Stents are used in sinus surgery with the aim of maintaining patency of sinus cavity avoiding restenosis from inflammation or scarring. The exact indication for stenting in sinus surgery however is still debated. The authors discussed the potential role of not only stenting but also using a biodegradable steroid-eluting stent composed of polylactide-co-glycolide impregnated with 370 micrograms of mometasone furoate. This stent is designed to give slow release of steroid over approximately 30 days. An intra-patient prospective double-blinded placebo control study where a steroid containing stent was compared with the contralateral placebo side showed reduced rates of polyposis, adhesions and middle turbinate lateralisation on the steroid side. They also reported no change to intraocular pressure. More recently, a new steroid-eluting stent has been designed with higher dose of mometasone and a longer duration of topical treatment which is showing promising results. Stenting in sinus surgery is not without risk however, with stent misplacement, orbital injury, retained material and chronic infection reported. A Cochrane review in 2015 was unable to draw any conclusion on the benefit of stenting in sinus surgery due to the intra-patient designs preventing the ability to perform health related quality of life outcomes. NICE concluded the same where the long-term efficacy of stenting is currently limited. Ultimately, stenting in sinus surgery, especially with steroid-impregnated stents, may have its benefits and its use is currently based on surgeon preference and clinical judgments. This may well change in the future once more evidence of its benefit becomes available.
Stenting and sinus surgery
Reviewed by Wai Sum Cho
Trends in the use of stents and drug-eluding stents in sinus surgery.
