title: Post-sinus surgery insertion of steroid-eluting bioabsorbable intranasal devices: A systematic review.
abstract: OBJECTIVE
  Postendoscopic sinus surgery corticosteroid administration reduces polyp formation, inflammation, and adhesions. Steroid-eluting bioabsorbable intranasal devices (SEBID) are novel interventions thought to improve local drug delivery while minimizing systemic side effects. The primary aim of this systematic review is to evaluate the efficacy and safety of bioabsorbable SEBIDs. The secondary aim is to inform clinical recommendations and to introduce clinicians to this novel technology.
  
  
  METHODS
  MEDLINE, PubMed, Embase, and Cochrane Database were searched according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
  
  
  METHODS
  Original articles assessing the efficacy of SEBIDs inserted after endoscopic sinus surgery. For each study, we recorded the efficacy endpoints and safety outcomes.
  
  
  RESULTS
  Seven studies met the inclusion criteria from 737 initial articles identified, including five prospective randomized controlled trials and two prospective single-cohort studies involving 394 sinuses within treatment arms. Patients were followed up for 2 to 6 months. Six studies demonstrated SEBID efficacy with statistical significance (P < 0.05). Steroid-eluting bioabsorbable intranasal devices were effective in reducing adhesion formation, polyp formation, inflammation, Lund-Kennedy scores, and perioperative sinus endoscopy scores. The devices improved patient-reported outcomes and olfaction while reducing postoperative interventions. They were not associated with adverse events and pose no ocular safety risk. Complications in three SEBID applications were reported.
  
  
  CONCLUSIONS
  There is limited data available on SEBIDS; further studies are required to determine whether they are safe and effective adjuncts postendoscopic sinus surgery. Future studies are needed to optimize the dosing regimen, compare devices, and provide long-term outcomes. Steroid-eluting bioabsorbable intranasal devices may tentatively be incorporated into future evidence-based practice.
authors.affiliation: Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Rizan
authors.affiliation: Department of Otolaryngology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Elhassan
mesh_terms: D020341:Absorbable Implants; D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D004343:Drug Implants; D004724:Endoscopy; D006801:Humans; D010254:Paranasal Sinus Diseases / Q000601:surgery*
chemical_list: D000305:Adrenal Cortex Hormones; D004343:Drug Implants
keywords: Steroid-eluting bioabsorbable intranasal device; chronic rhinosinusitis; functional endoscopic sinus surgery