Direct Delivery of High-Concentration Therapeutics for Refractory Chronic Rhinosinusitis.

Purpose: This study evaluates a novel route of administration for the treatment of refractory chronic rhinosinusitis (CRS).

Materials And Methods:  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.

Results: 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).

Conclusion: Intra-ethmoid lavage of antibiotic/steroid solution appears to be an effective, easily performed, and safe procedure for CRS patients refractory to MMT.