Editorial by Dr. Woodworth.

Abstract

Chronic rhinosinusitis (CRS) with and without nasal polyposis engenders significant morbidity for afflicted patients. The treatment landscape has rapidly changed with the introduction of several exciting breakthrough topical interventions. There is also a growing body of clinical trial evidence related to established therapies as well as preclinical/clinical data supporting several promising novel strategies in the treatment pipeline. This supplement to International Forum of Allergy and Rhinology is an up-to-date document summarizing recently published significant findings regarding topical therapies. The articles in this supplement are written by established, well-known authors at the forefront of research in the area of topical interventions. Article topics were primarily chosen based upon a recent body of clinical evidence within the last 5 years with a preponderance of evidence at least partly supporting use. The objective of this issue is to update practicing clinicians with balanced, comprehensive, and academically rigorous reviews concerning recent progress in this area. The first article is a succinct evidence-based review of nasal saline irrigations. Saline irrigation and rinsing as an adjunct to the medical management of chronic rhinosinusitis is established practice. Evidence-based reviews, such as the “International Consensus Statement on Allergy and Rhinosinusitis,” have concluded that saline rinses are beneficial for CRS. Succar et al. delve into several topics regarding this important intervention, including aspects of device, saline composition, and hygiene—particularly relevant due to a recent, highly publicized case of amoebic encephalitis. The next three articles discuss established and newer methods of topical steroid delivery in the form of corticosteroid irrigations, exhaled delivery devices, and implants. Topical steroids are recognized as one of the most important therapies in both CRS and CRS with nasal polyps. However, it is now accepted that distribution to the sinus mucosa is critical to improve benefit. Grayson and Harvey provide the latest clinical trial data regarding corticosteroid irrigation, as well as recent safety data supporting routine use. Another method to improve the distribution of steroids to the sinus mucosa is the novel, fluticasone exhalation delivery system (EDS-FLU). Kuan et al. describe robust clinical trial data supporting treatment for inflammatory sinus disease. Finally, Han and Kern provide a summary of the latest randomized, controlled trial data regarding both intraoperative stents (Propel and Propel mini) for CRS with nasal polyps and the Sinuva implant for postoperative recurrent nasal polyposis. The steroid implants have emerged as one of the most significant advancements in topical interventions. The fifth article on topical antibiotic therapy is controversial, especially in light of recent consensus documents arguing against routine use in CRS. Carlton et al. provide an update on the latest clinical trial data supporting, at least in part, the treatment of bacterial infection in CRS. The authors do an excellent job of outlining why consensus documents may have “got it wrong” due to reliance on randomized, controlled trial data that used flawed methods of delivery. Finally, there are a number of exciting novel topical therapies in the treatment pipeline for CRS. A large volume of clinical trial data and translational research related to this area has emerged over the past several years. Myake and Bleier outline a number of preclinical and clinical studies on bacterial modifying agents (e.g., phage cocktails to treat pseudomonas infection, colloidal silver, ciprofloxacin-eluting stent, nitric oxide nanoparticles, photodynamic therapy, probiotics) and mucociliary activators (cystic fibrosis transmembrane conductance regulator modulators, bitter taste agonists) that promise to advance therapeutic approaches to CRS.