Utilization of Corticosteroid Delivery Systems for Treatment of Nasal Polyposis - Episode 8
Naveen Bhandarkar, MD, discusses the use of sinus implants for the treatment of nasal polyposis.
Anju Peters, MD:Naveen, will you talk to us more with what you guys use more of with these sinus stents implants etc. Can you explain those and how long do they stay in there? Do they come out on their own, do you need to take them out?
Naveen Bhandarkar, MD: Yes, we do use those commonly in various situations. Now, the thing to understand about sinus implants is they can only be used in either an intraoperative or post-surgical setting, so none of the available implants can be used in a preoperative state. All the available implants are FDA approved and contain mometasone furoate. The implants come in 2 different basic doses as far as the amount of mometasone on there. The 3 of them have a 370-microgram dose, and then there's another one that has a 1350 microgram dose. The 370 microgram dose implants comes in 3 different shapes which have certain indications for various sinuses that we can go through the labeled indication if needed but in a large-scale summary of those are basically used either intraoperatively for their respective sinuses or post operatively for treating recurrent inflammation or polyps. Intraoperatively generally speaking we're using it both to control information and optimize healing where scar tissue is somewhat of an issue after surgery, especially when you're operating in severely inflamed disease state. To the other implant that is available that has the 1350 microgram dose is primarily used in a post operative setting again but specifically in the cavity so that one- and I didn't mention earlier. The other 3 implants that had the 370-microgram dose are 30-day implants with a polymer that bio resorbs over that period. This larger dose implant of 1350 microgram is a 90 day again bioresorbable polymer that then both of those will elude steroid over that period in a controlled release fashion and treat inflammation and polyps. The other question here about when we use them is based on nasal endoscopy findings and identification of focused problems in specific sinuses. For example, intraoperatively if I have a frontal sinus that is severely inflamed and the opening that we create is looking narrow and because of that inflammation I am concerned about scar tissue forming there, I will place an implant that's indicated for the frontal sinus outflow at the time of the surgery. Other times, postoperatively for example, let's say that we have a cavity that has recurrent nasal polyps and is obstructed as a result, that 1350 microgram implant which lasts 90 days might be a good option.
Transcript edited for clarity