Higher vs Standard Dose Steroid After Endoscopic Sinus Surgery for Nasal Polyposis

Topical nasal steroids are commonly prescribed to patients with chronic rhinosinusitis with nasal polyposis after endoscopic sinus surgery to improve symptoms and quality of life, as well as reduce the incidence of nasal polyp recurrence.¹ These nasal sprays have been shown to have minimal systemic absorption and can be safely used as a long-term maintenance therapy in patients with chronic rhinosinusitis with nasal polyposis.^2-5

However, there is an increasing emphasis on the use of higher-dose topical steroid therapy to further decrease disease burden and prevent polyp recurrence, especially during the postoperative period.¹ There is concern for increased systemic absorption, as well as the potential for adrenal suppression and other long-term systemic steroid effects.

Thus, researchers sought to determine whether a higher concentration of topical nasal steroid spray (dexamethasone; n=8) is more effective than the standard nasal steroid spray (fluticasone; n=10) in controlling symptoms and preventing recurrence of polyps in patients with chronic rhinosinusitis with nasal polyposis who underwent endoscopic sinus surgery. They found that both groups experienced significant improvements in postoperative Sino-Nasal Outcome Text (SNOT-22) and Lund-Kennedy nasal endoscopy scores over time, and that there was no significant difference in improvement between the groups.

“There is no significant increased benefit in using a higher dose nasal steroid spray (dexamethasone) compared to standard dose nasal steroid spray (fluticasone) in the postoperative period, thereby not justifying the known increased systemic effects of the higher dose spray,” the researchers concluded.¹

References

1. Seiberling KA, Kidd SC, Kim GH, Church CA. Efficacy of dexamethasone versus fluticasone nasal sprays in postoperative patients with chronic rhinosinusitis with nasal polyps [published online April 16, 2019]. Am J Rhinol Allergy. doi:10.1177/1945892419841355
2. Day JH, Anderson CB, Briscoe MP. Efficacy and safety of intranasal budesonide in the treatment of perennial rhinitis in adults and children. Ann Allergy. 1990;64:445-450.
3. Lindquist N, Balle VH, Karma P, et al. Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. Allergy. 1986;41(3):179-186.
4. Moller C, Ahlstrom H, Henrickson KA, et al. Safety of nasal budesonide in the long-term treatment of children with perennial rhinitis. Clin Exp Allergy. 2003;33(6):816-822.
5. Pipkorn U, Pukander J, Suonpaa J, et al. Long-term safety of budesonide nasal aerosol: a 5.5-year follow-up study. Clin Exp Allergy. 1988;18:253-259.