Topical corticosteroid spray is widely used after endoscopic sinus surgery (ESS) to reduce the recurrence of polyposis. However, it has not always shown satisfactory results in clinical practice. We compared the effects of topical spray and high-dose topical steroid gauze packing on the prevention of recurrent nasal polyps after ESS.
Methods
We selected 32 patients with recurrent nasal polyps after ESS. In group 1, 18 patients were treated with topical steroid spray and in group 2,14 patients were treated with triamcinolone acetonide–soaked (40 mg) gauze packing once a week for 2 months after revision ESS. We observed the recurrence of polyps between the two groups for 12 months.
Results
Polyps recurred in 8 of 18 patients in group 1 compared with 1 of 14 patients in group 2 (p = 0.044).
Conclusion
High-dose topical corticosteroid therapy may be more effective than low-dose topical therapy in preventing recurrent nasal polyps.
LarsenP.L., and TosM.Origin and structure of nasal polyps. In Nasal Polyposis: An Inflammatory Disease and Its Treatment.MygindN., and LilholdtT. (Eds). Copenhagen: Munks-gaard, 17–30, 1997.
2.
HiranoS., AsanoK., NambaM.Induction of apoptosis in nasal polyp fibroblasts by glucocorticoids in vitro.Acta Otolaryngol123: 1075–1079, 2003.
3.
MygindN., and AnderssonM.Topical glucocorticosteroids in rhinitis: Clinical aspects.Acta Otolaryngol126: 1022–1029, 2006.
4.
SaundersM.W., WheatleyA.H., GeorgeS.J.Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? In vivo and in vitro studies.Laryngoscope109: 785–790, 1999.
5.
LildholdtT., RundcrantzH., and LindqvistN.Efficacy of topical corticosteroid powder for nasal polyps: A doubleblind, placebo-controlled study of budesonide.Clin Otolaryngol20: 26–30, 1995.
6.
MygindN., PrytzS., SorensenH.Long-term treatment of nasal polyps with beclomethasone dipropionate aerosol.Acta Otolaryngol (Stockh)82: 252–255, 1976.
ValeraF.C., and Anselmo-LimaW.T.Evaluation of efficacy of topical corticosteroid for the clinical treatment of nasal polyposis: Searching for clinical events that may predict response to treatment.Rhinology45: 59–62, 2007.
9.
DijkstraM.D., EbbensF.A., PoublonR.M.L.Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery.Clin Exp Allergy34: 1395–1400, 2004.
10.
BeckerS.S., RasamnyJ.K., HanJ.K.Steroid injection for sinonasal polyps: The University of Virginia experience.Am J Rhinol21: 64–69, 2007.
11.
UllasR., and NicholasS.J.A prospective randomized blinded cross-over trial using nasal drops in patients with nasal polyposis: An evaluation of effectiveness and comfort level of two head positions.Am J Rhinol20: 379–400, 2006.
12.
HissariaP., SmithW., WormaldP.J.Short course of systemic corticosteroids in sinonasal polyposis: A doubleblind, randomized, placebo-controlled trial with evaluation of outcome measures.J Allergy Clin Immunol118: 128–133, 2006.
13.
Bross-SorianoD., Arrieta-GómezJ.R., and Prado-CallerosH.Infections after endoscopic polypectomy using nasal steroids.Otolaryngol Head Neck Surg130: 319–322, 2004.
14.
KroflicB., CoerA., BaudoinT.Topical furosemide versus oral steroid in preoperative management of nasal polyposis.Eur Arch Otorhinolaryngol263: 767–771, 2006.
15.
MuratY., FehmiD., RecepS.The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue.Am J Rhinol19: 248–250, 2005.
16.
KlossekJ.M., PeloquinL., FriedmanW.H.Diffuse nasal polyposis: Postoperative long-term results after endoscopic sinus surgery and frontal irrigation.Otolaryngol Head Neck Surg117: 355–361, 1997.
17.
MeltzerE.O., OrgelH.A., BackhausJ.W.Intranasal flunisolide spray as an adjunct to oral antibiotic therapy for sinusitis.J Allergy Clin Immunol92: 812–823, 1993.
18.
DesrosiersM., HussainA., FrenkielS.Intranasal corticosteroid use is associated with lower rates of bacterial recovery in chronic rhinosinusitis.Otolaryngol Head Neck Surg136: 605–609, 2007.
19.
QvarnbergY., KantolaO., SaloJ.Influence of topical steroid treatment on maxillary sinusitis.Rhinology30: 103–112, 1992.
20.
WeberR., KeerlR., RadziwillR.Videoendoscopic analysis of nasal steroid distribution.Rhinology37: 69–73, 1999.
21.
CannadyS.B., BatraP.S., CitardiM.J.Comparison of delivery of topical medications to the paranasal sinuses via “vertex-to-floor” position and atomizer spray after FESS.Otolaryngol Head Neck Surg133: 735–740, 2005.
22.
St MartinM.B., HitzmanC.J., WiedmannT.S.Deposition of aerosolized particles in the maxillary sinuses before and after endoscopic sinus surgery.Am J Rhinol21: 196–197, 2007.
23.
CitardiM.J., and KuhnF.A.Endoscopically guided frontal sinus beclomethasone instillation for refractory frontal sinus/recess mucosal edema and polyposis.Am J Rhinol12: 179–182, 1998.
24.
LavigneF., CameronL., RenziP.M.Intrasinus administration of topical budesonide to allergic patients with chronic rhinosinusitis following surgery.Laryngoscope112: 858–864, 2002.
25.
RobinsonS., AdamsD., and WormaldP.J.The effect of nasal packing and prednisolone on mucosal healing and reciliation in a sheep model.Rhinology42: 68–72, 2004.
