The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Allergic Rhinosinusitis with Polyps

Abstract

Nasal polyposis is one of the most common chronic upper airway diseases. Management of allergic rhinosinusitis with polyps is to control the disease process and the local immune response of the nasal mucosa. This is achieved by surgical removal of polypoid mucosa of all sinuses by functional endoscopic sinus surgery (FESS) followed by suppression of local immune response by using steroids. Budesonide nasal douching was introduced recently for postoperative management of patients with allergic rhinosinusitis. The therapeutic effectiveness and safety of this procedure are becoming accepted by many physicians. Evaluation of the efficacy of budesonide nasal irrigation in the postoperative management of chronic allergic rhinosinusitis with polyps. A total of 60 postoperative chronic allergic rhinosinusitis with polyps patients were randomly divided into two groups. Both groups received routine post-FESS medication as per the institute protocol. One group of patients received budesonide nasal douching in addition to regular care. Both groups were evaluated endoscopically at 1, 2, 6 and 10 weeks after surgery. Pre and postoperative quality of life change, the patient complaints, need for revision surgery were evaluated. Endoscopic Lund-Kennedy scoring (objective measurement) and Sino-Nasal Outcome Test-22 (subjective analysis) were used to compare the two postoperative groups. The average preoperative Sino-Nasal Outcome Test 22 score was 52.2. It was reduced to an average of 29.4 in patients who used the standard postoperative regimen and to 15.8 postoperatively in patients who had budesonide added to their douching solutions. The average endoscopy score was 2.2 for patients who did receive budesonide as compared to 2.9 for patients who did not receive budesonide nasal douching. Budesonide nasal douching can offer a safe and effective tool in managing local inflammatory response in allergic rhinosinusitis. It leads to a significantly better quality of life and has an adequate response on nasal mucosa-leading to less mucosal oedema and lower incidence of polypoidal changes postoperatively.

Effects of Endoscopic Sinus Surgery Combined with Budesonide Treatment on Nasal Cavity Function and Serum Inflammatory Factors in Patients with Chronic Sinusitis

“…Budesonide is a powerful anti-inflammatory and anti-allergic drug. After topical administration, it is beneficial to inhibit the activation of various inflammatory cells in the nasal cavity, reduce inflammatory damage in the lesion, and promote the absorption of mucosal edema, so as to accelerate the recovery of nasal function and relieve symptoms such as nasal congestion and purulent tears [ 10 ]. However, there are relatively few studies on the comprehensive efficacy of endoscopic sinus surgery combined with budesonide treatment in patients with sinusitis.…”

Sinonasal Irrigation After Endoscopic Sinus surgery – Past to Present and Future

“…Budesonide nasal irrigation has been found to be better that saline irrigation, with lesser mucosal oedema, secretions and scarring and lower incidence of postoperative polypoidal changes [ 27 , 28 ]. In a randomized double-blinded placebo-controlled trial in post sinus surgery patients, the corticosteroid nasal irrigation had greater improvement on nasal blockage, a greater improvement on Lund- Mackay score and less inflammation on modified Lund-Mackay score at 12 months compared to steroid nasal sprays [ 29 ].…”

Improved sinonasal symptom and endoscopy sinus scores with dose‐escalated intranasal mometasone irrigation in patients with refractory chronic rhinosinusitis

“…Postoperatively, patients continue maintenance topical therapies. Historically, steroid sprays have been used, although recent studies have shown that high‐volume steroid irrigations are more effective 3–5 . Numerous studies have demonstrated the safety of longitudinal intranasal use of various steroid irrigations 6 …”

“…Historically, steroid sprays have been used, although recent studies have shown that high-volume steroid irrigations are more effective. [3][4][5] Numerous studies have demonstrated the safety of longitudinal intranasal use of various steroid irrigations. 6 This is the first study to assess the effect of doseescalated intranasal mometasone irrigations on disease burden and patient-reported sinonasal symptoms following surgery.…”