title: Safety, feasibility, and efficacy of placement of steroid-eluting bioabsorbable sinus implants in the office setting: a prospective case series.
abstract: BACKGROUND
  The outcomes of endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) can be compromised by postoperative inflammation, recurrent polyposis, middle turbinate lateralization, and synechiae, often requiring subsequent interventions. A bioabsorbable steroid-eluting sinus implant placed in the operating room following ESS has been proven safe and effective in 2 randomized controlled trials and a subsequent meta-analysis, for its ability to preserve sinus patency, and reduce medical and surgical interventions. This trial sought to evaluate the safety, feasibility, and outcomes of implants placed in the office after achieving hemostasis.
  
  
  METHODS
  Twenty patients with CRS underwent ESS including bilateral ethmoidectomy. A steroid-eluting bioabsorbable implant was deployed into each ethmoid cavity in the office within 7 days after ESS. Endoscopic appearance of the ethmoid cavities was evaluated at 1 week, 2 weeks, and 4 weeks postoperatively by the operating surgeon and an independent blinded evaluator. Procedural tolerance was assessed at week 2 using a patient preference questionnaire. The 20-item Sino-Nasal Outcome Test (SNOT-20) questionnaire was completed at baseline, week 2, and week 4.
  
  
  RESULTS
  In-office placement of steroid-eluting bioabsorbable implants was well tolerated, with 90% of patients very satisfied with the overall experience, and 80% very satisfied with the recovery process. At 1 month, there were no significant adhesions or frank polyposis, and middle turbinate lateralization was only 5%. Compared to baseline, ethmoid sinus inflammation was significantly reduced (p = 0.03), and the mean SNOT-20 score was significantly improved (p < 0.001).
  
  
  CONCLUSIONS
  In-office placement of steroid-eluting bioabsorbable implants after achieving hemostasis was well tolerated and might improve local drug diffusion and surgical outcomes.
authors.affiliation: Collin County Ear Nose and Throat, Dallas, TX.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Matheny
authors.forename: Kenny B
authors.initials: KB
authors.lastname: Carter
authors.forename: Ewen Y
authors.initials: EY
authors.lastname: Tseng
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Fong
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D002908:Chronic Disease; D004343:Drug Implants; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010256:Paranasal Sinuses / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids
keywords: adhesions; bioabsorbable implant; corticosteroid; endoscopic sinus surgery; inflammation; local anesthesia; nasal polyps; office surgery; oral steroids; steroid releasing