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Initial Treatment With Oral Steroids for Chronic Sinusitis Accompanied by Nasal Polyps FREE

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The full report is titled “Treatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids. A Randomized Trial.” It is in the 1 March 2011 issue of Annals of Internal Medicine (volume 154, pages 293-302). The authors are S. Vaidyanathan, M. Barnes, P. Williamson, P. Hopkinson, P.T. Donnan, and B. Lipworth.

Ann Intern Med. 2011;154(5):I-34. doi:10.7326/0003-4819-154-5-201103010-00001
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What is the problem and what is known about it so far?

Chronic rhinosinusitis (CRS) is a common medical condition in which inflammation of the lining of the nose and sinuses (airspaces in the skull) causes poor drainage of fluids from the sinuses, leading to nasal congestion, pressure, and pain in the face. In some patients, repeated episodes of inflammation (for example, due to infections or allergies) cause the lining of the sinuses to swell with fluid and protrude as polyps, which may result in more inflammation and further impair drainage.

Why did the researchers do this particular study?

Nasal steroid sprays are widely used to attempt to reduce inflammation and treat CRS; however, their effectiveness might be reduced if polyps block the spray from adequately reaching inflamed areas. Although some physicians try to first open the sinuses with a short course of steroid pills so that subsequent steroid sprays can work better, it is unclear whether this strategy is effective.

Who was studied?

60 adults who were referred to ear, nose, and throat specialists by their primary physician for evaluation and treatment of CRS. The ear, nose, and throat specialists confirmed that CRS with nasal polyposis was present.

How was the study done?

The participants were randomly assigned to receive either steroid or placebo pills by mouth for an initial 2 weeks. After that, both groups received steroid drops and then steroid spray for a total of 26 weeks. The researchers measured the size of the polyps in the participants' noses before and after treatment and asked them to complete questionnaires about their symptoms (such as their sense of smell).

What did the researchers find?

Over the course of the 28-week study, participants who started out receiving the steroid pills had greater shrinkage of their nasal polyps than those who received placebo pills. In addition, those who received the steroid pills had greater improvement in their sense of smell. No problematic side effects were seen.

What were the limitations of the study?

The participants were evaluated by specially trained ear, nose, and throat physicians who were expert in recognizing nasal polyps. Not all patients with CRS have nasal polyps. Whether the treatment used in this study would be beneficial (or harmful) in patients who have not been evaluated by specialist physicians, or who do not have nasal polyps, is unknown.

What are the implications of the study?

Some patients who have CRS with nasal polyposis might benefit from initial treatment with steroid pills.





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