Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations

2012 ◽  
Vol 3 (2) ◽  
pp. 104-120 ◽  
Author(s):  
David M. Poetker ◽  
Luke A. Jakubowski ◽  
Devyani Lal ◽  
Peter H. Hwang ◽  
Erin D. Wright ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Evidence Based ◽  
Oral Corticosteroids

Treatment options for chronic rhinosinusitis with nasal polyps

2021 ◽  
Vol 42 (6) ◽  
pp. 450-460 ◽  
Author(s):  
Dana V. Wallace
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Evidence Based ◽  
International Consensus ◽  
Potential Harm ◽  
Intranasal Corticosteroids ◽  
Oral Corticosteroids ◽  
International Consensus Statement

Background: The management of chronic rhinosinusitis with nasal polyps (CRSwNP) is evolving, with an emphasis on treating the underlying type 2 inflammation. Objective: The objective was to summarize the updated evidence-based medical and surgical treatment recommendations for CRSwNP, including the position of biologics in the treatment algorithm. Methods: This review compared and contrasted the therapeutic recommendations presented by the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 and the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021. Results: The long-term use of intranasal corticosteroids and the short-term use of oral corticosteroids are strongly recommended, whereas corticosteroid-eluting implants are considered an option. Although the use of saline solution rinses is recommended, there is uncertainty as to whether irrigation is more effective than sprays. Oral aspirin (ASA) desensitization, followed by ASA ≥ 300 mg daily for patients with ASA-exacerbated respiratory disease may be considered. In general, the use of antifungal agents offers no benefit and potential harm. Although the use of oral antibiotics for an acute exacerbation is still debated, oral and topical antibiotics are discouraged for subacute or chronic use. Antileukotrienes are inferior to intranasal corticosteroids and are unlikely to provide added benefit when used concomitantly. It is unlikely that the benefit of oral antihistamines and decongestants outweigh the potential harm. Dupilumab is recommended for severe CRSwNP when consensus-determined criteria are met. Omalizumab may be an option with concomitant poorly controlled asthma. Mepolizumab and reslizumab may be used, particularly in patients with concomitant uncontrolled asthma. In allergic fungal rhinosinusitis, oral and topical antifungals, antileukotrienes, allergen immunotherapy, and omalizumab are therapeutic options. Although surgical intervention is recognized to be of benefit for CRSwNP, there are no evidence-based criteria to indicate when maximum medical treatment has failed. Conclusion: An evidence-based CRSwNP treatment algorithm for when to recommend surgery and/or initiate or discontinue biologics to maximize quality of life and cost-effectiveness is still lacking.

Evidence-based Surgery for Chronic Rhinosinusitis with and without Nasal Polyps

2014 ◽  
Vol 14 (4) ◽  
Author(s):  
Christos Georgalas ◽  
Marjolein Cornet ◽  
Gwijde Adriaensen ◽  
Susanne Reinartz ◽  
Carlijn Holland ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Evidence Based ◽  
Evidence Based Surgery

scholarly journals Nasal IL-25 predicts the response to oral corticosteroids in chronic rhinosinusitis with nasal polyps

2018 ◽  
Vol 141 (5) ◽  
pp. 1890-1892 ◽  
Author(s):  
Haiyu Hong ◽  
Fenghong Chen ◽  
Yueqi Sun ◽  
Qintai Yang ◽  
Wenxiang Gao ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyps ◽  
Oral Corticosteroids

scholarly journals Short Term Pre-Operative Oral Corticosteroids—Tissue Remodeling in Chronic Rhinosinusitis with Nasal Polyps

2021 ◽  
Vol 10 (15) ◽  
pp. 3346
Author(s):  
Kamil Radajewski ◽  
Paulina Kalińczak-Górna ◽  
Marek Zdrenka ◽  
Paulina Antosik ◽  
Małgorzata Wierzchowska ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Nasal Polyps ◽  
Tissue Remodeling ◽  
Oral Steroid ◽  
Topical Steroids ◽  
Preoperative Period ◽  
Oral Corticosteroids ◽  
Nasal Steroid ◽  
Group 1

Chronic rhinosinusitis is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps. The main histological features of tissue remodeling are changes in epithelial structure, oedema, degradation of ECM (extracellular matrix), angiogenesis, and subepithelial fibrosis. In this study, patients were divided into two groups: group 1—patients with CRSwNP (chronic rhinosinusitis with nasal polyps) taking a nasal steroid and an oral steroid in the preoperative period, and group 2—patients with CRSwNP taking only the nasal steroid in the preoperative period. All samples were subject to histopatologic evaluation. The aim of this study was to investigate the effect of oral corticosteroids and topical steroids on the tissue of paranasal sinuses. We have shown statistically significant decreases in tissue eosinophilia per 5HPF and decreased fibrosis in group 1. No significant differences were presented in the percentage of total tissue oedema, epithelium, neutrophils, basement membrane thickening and vessels. Using systemic administration of 40 mg of prednisone for seven days decreased the counts of eosinophils and decreased fibrosis in the nasal polyps tissue in CRSwNP.

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