Selected Podcast
Addressing a Hidden Epidemic: Chronic Rhinosinusitis
More than 635,000 Americans have had sinus surgery, but many still face recurring symptoms. In recent years, new advances in the treatment of nose polyps and sinus issues have proved to be more effective. In this episode, Robert Kern, MD, chief of Otolaryngology at Northwestern Medicine discuss the latest advances in the treatment of nose and sinus polyps.
Featured Speaker:
Robert Kern, MD
Robert Kern, MD is the Chair, Department of Otolaryngology – Head and Neck Surgery and the George A. Sisson, MD, Professor of Otolaryngology. Transcription:
Addressing a Hidden Epidemic: Chronic Rhinosinusitis
Melanie Cole (Host): More than 635,000 Americans have had sinus surgery, but many still face recurring symptoms. In recent years, new advances in the treatment of nasal polyps and sinus issues have proved to be more effective. Joining me today to discuss the latest advances in the treatment of nasal and sinus polyps is my guest, Dr. Robert Kern. He’s the chair of the Department of Otolaryngology, Head and Neck surgery, and a George A. Sisson Professor of Otolaryngology at Northwestern Medicine. Dr. Kern, it’s a pleasure to have you join us. Can you start by giving us a little background on what has been the standard treatment for nasal and sinus polyps.
Robert Kern, MD (Guest): First of all, chronic rhinosinusitis with and without nasal polyps is a gigantic healthcare problem that’s really been relatively unrecognized. We refer to it as a hidden epidemic, and some studies show that it affects about 10% of the population and some people fairly severely. The people that are severely impacted—meaning that they can’t breathe through their nose, they can’t smell, they lose time at work, they have problems with asthma—these are typically the patients with nasal polyps, which is the most severe form of sinusitis. Now, historically, these patients were treated with nasal steroids and oral steroids, which, although they’re fairly effective, they have a lot of side effects, and if that failed, or if now the steroids they were given was too great because of other health effects, we try to limit them. Under those circumstances, the patients were given—were recommended to have surgery. Now, surgery is fine, except that there’s a tendency for the polyps to recur. You could think of polyps as being like weeds and, you know , we’re weeding the garden, but the problem is that the weeds keep coming back.
Well, there are some new treatments out over the last really two to three years that are changing the way we manage this problem, and one of them is a device called SINUVA, which is an implantable device –small, it’s probably about as large as a fingernail—that has steroids imbedded in it, and it’s inserted into the sinus cavity, and it gives off the steroids locally—right in the nose. So, this has a couple of benefits. First, it doesn’t get access to the entire body, so you don’t have the systemic effects—negative effects—of steroids. Oral steroids, which work great and get throughout the whole body, have side effects. It’s sort of the equivalent of running your engine too hot. It’ll come back to bite you, so to speak, in the end. So, these steroids avoid that. The second advantage is nasal steroid sprays—which are the alternative—work well, but the problem is that most of the stuff you spray in your nose ends up down the back of your throat. So, very little of it gets to the action. Well, these devices have the steroid imbedded in it, so 100% gets right to where the problem is. You’re putting the weed killer right in the area where the weeds are, so to speak. So, these treatments are very well liked by the patient. They’re easy to put in in the office—these little devices—and they can be quite effective. They’re quite well-received. That’s one of the new treatment options for polyps. Now, there are some other new ones coming out. Another one is a type of—instead of the typical nasal spray—there’s a new spray device. Which instead of just squirting it in your nose, which as I said, most of it goes down the back of your throat, and you swallow it, it’s actually a device that you blow into, and that device is called Xhance. So, you blow it, and it actually blows it up inside your nasal cavity. So, again, more of the product gets to the action. More of the steroids get to the action without the side effects of it getting to the entire body. So, both of these products are two different ways to apply steroids—to apply the weed killer—directly on the weeds.
Host: Well, that was an excellent explanation, Dr. Kern. So, how have they changed the standard of care? Tell us about some of your outcomes and the results your patients are seeing. Are they liking this?
Dr. Kern: Well, they definitely like it because it’s easy to do, and there are two different ways to look at the problem. The implantable device is kind of like a burst treatment. It’s very effective, and you put it in. You don’t even have to think about it. It’s there, and it kind of—think of it like a mini-surgery. The other treatment, the Xhance device, which you blow into, is a daily treatment. That’s kind of like a maintenance to keep the problem from coming back, and the patients like them. They’re well tolerated. When you use the phrase standard of care—sometimes it takes a while for standard of care to get widely accepted just because people are not aware of the product. The patients aren’t aware of the product, and the insurance company sometimes are slow to adopt these things in terms of approval just because they’re not used to them, and they are not necessarily, you know, fully aware of their availability in the market.
Host: Well, that certainly is true, and the otolaryngology team at Northwestern is focused on providing this multidisciplinary approach to best treat your patients. Describe what that looks like for an ENT team, and why is it so important?
