Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging

BACKGROUND: The aim of this prospective study was to evaluate the efficacy of a combined (local and systemic) steroid therapy on the extent of chronic polypoid rhinosinusitis and patient symptoms. METHODS AND PATIENTS: Subjects of this study were 20 patients with severe c hronic polypoid rhinosinusitis with total or subtotal narrowing of the all sinuses, A nasal budesonide spray (2 x 0.1 mg/day) and an oral fluocortolon e medication with a daily reduction during a 12-day period (total dose: 560 mg = group 1) and a 20-day period (total dose: 715 mg = group 2), respecti vely, were administered, Before and after the steroid treatment we evaluate d the extent of the sinusitis with MRI and patient symptoms with symptom-re lated questionnaires, RESULTS: A significant reduction (>30%) of the chronic polypoid rhinosinusi tis was observed in 50% of MRI findings. The steroid effect on polypoid mas ses was heterogeneous in different anatomic areas (maxillary sinus 40%, ant erior ethmoid 19%, posterior ethmoid 33%, sphenoidal sinus 61%, frontal sin us 46%), Most sinusitis-related symptoms were distinctly diminished in most patients (80%), No major side effects were observed. CONCLUSIONS: A combined short-term steroid therapy is highly effective in c hronic polypoid rhinosinusitis, reducing the mucosal inflammation mainly in the large sinuses and reducing the incidence of symptoms significantly, Ho wever, this therapy was insufficient in the anterior ethmoid and cannot rep lace the current surgical treatment concept of the osteomeatal complex in C PR. The indication for such a short-term steroid therapy is the preoperativ e treatment. It facilitates functional endoscopic sinus surgery by reducing the extent of surgical procedures, the time, and thereby the risks of sinu s surgery.