Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies.

OBJECTIVE: This study aims to evaluate the increase in power of cochlear implants (CI) as the reference electrode (RE) position changes. Patients in whom it is necessary to use the full power of the device to achieve the desired stimulation levels, this strategy will ensure that stimulation capability is maximized. MATERIALS and METHODS: The variability in RE placement in the temporal bone has a measurable effect on the electrical current, impedance, and power consumption, and if the electrode position has a functional effect on the stimulation intensity. The following three approaches were used: 1) classical circuit analysis, 2) 2-dimensional numerical simulations, and 3) real temporal bone measurements using a purpose-made CI. RESULTS: The three approaches demonstrate a significant decrease in the current intensity and electrical resistance for distances that are closer to the intra-cochlear electrode. The results also demonstrate that to maintain a constant current, shorter distances require 33% less power. CONCLUSION: Reference electrode position during surgery can make significant differences in CI power consumption and threshold intensity, which allows a more powerful stimulation in complicated patients (i.e., those with otosclerosis). This study presents an attractive perspective to surgeons, as it shows a way to decrease consumption that might result in a longer battery life or more power to be devoted to coding strategy performance.