Daniel A. Carlton

Background: Topical antibiotic therapies have been investigated for their use in chronic rhinosinusitis (CRS). However, society guidelines and evidence‐based medicine reviews have recommended against the use of topical antibiotic therapy based on randomized controlled trials (RCTs). The purpose of this article is to review recent clinical research published since the aforementioned guidelines were published.Methods: A structured literature review was performed on clinical studies published in the last 5 years investigating the use of topical antibiotic therapies.Results: One double‐blinded, randomized controlled trial (DB‐RCT) supported the use of tobramycin using a vibrating aerosolizer; 1 non‐blinded non‐randomized controlled prospective trial lent support to use of topical ofloxacin for its anti‐biofilm properties; and 1 meta‐analysis found mupirocin irrigations to be beneficial in the short term. One Cochrane Review was unable to make a recommendation as no trial met the inclusion criteria. An additional systematic review found limited evidence to support the use of topical antibiotics with the exception of mupirocin irrigations that may be considered in Staphylococcus aureus infections. Two retrospective studies found that topical antibiotics change bacterial cultures of the sinuses.Conclusion: There is additional evidence to support continuing investigation of topical antibiotic therapies. Further, larger RCTs are required to establish the efficacy of topical antibiotic therapies.

Sinonasal malignancies are rare and heterogeneous cancers located adjacent to critical neurovascular structures. Proximity to the orbit, brain, cranial nerves, and carotid arteries make surgical resection technically challenging and potentially morbid. The gold standard surgical procedure for these cancers has traditionally been the open craniofacial resection. Endoscopic endonasal approaches emerged in the last two decades as a viable alternative for carefully selected patients. The rarity and heterogeneity of the cancers precludes randomized controlled trials. Evidence for surgical approaches is based on case series and multi‐analyses. Current evidence demonstrates that endoscopic approaches do not compromise survival and have lower complication rates. This article provides an update of the current literature examining outcomes for the endoscopic treatment of sinonasal malignancies.