{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:02:08Z","timestamp":1787770928134,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,6,26]],"date-time":"2022-06-26T00:00:00Z","timestamp":1656201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sinus surgery removes inflamed tissue, restores airflow, and improves delivery of medication into surgically opened spaces. The exhalation delivery system with fluticasone (EDS\u2010FLU; XHANCE<jats:sup>\u00ae<\/jats:sup>) uses a novel delivery system to create closed\u2010palate, positive\u2010pressure, bidirectional mechanics that significantly alter the deposition of the topically acting anti\u2010inflammatory medication. We ask whether EDS\u2010FLU efficacy differs for patients with recurrent symptoms after sinus surgery versus patients without surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to compare EDS\u2010FLU treatment responses in patients with recurrent symptoms after endoscopic sinus surgery (ESS) and patients who have never had sinus surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were pooled from two large, controlled trials (NAVIGATE I and II) for exploratory analyses. Chronic rhinosinusitis symptoms, polyp grade, and quality\u2010of\u2010life measures were compared between patients with prior ESS and those without prior ESS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with prior ESS (exhalation delivery system\u2013placebo [<jats:italic>n<\/jats:italic>\u00a0=\u00a053], EDS\u2010FLU 186\u00a0\u03bcg [<jats:italic>n<\/jats:italic>\u00a0=\u00a052], and EDS\u2010FLU 372\u00a0\u03bcg [<jats:italic>n<\/jats:italic>\u00a0=\u00a049]) and unoperated patients (exhalation delivery system\u2013placebo [<jats:italic>n<\/jats:italic>\u00a0=\u00a0108], EDS\u2010FLU 186\u00a0\u03bcg [<jats:italic>n<\/jats:italic>\u00a0=\u00a0108], and EDS\u2010FLU 372\u00a0\u03bcg [<jats:italic>n<\/jats:italic>\u00a0=\u00a0111]) treated with EDS\u2010FLU reported similar and substantial benefits as measured by multiple symptom and quality\u2010of\u2010life\/functioning outcomes (congestion score, 22\u2010Item Sinonasal Outcomes Test [SNOT\u201022], Rhinosinusitis Disability Index [RSDI], Patient Global Impression of Change) and by nasal polyp grade. In previously operated patients, unlike surgery\u2010naive patients, multiple outcomes (SNOT\u201022, RSDI, polyp grade) consistently showed numerically but not statistically greater responses to the higher dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with recurrent symptoms after sinus surgery who were treated with EDS\u2010FLU demonstrated significant symptom and quality\u2010of\u2010life improvement. Unlike unoperated patients, patients with prior ESS had a numerically but not statistically greater response to the higher dose of EDS\u2010FLU (two sprays per nostril twice a day).<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.23043","type":"journal-article","created":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T13:38:56Z","timestamp":1654695536000},"page":"31-41","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Efficacy of the exhalation delivery system with fluticasone in patients with chronic rhinosinusitis with nasal polyps whose symptoms recur after sinus surgery"],"prefix":"10.1002","volume":"13","author":[{"given":"Randall A.","family":"Ow","sequence":"first","affiliation":[{"name":"Sacramento Ear Nose Throat  Roseville California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary M.","family":"Soler","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Head and Neck Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald A.","family":"Leopold","sequence":"additional","affiliation":[{"name":"Department of Surgery College of Medicine University of Vermont  Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jivianne T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery UCLA David Geffen School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramy A.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"OptiNose US Inc.  Yardley Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Eastern Virginia Medical School  Norfolk Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,26]]},"reference":[{"issue":"29","key":"e_1_2_9_2_1","first-page":"1","article-title":"European position paper on rhinosinusitis and nasal polyps 2020","volume":"58","author":"Fokkens WJ","year":"2020","journal-title":"Rhinology"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22741"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2019.40.4182"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22376"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2011.0924"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.2002.00589.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.1998.2360560.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2014.1180"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2013.27.3880"},{"key":"e_1_2_9_11_1","unstructured":"XHANCE.Prescribing information. 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