Current concepts in topical therapy for chronic sinonasal disease

Area of Science:

• Otolaryngology
• Rhinology
• Inflammation Science

Background:

• Significant advancements in understanding chronic sinonasal inflammation mechanisms.
• Introduction of novel topical agents for sinonasal cavities in chronic rhinosinusitis (CRS) management.

Purpose of the Study:

• To provide an evidence-based review of the science behind topical management of sinonasal disease.
• To evaluate current and future strategies for topical therapy in CRS.

Main Methods:

• Literature review focusing on delivery devices, patient positioning, surgical status, and pharmaceutical/mechanical aspects of topical sinonasal therapy.
• Analysis of concepts related to topical treatment delivery to the paranasal sinuses.

Main Results:

• High-volume, positive-pressure irrigation in head-down positions enhances topical solution delivery and mechanical action.
• Unoperated sinuses show limited benefit from topical therapy; enhanced steroid therapy and surfactants are promising pharmaceutical approaches.
• Future therapies may involve innate immune system enhancers; antibiotic effects are complex, potentially addressing disease modification rather than pathology.

Conclusions:

• Topical therapies, particularly when applied post-surgery, are poised to become the primary treatment for chronic inflammatory rhinosinusitis.
• Optimized delivery methods and targeted pharmaceutical agents are crucial for effective sinonasal disease management.