Rhinosinusitis future or investigational therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Future or Investigational Therapies

Medical therapy

• Topical corticosteroids with improved delivery route: Recently, there has been efforts to investigate the efficacy of topical corticosteroids in treatment of chronic rhinosinusitis in order to increase the efficacy of the anti-inflammatory agents and minimizes the long term side effects of the systemic agents. Large volume delivery and steroid-eluting stents are recent successful approaches for direct delivery of steroids to the paranasal sinuses. However the cost effectiveness and possible need for stent replacement are limitations that should be considered.
• Monoclonal antibodies against inflammatory agents: Currently, monoclonal antibodies against IL-5, IL-4R and IgE have been administered systemically to the patients with severe forms of the disease, unresponsive to conventional therapy or patients with comorbid asthma. Systemic administration of these agents with considerable cost and side effects has limited their use.
• Identifying predictors of patient compliance and treatment response: As for chronic rhinosinusitis-similar to other chronic diseases- there is issue with patient compliance. Hence, it is important to investigate methods to monitor the patients compliance and response to treatment.
• Alternative or complementary therapies for surgery in recurrent cases:
• Finding a "cure" for chronic rhinosinusitis: Most of the current therapeutic approaches have lead to a cure for chronic rhinosinusitis, especially the subtype with polyps. It is suggested that correcting the immune dysfunction of the patients in long term would pave the way to finding a "cure" for chronic rhinosinusitis.

Surgery

Balloon dilation has been of debate in the last decade. In this operation it is important to choose the optimal sinus cavity and the appropriate size of the surgical ostia. Further investigation is required to assess possible novel medical therapies before placing the undue burden of surgery on the patient and the system. Lastly, future investigations for predictors of surgery response is recommended.