ENDOSCOPICALLY GUIDED FRONTAL-SINUS BECLOMETHASONE INSTILLATION FOR REFRACTORY FRONTAL SINUS RECESS MUCOSAL EDEMA AND POLYPOSIS/

Despite its metabolic complications, systemic corticosteroid therapy r emains a mainstay in the treatment of refractory polyposis after endos copic frontal sinusotomy. Furthermore, topical nasal corticosteroids o ften fail, presumably due to the relatively small dosage actually abso rbed by the polyps. In order to minimise steroid complications while i ncreasing the locally absorbed dose, beclomethasone (approximately 1 c c, 84 mcg/100 mu l) was instilled under endoscopic guidance directly i nto the frontal sinus in 31 instances in 16 patients with postoperativ e frontal recess/sinus polyposis and mucosal edema. The frontal recess /sinus polyposis/edema resolved completely in 9 frontal sinuses, impro ved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complicatio ns were noted. AM cortisol levels remained in the normal range. Endosc opically guided frontal sinus beclomethasone instillation should be co nsidered for the treatment of refractory post-operative-frontal sinus/ recess polyposis/edema. Further basic and clinical research into the p athophysiology of the nasal mucosa is also warranted.