Dr. Kern: Well, we try to provide comprehensive care, and we do that in concert—not just with our ENT specialists, but also with allergists we work with very closely. We have the great fortune of working with an outstanding group of allergists and basic science researchers that work not just on the biology of the problem in the laboratory, but also work with industry designing and fulfilling clinical trials that help evaluate these new state-of-the art products, and we’ve had this in place now for nearly 20 years, and it’s grown now that we get more money from the NIH to study sinusitis and nasal polyps than anyone in the world, really. So, we have a very large research program. That permits us to bring the latest products to our patients. I just really covered two of the ones that are more or less going live right now. There are other products and other trials that we offer—more experimental—not dangerous, but we just don’t know whether they’ll really work as well as what we have now, but they’re available for patients who, for whatever reason, haven’t responded to the current standard of care, to offer them an opportunity to participate in a trial, and perhaps get relief by newer, emerging medications. There are a number of therapies—pills, as well as new injectable therapies out there—there is just a new product launched by Santa Fe Regeneron called Dupixent, D-U-P-I-X-E-N-T, which is a new biologic medication for shrinkage of polyps that’s just received FDA approval, and there are a couple other biologic. We call them biologics because they’re really immunoglobulins. They’re very large molecules, and they can’t be taken by a pill. They’re usually injected under the skin, and these are once-a-month treatments that are very new, very avant-garde, so to speak. They’re just recently available for polyp patients. They’ve been used for asthma and for atopic dermatitis and other problems, but they’re just new to nasal polyps, and we’re fortunate to participate in the trials of these products and launch them now that they’ve been made available—to have available the products that will be launched to the general public in the next year or so—other biologic therapies. The treatment of sinusitis has long been kind of an orphan disorder, as I said, but it’s really undergoing a kind of renaissance right now.
Host: What an exciting time to be in otolaryngology. As we wrap up Dr. Kern, what would you like other providers to know about treating nasal and sinus polyps and the SINUVA procedure and all of the exciting research and trials that you’re doing there at Northwestern Medicine?
Dr. Kern: We’d be very happy to see anyone—any of the more difficult patients particularly that you are having trouble with. There’s a subgroup of polyp and sinus patients that have aspirin allergy. We have a particular interest. We have a number of NIH grants looking into this. These are the most—very most—severe patients, and we have an array of medical, surgical, and device-like treatments, including SINUVA, including Xhance, including Dupixent, and including some new, innovative surgical treatments that can manage these patients. So, we’d be happy to see anyone. Please, if you think of us, we’d be very grateful, and we’re very interested in helping these patients.
Host: Thank you so much Dr. Kern, for joining us today, and that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates, please follow us on your social channels. I’m Melanie Cole.
Addressing a Hidden Epidemic: Chronic Rhinosinusitis
Melanie Cole (Host): More than 635,000 Americans have had sinus surgery, but many still face recurring symptoms. In recent years, new advances in the treatment of nasal polyps and sinus issues have proved to be more effective. Joining me today to discuss the latest advances in the treatment of nasal and sinus polyps is my guest, Dr. Robert Kern. He’s the chair of the Department of Otolaryngology, Head and Neck surgery, and a George A. Sisson Professor of Otolaryngology at Northwestern Medicine. Dr. Kern, it’s a pleasure to have you join us. Can you start by giving us a little background on what has been the standard treatment for nasal and sinus polyps.
Robert Kern, MD (Guest): First of all, chronic rhinosinusitis with and without nasal polyps is a gigantic healthcare problem that’s really been relatively unrecognized. We refer to it as a hidden epidemic, and some studies show that it affects about 10% of the population and some people fairly severely. The people that are severely impacted—meaning that they can’t breathe through their nose, they can’t smell, they lose time at work, they have problems with asthma—these are typically the patients with nasal polyps, which is the most severe form of sinusitis. Now, historically, these patients were treated with nasal steroids and oral steroids, which, although they’re fairly effective, they have a lot of side effects, and if that failed, or if now the steroids they were given was too great because of other health effects, we try to limit them. Under those circumstances, the patients were given—were recommended to have surgery. Now, surgery is fine, except that there’s a tendency for the polyps to recur. You could think of polyps as being like weeds and, you know , we’re weeding the garden, but the problem is that the weeds keep coming back.
