Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Preoperative and postoperative medical therapies for chronic rhinosinusitis:National surveys among Chinese otolaryngologists

Objective:The aim of this study was to evaluate clinical practice patterns of preoperative and postoperative medical therapies immediately surrounding sinus surgery for chronic rhinosinusitis(CRS)by Chinese otolaryngologists.Methods:Two anonymous web-based surveys of preoperative and postoperative medical therapies were performed.These surveys assessed the frequency of prescription of oral corticosteroids,intranasal corticosteroid sprays,oral antibiotics,nasal saline irrigation,oral antihistamines,nasal antihistamines,anti-leukotriene agents,topical decongestants and oral mucolytics.Results:A total of 304(17.5%)preoperative and 143(23.5%)postoperative questionnaires were completed and returned.Seventy-eight percent,63%and 56%of respondents used preoperative intranasal corticosteroid sprays,oral antibiotics and oral mucolytics“always or often”,respectively.Ninety-four percent,93%,72%and 69%of respondents used postoperative intranasal corticosteroid sprays,nasal saline irrigation,oral antibiotics and oral mucolytics“always or often”,respectively.Oral antihistamines,nasal antihistamines,anti-leukotrienes and topical decongestants were not commonly used preoperatively or postoperatively.Conclusions:Our study demonstrated that current practice patterns of preoperative medical therapies among otolaryngologists are not uniformly based on evidence-based outcomes research.Postoperative oral antibiotics,intranasal corticosteroid sprays,nasal saline irrigation and oral mucolytics are commonly used by a majority of Chinese otolaryngologist for CRS.Practice patterns of postoperative medical therapy reflect recent guidelines.