xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

(Continues)

Option: Corticosteroid-eluting implants can be considered as an option in a previously

operated ethmoid cavity with recurrent nasal polyps

If not controlled with INCS, strong recommendation for corticosteroid irrigation; recommendation for

atomization/nebulization

considered for patients with

severe CRSwNP who have not improved despite other

medical and surgical treatment options

Recommended: Post-operative patients

Option: Non-surgical/medical management

Option: Exhalation delivery

Recommendation: May be

Benefit-Harm Assessment Policy Level

Benefits appear to outweigh harm

High Likely benefit over harm in patients

with CRSwNP not responsive to

medical and surgical standard of care

harm compared with oral corticosteroids but caution in

patients on multiple topical therapies

benefit over harm,

with increased cost

compared to nasal sprays

Moderate Benefit outweighs

Preponderance of

Moderate to High

Moderate to High

Intervention Grade Benefit Harm Cost CRSsNP:

No findings of increased risk of elevated

intraocular pressure or cataracts

Some evidence of systemic absorption with first generation corticosteroids

especially with multiple modalities of therapy

hyper-eosinophilia

Epistaxis, nasal irritation; See Table II-1. No evidence of adrenal suppression using

irrigation delivery

Conjunctivitis and

A Reduction in ethmoid obstruction, polyp grade, decreased

need for revision

ESS, reduced nasal

obstruction scores

tions/Atomization/

Nebulization have

shown benefit over INCS. Exhalation

devices have shown

benefit over placebo

A Decreased polyp size, improved nasal

congestion, sinus imaging scores,

sense of smell, and asthma control

HR-QoL, subjective

symptom scores and endoscopic appearance in

postoperative patients.

B Corticosteroid Irriga

A Improvement in

TABLE I-4 (Continued)

Corticosteroid

Eluting Implants

Corticosteroid Irrigations

Non-Standard

Corticosteroid Delivery

Dupilumab

(Biologic)

CRSwNP:

CRSwNP:

CRSwNP: