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Daily Medical Update
Acute and chronic sinusitis
Thursday, April 02, 2026
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🔬 Practice‑Changing Findings
Evidence from RCTs and meta‑analyses published in the last 12 months.
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Current allergy and asthma reports (2025) - Network Meta-Analysis
Key Findings
- RESS was associated with lower recurrence vs FESS (RR 2.37, 95% CI 1.64-3.43) and vs EESS (RR 2.22, 95% CI 1.48-3.36).
- EESS showed fewer revision surgeries vs FESS (RR 2.95, 95% CI 1.89-4.82).
- RESS improved overall symptom/severity VAS vs FESS (MD -2.82) and vs EESS (MD -2.64), with no significant complication-rate difference.
📋 Practice Implication: For CRSwNP with high recurrence risk, the extent of mucosal resection should be an explicit preoperative decision because more aggressive ESS approaches may reduce recurrence without a clear complication penalty.
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Medicine (2025) - Meta-Analysis
Key Findings
- Balloon catheter dilation produced lower postoperative SNOT-20 scores vs FESS (SMD -0.25, 95% CI -0.42 to -0.07).
- Operating time was shorter and complications were lower vs FESS (OR 0.14, 95% CI 0.08-0.26).
- Revision surgery and Lund-Mackay scores did not differ significantly vs FESS.
📋 Practice Implication: For anatomically suitable CRS, balloon dilation is a reasonable lower-morbidity alternative when the goal is symptom relief with less operative burden rather than a full tissue-removing ESS approach.
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International forum of allergy & rhinology (2025) - Randomized Controlled Trial
Key Findings
- LYR-220 improved SNOT-22 vs sham from week 2 onward, with a between-group difference of -16.8 at week 24 (p = 0.007).
- Three cardinal symptom scores improved vs sham at week 24 (between-group difference -1.50, p = 0.02), and ethmoid opacification volume improved by -8.14 (p = 0.035).
- No treatment-related serious adverse events occurred, and loss-of-smell scores improved vs sham from week 8 through week 24 (-0.87, p = 0.026).
📋 Practice Implication: In recurrent CRS after prior ethmoid surgery, a long-acting steroid implant may be a useful escalation before another revision pathway, particularly when sustained local anti-inflammatory control is needed.
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Recent higher-significance evidence for sinusitis is concentrated in chronic rhinosinusitis, especially CRSwNP and postoperative management rather than uncomplicated acute disease. Network and randomized data suggest lower recurrence with more extensive ESS approaches in selected polyp disease, lower complication burden with balloon dilation for eligible CRS, and meaningful 24-week symptom improvement from a long-acting mometasone implant after prior ethmoid surgery.
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