Dr. Howard Smith Oncall

Vidcast:  https://www.instagram.com/p/C48pAtGLNIy/ The FDA has improved what is described as a new treatment for certain chronic nasal and sinus infections. This therapy for so-called chronic rhinosinusitis without nasal polyps employs the long-used steroid nasal spray fluticasone, branded as Flonase, but delivers this drug using a novel dispenser that employs a higher pressure exhalation delivery system called the Xhance, marketed by the Opinose company.  The device sports a blow hole into which the patient forces air under pressure.  This pressurized exhaled air carries the steroid mist up into the higher reaches of the nasal cavity.   Two company-sponsored so-called phase 3 studies demonstrated that the Xhance system with the topical steroid versus a comparable exhalation delivery system with placebo solution led to fewer nasal and sinus symptoms and improved sinus aeration on imaging.  It would seem that the controls are flawed.  An appropriate control would be the Xhance exhalation steroid delivery s