{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T01:35:39Z","timestamp":1777426539966,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T00:00:00Z","timestamp":1751673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2022R1F1A1066232"],"award-info":[{"award-number":["2022R1F1A1066232"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Otol Rhinol Laryngol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Novel biomechanics of the exhalation delivery system can deliver fluticasone (EDS-FLU; XHANCE) to sinonasal areas above the inferior turbinate, especially sinus drainage pathways not reached by standard nasal sprays. This study aimed to evaluate the effectiveness of EDS-FLU in treating chronic rhinosinusitis (CRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Studies were retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to April 2024. We analyzed 5 studies that compared EDS-FLU with a control group (exhalation delivery system with placebo) on various outcomes, including the 22-item Sinonasal Outcome Test (SNOT-22), nasal symptom scores (congestion, facial pain, olfactory dysfunction, and rhinorrhea), nasal polyp scores, surgical indication rate, and the incidence of adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Five studies with 2129 patients were included. EDS-FLU significantly improved SNOT-22 score (\u221220.9657 [\u221223.5639; \u221218.3674]) and the polyp score (\u22121.5099 [\u22121.7810; \u22121.2388]) after 6\u2009months. The incidence of epistaxis was significantly higher in the treatment group compared to the control group (OR\u2009=\u20095.7954 [2.1004; 15.9909]). Effects of EDS-FLU on polyp score (\u22120.6497 [\u22120.8186; \u22120.4807]), responder rate (OR\u2009=\u20092.1755 [1.2784; 3.7020]), complete responder rate (OR\u2009=\u20092.0423 [1.0109; 4.1262]), surgical indication rate (OR\u2009=\u20090.7313 [0.5459; 0.9797]), and SNOT-22 score (\u22126.1513 [\u221211.3054; \u22120.9972]) were significantly higher in the treatment group than in the control group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study demonstrated that EDS-FLU (372\u2009\u00b5g twice daily) produced statistically significant improvements compared to EDS-placebo in multiple subjective and objective outcomes, although some adverse effects, such as epistaxis, may occur.<\/jats:p>\n                  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