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irrigations (total dose of 2 mg per day), there were no de- tectable cases of HPA suppression in this patient cohort. Future prospective studies with larger sample sizes are

needed to confirm the findings from this study to ensure high-volume budesonide irrigations are a safe, long-term therapeutic option for CRS.

References 1. Chen Y, Dales R, Lin M. The epidemiology of chronic rhinosinusitis in Canadians. Laryngoscope . 2003;113:1199–1205. 2. Hastan D, Fokkens WJ, Bachert C, et al. Chronic rhi- nosinusitis in Europe—an underestimated disease. A GA(2)LEN study. Allergy . 2011;66:1216–1223. 3. Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: a systematic review. JAMA . 2015;314:926–939. 4. Rudmik L, Hoy M, Schlosser RJ, et al. Topical ther- apies in the management of chronic rhinosinusitis: an evidence-based review with recommendations. Int Fo- rum Allergy Rhinol . 2013;3:281–298. 5. Rudmik L. High volume sinonasal budesonide ir- rigations for chronic rhinosinusitis: an update on the safety and effectiveness. Adv Pharmacoepidemiol Drug Saf . 2014;3:148. 6. Harvey RJ, Goddard JC, Wise SK, Schlosser RJ. Ef- fects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg . 2008;139:137–142. 7. Snidvongs K, Kalish L, Sacks R, Sivasubramaniam R, Cope D, Harvey RJ. Sinus surgery and de- livery method influence the effectiveness of topi- cal corticosteroids for chronic rhinosinusitis: system- atic review and meta-analysis. Am J Rhinol Allergy . 2013;27:221–233. 8. Harvey RJ, Debnath N, Srubiski A, Bleier B, Schlosser RJ. Fluid residuals and drug exposure in nasal irri- gation. Otolaryngol Head Neck Surg . 2009;141:757– 761. 9. Miller TR, Muntz HR, Gilbert ME, Orlandi RR. Com- parison of topical medication delivery systems after sinus surgery. Laryngoscope . 2004;114:201–204. 10. Bleier BS, Debnath I, Harvey RJ, Schlosser RJ. Temporospatial quantification of fluorescein-labeled sinonasal irrigation delivery. Int Forum Allergy Rhi- nol . 2011;1:361–365. 11. Thomas WW 3rd, Harvey RJ, Rudmik L, Hwang PH, Schlosser RJ. Distribution of topical agents to the paranasal sinuses: an evidence-based review with recommendations. Int Forum Allergy Rhinol . 2013;3:691–703.

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