title: Treatment of recurrent sinonasal polyposis with steroid-infused carboxymethylcellulose foam.
abstract: BACKGROUND
  Recurrence of sinonasal polyposis after endoscopic sinus surgery can be difficult to manage. Topical steroid sprays and irrigations may not provide adequate treatment and systemic steroid therapy is limited by side effects. This study was designed to evaluate the efficacy of steroid-infused carboxymethylcellulose (CMC) foam as a treatment for recurrence of chronic rhinosinusitis with nasal polyposis after endoscopic sinus surgery.
  
  
  METHODS
  A prospective cohort study was performed enrolling patients with recurrent sinonasal polyposis after endoscopic sinus surgery. All patients had development of symptomatic polyp disease despite aggressive postoperative topical steroid treatment. The study treatment entailed endoscopic placement of 4 mL of CMC foam hydrated with triamcinolone, 40 mg/mL (Kenalog 40; Bristol-Myers Squibb, New York, NY), into the ethmoid cavities bilaterally. Patients were evaluated using videoendoscopy and the Sino-Nasal Outcomes Test 20 (SNOT-20) at three time points: immediately before treatment, 7-14 days after treatment, and 28-35 days after treatment. The videoendoscopies were randomized and scored in a blinded fashion using a modification of the perioperative sinus endoscopy (POSE) scoring system.
  
  
  RESULTS
  Ten treatments were performed in eight patients; two patients underwent two treatments each. Mean SNOT-20 score improved at both 1 week and 1 month after treatment (2.44 versus 1.65, p < 0.05, and 2.44 versus 1.36, p < 0.01, respectively). Videoendoscopy also revealed improvement when evaluated with the modified POSE score at 1 week (11.8 versus 8.2, p < 0.001), and 1 month (11.8 versus 7.9, p < 0.001).
  
  
  CONCLUSIONS
  Endoscopic placement of steroid-infused CMC foam improves symptoms and endoscopic findings in patients with recurrent sinonasal polyposis after endoscopic sinus surgery.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of California-San Francisco, 2233 Post Street, San Francisco, CA 94115, USA. spletcher@ohns.ucsf.edu
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pletcher
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage*; D002908:Chronic Disease; D015331:Cohort Studies; D004724:Endoscopy; D006801:Humans; D008875:Middle Aged; D009298:Nasal Polyps / Q000188:drug therapy*; D011446:Prospective Studies; D012008:Recurrence; D012852:Sinusitis / Q000188:drug therapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D014222:Triamcinolone Acetonide; D002266:Carboxymethylcellulose Sodium