ArticleFrontiers in allergy2026
Combined in-office endoscopic debridement and supine head-hanging budesonide instillation for postoperative difficult-to-treat chronic rhinosinusitis with nasal polyps: a retrospective cohort study.
Article in Frontiers in allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Difficult-to-treat chronic rhinosinusitis with nasal polyps (CRSwNP) may remain uncontrolled after adequate endoscopic sinus surgery and guideline-directed postoperative therapy. Obstructive edematous or polypoid tissue in the operated sinus cavity may limit topical corticosteroid access and delay mucosal recovery. We evaluated whether an intensified outpatient strategy-targeted in-office endoscopic debridement followed by supine head-hanging budesonide instillation-was associated with earlier recorded postoperative cavity epithelialization. Methods: This single-center retrospective cohort included 102 adults treated from January 2020 to January 2025 and reassessed against EPOS 2020 difficult-to-treat criteria. Fifty-two patients received the intensified strategy, and 50 received conventional budesonide nasal spray; both groups received the same 7-day oral methylprednisolone course. The primary endpoint was recorded postoperative cavity epithelialization at 12 weeks. Secondary endpoints included 8-week epithelialization, time to first recorded epithelialization, symptom and Lund-Kennedy score improvement, exploratory adjusted association with 12-week epithelialization, and adverse events documented in records. Because the intensified strategy comprised multiple co-delivered components, the study evaluated the overall strategy, not individual components. Results: Epithelialization by week 8 was recorded in 43/52 (82.69%) intensified-strategy patients and 20/50 (40.00%) conventional-strategy patients ( Conclusion: In adults with postoperative difficult-to-treat CRSwNP, the intensified outpatient strategy was associated with earlier and more frequent recorded postoperative cavity epithelialization than conventional budesonide nasal spray. These findings indicate a strategy-level association and do not isolate component effects or establish comparative safety. The 12-week endpoint reflects early recorded epithelialization and does not establish durable disease control or recurrence prevention. Prospective component-controlled or factorial studies with follow-up of at least 12 months are needed.
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