Direct Delivery of High-Concentration Therapeutics for Refractory Chronic Rhinosinusitis

This study evaluates a novel route of administration for the treatment of refractory chronic rhinosinusitis (CRS). This prospective case series, conducted at a single institution, included 11 patients with refractory chronic rhinosinusitis (CRS) who had not responded to maximal medical therapy (MMT). Each patient received an antibiotic/steroid solution administered via sinus puncture and lavage (SP&L) into the anterior ethmoid air cells under topical anesthesia. SP&L procedures were performed on days one, three, and five of the study. Sino-Nasal Outcome Test-22 (SNOT-22) scores were recorded in the clinic before the first SP&L (day one), after the final lavage (day five), and at the final follow-up visit on day 30. Baseline SNOT-22 scores from day one were compared to those obtained on days five and 30 to assess symptom changes over time. Ten patients completed the study, with nine patients receiving durable relief. The median baseline SNOT-22 score was 31, the median day five SNOT-22 score was 6.5, and the median day 30 SNOT-22 score was 9. Mean±SD was 30.4±3.1, 8.9±5.9, and 11.1±9.5, respectively. Compared to baseline, the SNOT-22 scores at both day five and day 30 were highly significantly decreased (p < 0.0001). Intra-ethmoid lavage of antibiotic/steroid solution appears to be an effective, easily performed, and safe procedure for CRS patients refractory to MMT.