Topical Triamcinolone Acetonide/Carboxymethylcellulose Foam for Acute Exacerbations of Chronic Rhinosinusitis/Nasal Polyposis

Abstract

Objectives:

Chronic rhinosinusitis with nasal polyposis (CRS/NP) is a medical disease that is managed more effectively after endoscopic sinus surgery (ESS). Despite topical steroid management, acute inflammatory exacerbations (AEs) are common and typically treated with oral prednisone with well documented side effects. The objective of the current study was to critically evaluate the topical application of triamcinolone acetonide (160mg) in carboxymethylcellulose foam (TA/CMC) for AEs of CRS/NP after ESS.

Methods:

CRS/NP patients managed with ESS by a single rhinologist over a 5 year period were included in the study. Data were reviewed regarding demographics, number of AEs, revision surgery, Sinonasal Outcomes Test-22 scores (SNOT-22), frequency of oral prednisone and/or TA/CMC, and notable side effects.

Results:

A total of 371 CRS/NP patients were managed with ESS (49.3 weeks follow-up, range 2-249). All patients were managed with topical saline irrigations BID containing budesonide (0.5mg) or mometasone (0.6mg). Revision surgery was required in 8 patients. During this time period, 130 patients (46 years, range 28-48) developed 267 AEs. Prior to initiating use of TA/CMC in 2010, 66 AEs were treated with prednisone. Subsequently, 116 out of 201 AEs were managed with TM/CMC with a sequential decrease in prednisone use over the last 3 years (77%, 39%, and 32%). SNOT-22 scores (n=33 within 3 weeks) decreased significantly following TA/CMC instillation (1.69+/-0.86, pre vs. 1.23+/-0.8, post; P < 0.01).

Conclusions:

Management of AEs of CRS/NP changed dramatically with the use of TA/CMC in the current evaluation. The treatment appears well tolerated and is a useful tool for CRS/NP AEs in postoperative patient.