Nasonex Sinus Implant for Chronic Sinusitis

The FDA on August 15, 2011 approved of a novel dissolvable sinus implant that slowly releases mometasone furoate steroid (same active ingredient as Nasonex steroid nasal spray) directly onto the sinus mucosa.

The spring-like implant is placed at the time of sinus surgery and automatically expands and conforms to the sinus cavity regardless of size and shape.

The theory is that by continuously delivering a low dose steroid directly to the sinus cavity, sinus inflammation will decrease and risk of scarring will decrease resulting in an overall decrease in chronic sinusitis for the patient after sinus surgery.

This is a GREAT idea and studies have born out its effectiveness. Hopefully other drug-eluting dissolvable stents like this will be developed in the future!

Developed by Intersect ENT, the implant is called "Propel."

Read about the FDA approval here.

References:
Safety and efficacy of a novel bioabsorbable, steroid eluting sinus stent. INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY. 2011;1(1):23-32.

Advances in the Surgical Management of Chronic Sinusitis and Nasal Polyps. CURRENT ALLERGY AND ASTHMA REPORTS. Published online 08 February 2011

Controlled steroid delivery via bioabsorbable stent: Safety and performance in a rabbit model. AMERICAL JOURNAL OF RHINOLOGY & ALLERGY. November–December 2009, Vol. 23, No. 6.

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Dr. Chang Extensively Quoted in Outpatient Surgery Magazine Article

In the August 2011 edition of Outpatient Surgery Magazine, Dr. Chang was extensively quoted for an article describing use of image-guided sinus surgery.

In the article titled "The Benefits of Image-Guided Sinus Surgery," Dr. Chang described the advantages such technology brings to endoscopic sinus surgery.

Click here to read the full article.

Click here to read more about chronic sinusitis as well as watch a video of this technology being used.

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New Webpage on Balloon Sinuplasty to Treat Chronic Sinusitis

A new webpage has been created describing the balloon sinuplasty technique to address chronic sinus infections.

Briefly, a balloon catheter (similar to angioplasty used to treat clogged heart arteries) is used to enlarge the openings into the sinus cavities without the need for any cutting or tissue removal.

Read more here.

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MRSA Sinusitis

There seems to be an increasing number of patients I see with MRSA sinusitis. Not many, but definitely not rare. These patients are understandably very concerned with how to treat their MRSA sinusitis.

Beyond the usual protocol that applies to any MRSA infection, if the sinusitis is severe, sinus surgery is recommended for 3 main reasons.

1) Get the infection cleaned out surgically (much like draining an abscess of the skin)
2) Enlarge the openings of the sinus cavity to allow good post-op topical treatment in order to potentially avoid oral and IV antibiotics (though they still may be needed)
3) Sinus infection can be carefully followed endoscopically in the future

By opening up the sinuses, topical treatment can be performed that is sometimes more effective that IV or oral routes as higher concentrations of medication can be delivered right to the area of concern (instead of oral or IV routes which go throughout the entire body causing side effects).

Such topical treatment include:

• Saline flushes (Neilmed Sinus Rinse is our preferred method though irrigation devices shown below are also fine)
• Bactroban Cream or Cortisporin Ointment injection directly into the sinus cavity
• Antibiotic flushes to the sinus cavity
• Chemical saline flushes to the sinus cavity (my favorite being No-Tears Johnson's Baby Shampoo - 1 tsp in 250 cc of saline)

Debridement of the sinus cavity can also be easily performed after sinus surgery in the office.

Once the active MRSA sinusitis infection has cleared, continued topical treatment with daily saline nasal flushes help prevent future sinus infections.

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