30-Second Takeaway
- ESS and biologics both control CRSwNP but with different cost, risk, and access profiles
- High-dose budesonide spray outperforms high-volume irrigation for endoscopic control in nonoperated CRS
- More extensive ESS (LOEM t3–t4) reduces and delays treatment escalation in higher-risk CRSwNP
- Post-ESS biologics substantially cut systemic steroids, antibiotics, visits, and revision ESS in real-world CRSwNP
- Barrier oral gel meaningfully reduces severe mucositis, pain, and nutritional decline during head and neck radiotherapy
Week ending January 10, 2026
Sinus, skull base, tinnitus, and head & neck updates with immediate practice implications
ESS versus biologics for CRSwNP show similar sinonasal outcomes
This Rhinology systematic review and meta-analysis compared real-world sinonasal outcomes between functional ESS and biologic therapy for CRSwNP. Biologics targeted type 2 inflammation, including dupilumab, omalizumab, and mepolizumab, often in patients with asthma or AERD. The authors conclude that ESS, the standard for medically refractory disease, achieves sinonasal outcomes broadly comparable to biologic therapy. Therapeutic choice should integrate comorbidities, patient preference, access, and long-term safety and cost considerations.
High-dose budesonide spray beats irrigation in severe nonoperated CRS
This double-blind randomized trial compared 1,000 μg/day budesonide via high-volume irrigation versus nasal spray for 3 months in severe, surgery-naïve CRS. Sixty-seven patients completed treatment, including CRSwNP, CRSsNP, and diffuse primary CRS phenotypes (CCAD, eCRS, neCRS). High-dose spray produced superior endoscopic improvement overall, particularly in CRSwNP and CCAD, compared with irrigation. SNOT-22 improvements were similar between groups, but spray reduced the proportion of uncontrolled patients on a clinical control questionnaire. Findings support high-dose budesonide spray as preferred first-line topical therapy in nonoperated severe CRS awaiting surgery.
Long-term sound therapies modestly reduce chronic tinnitus handicap
This multicenter double-blind RCT randomized 440 adults with chronic subjective tinnitus to four daily 2-hour sound therapies for 9 months. Interventions were unmodified music, music plus pitch-centered narrowband noise, high-frequency-enhanced music, and digital frequency-customised relieving sound. Across all groups, THI scores declined significantly from baseline to 9 months and benefits persisted 3 months after stopping treatment. Only one patient achieved complete remission, highlighting that cure is rare even with prolonged sound therapy. Clinicians can present sound therapy as low-risk and capable of durable THI reductions, but not a curative intervention for most.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.