M. Damm et al., Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging, OTO H N SUR, 120(4), 1999, pp. 517-523
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.