Well, there are some new treatments out over the last really two to three years that are changing the way we manage this problem, and one of them is a device called SINUVA, which is an implantable device –small, it’s probably about as large as a fingernail—that has steroids imbedded in it, and it’s inserted into the sinus cavity, and it gives off the steroids locally—right in the nose. So, this has a couple of benefits. First, it doesn’t get access to the entire body, so you don’t have the systemic effects—negative effects—of steroids. Oral steroids, which work great and get throughout the whole body, have side effects. It’s sort of the equivalent of running your engine too hot. It’ll come back to bite you, so to speak, in the end. So, these steroids avoid that. The second advantage is nasal steroid sprays—which are the alternative—work well, but the problem is that most of the stuff you spray in your nose ends up down the back of your throat. So, very little of it gets to the action. Well, these devices have the steroid imbedded in it, so 100% gets right to where the problem is. You’re putting the weed killer right in the area where the weeds are, so to speak. So, these treatments are very well liked by the patient. They’re easy to put in in the office—these little devices—and they can be quite effective. They’re quite well-received. That’s one of the new treatment options for polyps. Now, there are some other new ones coming out. Another one is a type of—instead of the typical nasal spray—there’s a new spray device. Which instead of just squirting it in your nose, which as I said, most of it goes down the back of your throat, and you swallow it, it’s actually a device that you blow into, and that device is called Xhance. So, you blow it, and it actually blows it up inside your nasal cavity. So, again, more of the product gets to the action. More of the steroids get to the action without the side effects of it getting to the entire body. So, both of these products are two different ways to apply steroids—to apply the weed killer—directly on the weeds.
Host: Well, that was an excellent explanation, Dr. Kern. So, how have they changed the standard of care? Tell us about some of your outcomes and the results your patients are seeing. Are they liking this?
Dr. Kern: Well, they definitely like it because it’s easy to do, and there are two different ways to look at the problem. The implantable device is kind of like a burst treatment. It’s very effective, and you put it in. You don’t even have to think about it. It’s there, and it kind of—think of it like a mini-surgery. The other treatment, the Xhance device, which you blow into, is a daily treatment. That’s kind of like a maintenance to keep the problem from coming back, and the patients like them. They’re well tolerated. When you use the phrase standard of care—sometimes it takes a while for standard of care to get widely accepted just because people are not aware of the product. The patients aren’t aware of the product, and the insurance company sometimes are slow to adopt these things in terms of approval just because they’re not used to them, and they are not necessarily, you know, fully aware of their availability in the market.
Host: Well, that certainly is true, and the otolaryngology team at Northwestern is focused on providing this multidisciplinary approach to best treat your patients. Describe what that looks like for an ENT team, and why is it so important?
Dr. Kern: Well, we try to provide comprehensive care, and we do that in concert—not just with our ENT specialists, but also with allergists we work with very closely. We have the great fortune of working with an outstanding group of allergists and basic science researchers that work not just on the biology of the problem in the laboratory, but also work with industry designing and fulfilling clinical trials that help evaluate these new state-of-the art products, and we’ve had this in place now for nearly 20 years, and it’s grown now that we get more money from the NIH to study sinusitis and nasal polyps than anyone in the world, really. So, we have a very large research program. That permits us to bring the latest products to our patients. I just really covered two of the ones that are more or less going live right now. There are other products and other trials that we offer—more experimental—not dangerous, but we just don’t know whether they’ll really work as well as what we have now, but they’re available for patients who, for whatever reason, haven’t responded to the current standard of care, to offer them an opportunity to participate in a trial, and perhaps get relief by newer, emerging medications. There are a number of therapies—pills, as well as new injectable therapies out there—there is just a new product launched by Santa Fe Regeneron called Dupixent, D-U-P-I-X-E-N-T, which is a new biologic medication for shrinkage of polyps that’s just received FDA approval, and there are a couple other biologic. We call them biologics because they’re really immunoglobulins. They’re very large molecules, and they can’t be taken by a pill. They’re usually injected under the skin, and these are once-a-month treatments that are very new, very avant-garde, so to speak. They’re just recently available for polyp patients. They’ve been used for asthma and for atopic dermatitis and other problems, but they’re just new to nasal polyps, and we’re fortunate to participate in the trials of these products and launch them now that they’ve been made available—to have available the products that will be launched to the general public in the next year or so—other biologic therapies. The treatment of sinusitis has long been kind of an orphan disorder, as I said, but it’s really undergoing a kind of renaissance right now.
Host: What an exciting time to be in otolaryngology. As we wrap up Dr. Kern, what would you like other providers to know about treating nasal and sinus polyps and the SINUVA procedure and all of the exciting research and trials that you’re doing there at Northwestern Medicine?
Dr. Kern: We’d be very happy to see anyone—any of the more difficult patients particularly that you are having trouble with. There’s a subgroup of polyp and sinus patients that have aspirin allergy. We have a particular interest. We have a number of NIH grants looking into this. These are the most—very most—severe patients, and we have an array of medical, surgical, and device-like treatments, including SINUVA, including Xhance, including Dupixent, and including some new, innovative surgical treatments that can manage these patients. So, we’d be happy to see anyone. Please, if you think of us, we’d be very grateful, and we’re very interested in helping these patients.
Host: Thank you so much Dr. Kern, for joining us today, and that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates, please follow us on your social channels. I’m Melanie Cole.