Topical Corticosteroids in Nasal Polyposis

Abstract

Nasal polyps are the common end-point of a number of conditions characterised by inflammation and are rarely 'curable' in its true sense. After consideration of the underlying aetiology and confirmation of the diagnosis, they are normally managed by a combination of medical and surgical interventions. Of these, topical corticosteroids have proved to be the medical treatment of choice. The objectives of the medical management are to eliminate or reduce the size of polyps, re-establish nasal airway and nasal breathing, improve or restore the sense of smell, and prevent recurrence of nasal polyps. The mechanism of action of corticosteroids may be by a multifactorial effect on various aspects of the inflammatory reaction, the effect being initiated by their binding to a specific cytoplasmic glucocorticoid receptor. At a cellular level, there is a reduction in the number of antigen-presenting cells, in the number and activation of T cells, in the number of mast cells, and in the number and activation of eosinophils. When polyps are large (grade 3) topical medication is difficult to instil in a very blocked nose and surgery or short term systemic corticosteroids may be required. Topical corticosteroids are of use in the primary treatment of nasal polyps when they are of a small or medium size (grades 1 and 2) and in the maintenance of any therapeutic improvement. The efficacy of topical corticosteroids such as betamethasone sodium phosphate nose drops, beclomethasone dipropionate, fluticasone propionate and budesonide nasal sprays in reducing polyp size and rhinitis symptoms has been demonstrated in several randomised, placebo-controlled trials. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Placebo-controlled studies of agents that have shown a significant clinical effect in the management of nasal polyposis are reviewed.

Aspectos histológicos do pólipo rinossinusal

“…Other options are systemic corticosteroids and even antibiotics, such as the macrolides, which also have anti-inflammatory effects on nasal and sinusal polyps. [14][15][16] Thus, the morphological structure of nasal polyps may undergo significant alterations due to medical treatment, particularly when topical and systemic corticosteroids are used. Based on this assumption, the purpose of our study was to analyze nasal polyp histology in patients that had not undergone drug therapy for polyps.…”

Comparative study of conventional versus microdebrider assisted endoscopic sinus surgery in sinonasal polyposis

“…13,14 The high tendency to recurrence and risk of systemic side effects with steroids make surgical management more favourable for recurrent cases. 15 The recent modality, microdebrider assisted endoscopic sinus surgery offers better therapeutic approach for patients when compared to endoscopic sinus surgery with the conventional instruments. 6,8 The major advantages in utilizing the microdebrider as the primary instrument in endoscopic sinus surgery is the cost-effectiveness of the tool as multiple functions may be achieved with a single instrument, serving advantageous in a limited working area in narrow nasal cavities having proximity to skull base.…”

Glucocorticoid Resistance in the Upper Respiratory Airways

“…The main reasons for GC failure are: limited action of topical GC in extensive diseases [53], poor compliance with treatment [54] , and cellular/molecular resistance to GC [36,55]. Among cellular and molecular mechanisms of GC resistance, the main lines investigated are GR -GR interaction and TF influence.…”