Impact of Topical Corticosteroid Irrigations on Sinonasal Wound Healing

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease frequently requiring surgical intervention and the long-term use of topical corticosteroids to control patient symptoms. However, corticosteroids may delay postoperative recovery following sinus surgery by disrupting tissue inflammation, a key mediator of early wound healing. This study therefore seeks to assess the impact of topical corticosteroids on sinonasal epithelial healing following local injury.

Methods

Primary human nasal epithelial cells (HNECs) were collected from two patients with CRSwNP and differentiated at air–liquid interface (ALI). A linear scratch was introduced to each monolayer of differentiated HNECs, followed by apical treatment with or without budesonide (2 μg/mL) to simulate topical use. Live-cell imaging assessed time to wound closure. Epithelial barrier function was assessed with trans-epithelial electrical resistance (TEER) before the injury as a baseline, immediately post-injury, and at 12 and 24 hours.

Results

All wounds closed within 19 hours. The average time to wound closure was 15.1 hours for CRSwNP HNECs exposed to budesonide and 12.3 hours for those exposed to control media. This difference was statistically significant (P = .0033) despite a relatively small cohort. TEER values universally increased following an initial drop from baseline induced by scratch injury. No statistically significant difference in TEER recovery was observed between groups.

Conclusion

Wound closure was delayed in CRSwNP HNECs exposed to budesonide versus control; however, no wounds failed to close, and no difference was identified in the return of epithelial barrier function. Topical corticosteroids may be safely initiated 24 hours following ESS.