Postoperative Management of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps: Impact of High-Dose Corticosteroid Nasal Spray

Abstract

Introduction Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrent mild and moderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 ( p < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 ( p < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…However, the data reporting in this study is poor 1542 . A small cohort study, assessing post ESS CRSwNP patients that had mild recurrent polyps on once daily mometasone 200 μg were evaluated on twice daily regime, finding reduced polyp score over once daily therapy 1581 …”

Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis

“…In addition to improvements in the above outcomes, RWE studies reported that non-biologics improved SNOT-22 scores, Lund-Kennedy CT and endoscopic scores, total symptom scores by VAS, and nasal polyp scores (Supplementary Tables 5, 7 , 9, 11, 13, and 14). Four RCTs [77][78][79][80] and 4 RWE studies [81][82][83][84] reported on non-biologics (corticosteroids and ESS) for patients with eCRSwNP. All eight studies demonstrated improvement in clinical outcomes.…”

Predictors of Disease Control After Endoscopic Sinus Surgery Plus Long-Term Local Corticosteroids in CRSwNP

“…Some authors, in fact, have noted the potential risks of long-term use of daily budesonide nasal irrigations on hypothalamic-pituitary-adrenal axis suppression, especially during concomitant use of pulmonary steroid inhalers. 33,34…”