Rhinosinusitis future or investigational therapies

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


Future investigation is required for treatment strategies of rhinosinusitis including target, delivery rout, side effects and efficacy of the therapeutic agents and patient response to different methods of surgery.

Future or Investigational Therapies

Medical therapy

There are several therapeutic approaches proposed for the treatment of rhinosinusitis[1]:

  • 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[2][3][4][5]: 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 assess 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.


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 is recommended to assess methods to predict the response to surgery.[1]


  1. 1.0 1.1 Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM; et al. (2016). "International Consensus Statement on Allergy and Rhinology: Rhinosinusitis". Int Forum Allergy Rhinol. 6 Suppl 1: S22–209. doi:10.1002/alr.21695. PMID 26889651.
  2. Gevaert P, Calus L, Van Zele T, Blomme K, De Ruyck N, Bauters W; et al. (2013). "Omalizumab is effective in allergic and nonallergic patients with nasal polyps and asthma". J Allergy Clin Immunol. 131 (1): 110–6.e1. doi:10.1016/j.jaci.2012.07.047. PMID 23021878.
  3. Gevaert P, Van Bruaene N, Cattaert T, Van Steen K, Van Zele T, Acke F; et al. (2011). "Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis". J Allergy Clin Immunol. 128 (5): 989-95.e1-8. doi:10.1016/j.jaci.2011.07.056. PMID 21958585.
  4. Pinto JM, Mehta N, DiTineo M, Wang J, Baroody FM, Naclerio RM (2010). "A randomized, double-blind, placebo-controlled trial of anti-IgE for chronic rhinosinusitis". Rhinology. 48 (3): 318–24. doi:10.4193/Rhin09.144. PMID 21038023.
  5. Gevaert P, Lang-Loidolt D, Lackner A, Stammberger H, Staudinger H, Van Zele T; et al. (2006). "Nasal IL-5 levels determine the response to anti-IL-5 treatment in patients with nasal polyps". J Allergy Clin Immunol. 118 (5): 1133–41. doi:10.1016/j.jaci.2006.05.031. PMID 17088140.

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