to prevent the recurrence of nasal polyposis after fess , nasal steroid is enough or oral steroids are mandatory ?
I think nasal steroid spray is enough for post-op: nasal polyp cases. And then nasal douching is needed. We can use oral steroid in pre-op: to reduce polyp size & vascularity.
To my experience oral steroids combined with corticosteroid spray are essenital pre operatively to reduce size &vascularity of polyps,but postoperatively i think local steroids are suffecient
In the immediate post-operative days, there is is a lot of discharge and crustations and in some cases packs. I usually prefer to administer oral steroids for 7-10 days until the cavities are clear and then put the patient on local steroids.
I do not kow of any study that has looked into this question specifically. Therefore, just adding my personal preference without any solid scientific backup, I prefer to use only nasal steroids mometazone spray, but twice the dose (2 puffs twice daily) for the first month after FESS. Then, I reduce it to 2 puffs once daily for the rest of his life. I advise them never to stop the steroid spray.
Preoperatively however, I always use both oral and local steroids.
I don't know is their any prooved guide lines in concern of this issue ! however I agre prof Badr that the systemic corticosteriods are essential in the posoperative days. My trend is to give 1 week pre. as well as 1 week posoperative.Local sprays are given pre and post as well.
First we have to ascertain whether its Polyposis with allergic fungal sinusitis in which case I give oral steroids 0.75 mg / Kg body weight 10 days before surgery and continue post-op for one month gradually tapering. In other cases i prefer to continue post op intranasal steroids up to 6 months.
The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 (EPOS 2012) mentioned 17 investigations on the outcome of intranasal corticosteroids versus placebo for the postoperative treatment of CRSwNP, 12 of which supported the use of nasal steroids. In analyzing the evidence and recommendations for the postoperative treatment of adults with CRSwNP, the same EPOS 2012 Position Paper said that the value of both topical and oral steroids was supported by a Ia level of evidence and an A grade of recommendation.
In a very recent, preliminary and unpublished study of our group (Padova University) comparing two groups of patients with eosinophilic-type CRSwNP (a histological variant of CRSwNP that carries a high risk of recurrence after FESS) who were treated postoperatively with local nasal steroids alone vs local nasal plus oral steroids, we found no significant differences in the two groups’ recurrence rates and disease-free intervals. On the other hand, it was worth noting that administering a combination of postoperative local nasal and oral steroids we found a significantly lower recurrence rate than the use of local nasal steroids alone in patients with eosinophilic-type CRSwNP who also had asthma or ASA intolerance.
Most studies do conclude that in the POST-operative period, topical / nasal steroids are the only medication required to achieve disease free intervals. I do follow the same too, however our patients are kept on regular endoscopic follow-up and if there is any early recurrence of polyposis seen, we start them on a short course of oral steroids over 10 days.
In the next future see also:
Brescia G, Marioni G, Franchella S, Ramacciotti G, Pendolino AL, Callegaro F, Giacomelli L, Marino F, Martini A. Postoperative steroid treatment for eosinophilic-type sinonasal polyposis. Acta Otolaryngol (Stockh), in press
Dear Dr. Gino Marioni, would you mention the sample size of your research groups & the postop F/U duration. Thanks
32 patients with eosinophilic-type CRSwNP underwent post-operatively local steroid nasal therapy (group A); 28 patients with eosinophilic-type CRSwNP underwent post-operatively local steroid nasal therapy plus two cycles per year of oral steroids (group B).
The paper will be available soon:
Brescia G*, Marioni G*, Franchella S, Ramacciotti G, Pendolino AL, Callegaro F, Giacomelli L, Marino F, Martini A. Postoperative steroid treatment for eosinophilic-type sinonasal polyposis. Acta Otolaryngol (Stockh), in press.
Post-operative steroid treatment for eosinophilic-type sinonasal polyposis.
Brescia G, Marioni G, Franchella S, Ramacciotti G, Pendolino AL, Callegaro F, Giacomelli L, Marino F, Martini A.
Acta Otolaryngol. 2015;135(11):1200-4. doi: 10.3109/00016489.2015.1063784
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