Polypoidal chronic rhinosinusitis & allergic fungal sinusitis are the most famous sinonasal disorders all over the world which resist medical or surgical treatment by its recurrence even after use of new technology "sinoplasty". Recently, steroid nasal irrigation was used giving a promising result including significant improvement without need of surgery & also used post FESS leading to long durated improvement with delay of recurrence. These results overcome the results obtained by classic steroid nasal spray as I noted in my institute with some patients treated by steroid nasal irrigation.
During my residency training, I have had experience using nasal saline irrigations supplemented with pulmicort instillations. I found a high rate of success using this treatment method for primary treatment and post-surgical treatment/maintenance regime, especially in CRS with polyps.
Thanks much Dr. Vincent for your sharing. Are there any recent experience in your institute regarding steroid nasal irrigation & what is the protocol of use & outcome?
I started irrigations with Budesonide 1mg/2ml dissolved in 240ml saline in patients with recurrent eosinophilic nasal polyps after reading publications and listening to oral presentation of Prof. Harvey fom Sydney, Australia. It seems important that irrigation is applied with pressure in order to enter the sinuses which works best after having created wide ostia surgically, for the frontal sinus a Draf Typ III median drainage is optimal. Subjective success is good but I have just started following my patients with a SNOT-20.
Thanks Dr. Bernhard for your sharing. Is SNOT-20 enough alone to assess the outcome of use of steroid irrigation. I think a comparative group using classic steroid spray is useful to know any significant difference regarding results of the two groups.
During the last Academy meeting, budesonide/saline irrigation was quite often discussed topic and there was consensus that it is an effective treatment for post ESS cases to delay the recurrence. I am planning to start this treatment. will update my findings.
I noted that one of the followers of my last above mentioned comment disliked that comment. So i try to clarify more & more. I rethank Dr. Bernhard for his sharing & i'd like to ask him, Is SNOT-20 enough alone to assess the outcome of use of steroid irrigation? In other wards, regarding your observation of your cases, what about the other findings, endoscopic & imaging, does they accord with patient' answer of SNOT-2O? I think a comparative group using classic steroid spray is useful to know any significant difference regarding results of the two groups. I hope Dr. Bernhard rejoin us again & give more details about any other findings (endoscopic & sinus imaging) found during following his patients. Thanks for all.
Laryngoscope. 2003 Apr;113(4):683-7.
Corticosteroid treatment in nasal polyposis with a three-year follow-up period.
Bonfils P1, Norès JM, Halimi P, Avan P.
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Abstract
OBJECTIVES/HYPOTHESIS:
The management of nasal polyposis is undoubtedly a controversial subject. The part played by surgery seems to be steadily growing, if the number of published reports dedicated to this approach is any yardstick. Although the medical treatment remains the undisputed therapeutic mainstay, trials dedicated to the long-term assessment of its overall efficacy are scarce.
STUDY DESIGN:
Retrospective medical record review.
METHODS:
The aim of the study is focused on the evaluation of a dual modality, topical and systemic, over a follow-up period of 3 years. In all, 100 patients were treated according to a standardized therapeutic protocol combining short-term oral administration of prednisolone and daily intranasal spray of beclomethasone.
RESULTS:
Over the follow-up period of 3 years, this dual modality proved to be successful in 85% of the patients; only 15% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 58% to 80%, according to the symptom type. The daily dosage of prednisolone and beclomethasone was progressively decreased while the gain in nasal comfort was being preserved.
CONCLUSIONS:
Management of nasal polyps should be primarily medical. Resorting to surgical procedures should not be envisaged before a trial is conducted of dual steroid therapy under a regimen of strict compliance to treatment.
Acta Otolaryngol. 2007 Apr;127(4):436-46.
Evaluation of the combined medical and surgical treatment in nasal polyposis. I: functional results.
Bonfils P1.
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Abstract
CONCLUSION:
This prospective study is the first in the literature to present long-term results of a combined medical and surgical treatment in patients with nasal polyposis (NP) including strict inclusion criteria, analysis of the results in terms of clinical amelioration, polyp size reduction, and steroid consumption. The results of the present study show that combined surgery and corticosteroid therapy is effective in the treatment of NP.
OBJECTIVE:
Most publications on outcome after functional endoscopic sinus surgery (FESS) include patients with various pathologies. The aim of this study was to provide reference information for FESS in patients with NP with strict inclusion and exclusion criteria.
MATERIALS AND METHODS:
This was a prospective study involving 194 consecutive patients. Clinical symptoms, polyp size, and steroid consumption were evaluated before and after FESS (mean follow-up, 74 months). An actuarial analysis using the Kaplan Meier life table method was performed with regard to the 3- and 5-year symptoms control rates.
RESULTS:
All symptoms were improved after FESS. The 5-year actuarial nasal obstruction control rate was 65.8%. The 5-year actuarial severe posterior rhinorrhea control rate was 82.9%. The 5-year actuarial smell loss and anosmia control rates were 17.7% and 65.8%, respectively. Polyp volume and steroid consumption decreased significantly after FESS.
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