are still many questions that need to be answered before he recommends stents to patients: “Do patients still have to be periodically on antibiotics? Do they have to periodically use nasal or oral steroids? Do they still have recurring infections or need to have additional endoscopic surgery down the road?”
Dr. Citardi said additional research may help to refine the steroid dose as well. “One of the concerns is that the total dose of mometasone in the device is actually pretty low.
I suspect that many patients with more severe forms of inflammation of the sinuses will need a higher steroid dose,” he said. “We also need to be careful of the impact of the dissolving material on the sinus mucosa. That’s something that may be hard to fully describe in a small study.”
Despite the need for additional research, Dr. Marple sees potential for drug-eluting stents. “I think this is just scratching the surface of an exciting new era in manipulations and treatment of the paranasal sinuses,” he said. “This mixes the mechanical aspects of therapeutic intervention of the paranasal sinuses, which surgery has provided in the past, with medications that allow suppression of the inflammatory component. It’s this overlap in device and medication that really positions us to better treat many patients with chronic sinus disease.”