Rhinosinusitis with nasal polyps: main aspects of anti-relapse therapy and recovery of nasal breathing

Abstract

Objective. This study was conducted to increase effectiveness of anti-relapse therapy of chronic rhinosinusitis with polyps to create a stable long-term remission in the long-term postoperative period.Patients and research methods. 60 patients with total spread of polyposis process in the nasal cavity and paranasal sinuses were examined. All patients underwent endoscopic polysinusotomy and 3 weeks after surgery, basic anti-relapse therapy of PRS in the form Of nasonex intranasal spray of 400 mcg/day for 6 months in combination with irrigation with isotonic salt solutions was prescribed. At the same time, 30 patients 1.5 months after polysinusotomy were additionally given a short course of systemic corticosteroid therapy with Methylprednisolone, starting at 20 mg/day in combination with Omeprazole at 20 mg /day for 14 days. Subjective assessment of the patients ‘condition was carried out by questionnaire, for objective diagnosis acoustic rhinometry and CT of the paranasal sinuses were used.Results. Simultaneous administration of a short course of corticosteroid therapy in combination with prolonged intranasal use of Nasonex spray in patients with nasal polyps in the postoperative period contributed to the most rapid subjective improvement of nasal breathing. The combined scheme in 27 (90%) subjects showed a statistically significant improvement in intra-nasal aerodynamics (p<0.05) 2 months after polysinusotomy according to the results of acoustic rhinometry, the average MPPS1 was 0.67 ± 0,04 cm2 before and after the decongestant test. In 13 patients (44,3%) who received only intranasal corticosteroids reactive edema from the nasal mucosa were more pronounced, which contributed to the formation of zones of pathological narrowing of the nasal flow and a decrease in МППС1 to 0.43 ± 0,04см2 to test with decongestant. 2 years after surgical treatment in patients undergoing a combined course of corticosteroid therapy in relation to patients receiving only monotherapy with intranasal corticosteroids, there was no recurrence of polyposis in 86.7% of cases (26 patients), against 66.7% (20 patients), receiving only intranasal corticosteroids.