Sensitivity of a New Grading System for Studying Nasal Polyps with the Potential to Detect Early Changes in Polyp Size after Treatment with a Topical Corticosteroid (Budesonide)

Abstract

We have previously compared different scoring systems for endoscopic staging of nasal polyps. Of the five methods evaluated, we found that two were better than the others with regard to reproducibility and agreement between physicians. One method was lateral imaging, developed by the authors, and the other was a scoring system developed by Lildholdt et al. The main objective of the present study was to compare the sensitivity of these two methods. Another aim was to study the effect on nasal polyposis of topical nasal corticosteroids over a 2-week period. Patients with bilateral nasal polyposis (n = 100) were randomized to a 2-week treatment with a topical corticosteroid (budesonide aqueous nasal spray: 128 microg b.i.d.) or placebo in a double-blind manner. Nasal symptoms were scored before treatment and after 3, 7 and 14 days of treatment, and the patients underwent nasal endoscopy at clinical visits. Patients treated with active substance had an improvement in their symptoms, an effect already detectable after 3 days of treatment, compared with those who received placebo. In addition, a statistically significant decrease in polyp size could be registered after 14 days using lateral imaging but not with the other scoring system. In conclusion, lateral imaging was more sensitive and could detect effects earlier than the other scoring system and can be recommended for the endoscopic staging of nasal polyps in clinical studies.

Sinus Surgery and Delivery Method Influence the Effectiveness of Topical Corticosteroids for Chronic Rhinosinusitis: Systematic Review and Meta-Analysis

“…18,20 The correlation coefficient was calculated in the experimental and control groups from some studies 38,39 and was used to calculate the imputation of standard deviation of change in symptom scores for other studies. 18,[34][35][36] …”

“…For missing standard deviations, either 95% CIs, 23,31,32 standard error. 19,21,[33][34][35][36][37] p value, 26 range, 20 or interquartile ranges 18,20 was used for estimation to impute standard deviations. For missing means, medians were converted.…”

“…For 27 trials (56.3%), 17,19,20,26,30,33,34,[37][38][39]43,[46][47][48]50,[52][53][54][55][56][57][58][59][60][61][62]64 patients (all or the majority) had sinus surgery before administering steroid either as a cointervention or they had previous surgery documented. In 15 (31.3%) studies, 18 …”

Intranasal Diprospan Injection for Chronic Rhinosinusitis Treatment-Two Case Reports

“…Cultures can also be obtained endoscopically [13]. Discolored nasal discharge, polyps, or polypoid swelling seen with anterior rhinoscopy or endoscopy, and edema or erythema of the middle meatus or ethmoid bulla seen on endoscopy, are consistent with CRS [2,14]. In Case 1 patient polyps are closed both nasal passages and endoscopicaly was possible to view only 1,5 cm of the nasal passage depth.…”

Objective Outcomes in Endoscopic Sinus Surgery

“…After finding poor inter-rater agreement using the Lund-Mackay polyp scoring but a high correlation using lateral imaging and the four step scoring system proposed by Lildholdt et al, that same group then conducted a study in 2002 to identify the sensitivity of grading systems for detect early changes in polyp disease with topical budesonide treatments in a prospective, randomized placebo controlled trial. Lateral imaging showed statistically significant changes in polyp size was detectable after 14 days of topical corticosteroid use and found to be more sensitive than the Lildholdt staging (Johansson et al, 2002). Rasp et al from the Ludwig-Maximilians-Universität in Munich proposed a four grade polyp score to include early polypoid changes and was again validated and employed to evaluate effect of topical and systemic steroid therapy (see table 7) (Rasp et al, 2000, Kramer&Rasp, 1999.…”