Introduction
➤ Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory
disease of the nasal mucosa and sinuses that lasts at least 12 weeks.
➤ CRSwNP affects about 2–4% of people with symptoms such as smell loss,
nasal obstruction, thick nasal drainage, and facial pressure.
➤ Some patients with CRSwNP also have comorbid asthma and develop acute
respiratory reactions to nonsteroidal anti-inflammatory drugs (NSAIDs).
Table 1. Topical Steroids
Intranasal
corticosteroid
(INCS) delivery type Description
Usual
administrator
Stent Steroids are found within the matrix of a
device implanted in the nasal cavities and are
gradually released over a timespan following
the operation. e implant exerts a mechanical
function in maintaining sinus patency. e
implanted device is either absorbed by the
mucosae or is surgically removed.
Administered
by surgeons
intra-operatively
Spray Corticosteroids are suspended in an aqueous
medium with varying concentrations. e
delivery is entirely self-administered, with the
patient having to press the applicator aer
clearing the nostrils and assuming a proper head
position.
Self-administered
Rinse Steroids are suspended in a saline solution.
e compound is first inserted into a recipient
(i.e., syringe, bottle) and then squeezed into
a nostril, having the head tilted sideways. e
process is repeated for both nostrils several
times as instructed either by study investigators
(if in a trial) or by the treating physician.
Self-administered
Exhalation delivery
system (EDS)
Corticosteroids are suspended in an aqueous
medium. e delivery system uses the patient's
exhaled breath to propel medication into the
inner nose. By exhaling through the EDS, the
patient physiologically seals the so-palate,
isolating the nose from downstream airways,
preventing drug dispersion.
Requires specific
device and some
basic training.
Drops Corticosteroids within an aqueous suspension.
A proper administration requires patients to
adopt and maintain specific body postures as
described either by study investigators (if in a
trial) or in the patient information leaflet. e
daily dose can either be split between nostrils
or administered into a single nostril per day,
alternating between the two.
Self-administered.
Requires specific
instructions.
