Skip to main content

Advertisement

SpringerLink
Log in

Oral Steroid Therapy in Chronic Rhinosinusitis with and without Nasal Polyposis

  • SINUSITIS (ML KOWALSKI, SECTION EDITOR)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Chronic rhinosinusitis (CRS) is a heterogeneous group of disorders characterized by inflammation of the sinonasal mucosa. CRS can be divided into two subtypes: CRS without polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). Corticosteroids are frequently employed to treat CRS due to their potent anti-inflammatory effects. Treatment of CRS with oral steroids must be carefully balanced against potential adverse effects. This article reviews the current literature on management of CRS with systemic corticosteroids. We discuss the available evidence in CRSsNP, CRSwNP, and allergic fungal sinusitis (AFS). Studies are evaluated for level of evidence and graded to provide evidence-based recommendations. Our review finds a lack of high-quality evidence supporting oral corticosteroid therapy in CRSsNP. In comparison, randomized controlled trails support the use of oral corticosteroids for CRSwNP. Similarly, systemic steroids for AFS treatment are supported by quality studies demonstrating efficacy. Utilization of steroids is also recommended in the perioperative setting for CRSwNP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as • Of importance •• Of major importance

  1. Rosenfeld RM, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007;137 Suppl 3:1–31.

    Article  PubMed  Google Scholar 

  2. Bhattacharyya N. Clinical and symptom criteria for accurate diagnosis of CRS. Laryngoscope. 2006;116 Suppl 110:1–22.

    Article  PubMed  Google Scholar 

  3. Pynnonen MA, Terrell JE. Conditions that masquerade as CRS: a medical record review. Arch Otolaryngol head Neck Surg. 2006;132:748–51.

    Article  PubMed  Google Scholar 

  4. Pleis JR, Lucas JW, Ward BW. Summary health statistics for U.S. adults: national health interview survey, 2008. Vital Health Stat. 2009;242:1–157.

    Google Scholar 

  5. Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Ann Otol Rhinol Laryngol. 2011;20(7):423–7.

    Google Scholar 

  6. Leung R, et al. Upfront computed tomography scanning is more cost-beneficial than empiric medical therapy in the initial management of chronic rhinosinusitis. Int Forum Allergy Rhinology. 2011;1(6):471–40.

    Article  Google Scholar 

  7. Van Crombruggen K, Zhang N, Gevaert P, Tomassen P, Bachert C. Pathogenesis of chronic rhinosinusitis: inflammation. J Allergy Clin Immunol. 2011;128(4):728–32.

    Article  PubMed  Google Scholar 

  8. Kaszuba SM, Stewart MG. Medical management and diagnosis of chronic rhinosinusitis: a survey of treatment patterns by united states otolaryngologists. Am J Rhinol. 2006;20(2):186–90.

    PubMed  Google Scholar 

  9. Dubin MG, Liu C, Lin SY, Senior BA. American rhinologic society member survey on "maximal medical therapy" for chronic rhinosinusitis. Am J Rhinol. 2007;21(4):483–8.

    Article  PubMed  Google Scholar 

  10. OCEBM Levels of Evidence Working Group. “The Oxford 2011 Levels of Evidence”. Oxford Centre for evidence-based medicine. http://www.cebm.net/index.aspx?o=5653. Accessed June 15th 2012.

  11. •• Lal D, Hwang PH. Oral corticosteroid therapy in chronic rhinosinusitis without polyposis: a systematic review. Int Forum Allergy Rhinol. 2011;1(2):136–43. Systematic review of the literature for the use of corticosteroids in CRSsNP. Concluded that there is a paucity of high-level of evidence studies supporting the use of corticosteroids in CRSsNP.

    Article  PubMed  Google Scholar 

  12. Tosca MA, Cosentino C, Pallestrini E, et al. Medical treatment reverses cytokine pattern in allergic and nonallergic chronic rhinosinusitis in asthmatic children. Pediatr Allergy Immunol. 2003;14:238–41.

    Article  PubMed  Google Scholar 

  13. Subramanian HN, Schechtman KB, Hamilos DL. A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis. Am J Rhinol. 2002;16(6):303–12.

    PubMed  Google Scholar 

  14. Lal D, Scianna JM, Stankiewicz JA. Efficacy of targeted medical therapy in chronic rhinosinusitis, and predictors of failure. Am J Rhinol Allergy. 2009;23(4):396–400.

    Article  PubMed  Google Scholar 

  15. Marple BF, Stankiewicz JA, Baroody FM, et al. Diagnosis and management of chronic rhinosinusitis in adults. Postgrad Med. 2009;121:121–39.

    Article  PubMed  Google Scholar 

  16. Scadding GK, Durham SR, Mirakian R, et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy. 2008;38:260–75.

    Article  PubMed  CAS  Google Scholar 

  17. •• Fokkens WJ, Lund VJ, Mullol J, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:3. preceding table of contents, 1–298. Exhaustive evidence based review of the literature on rhinosinusitis and represents the most comprehensive review currently in the literature. A shorter summary paper is also available to improve readability entitled “EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists” published in Rhinology March 2012.

    PubMed  Google Scholar 

  18. Slavin RG, Spector SL, Bernstein IL, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005;116:S13–47.

    Article  PubMed  Google Scholar 

  19. •• Martinez-Devesa P, Patiar S. Oral steroids for nasal polyps. Cochrane Database Syst Rev. 2011;6(7):CD005232. Systematic review of the literature on the use of oral corticosteroids for the management of CRSwNP. Identified 3 studies meeting inclusion criteria and concluded the use of systemic steroids in CRSwNP was supported.

    Google Scholar 

  20. Hissaria P, Smith W, Wormald PJ, et al. Short course of systemic corticosteroids in sinonasal polyposis: a double-blind, randomized, placebo-controlled trial with evaluation of outcome measures. J Allergy Clin Immunol. 2006;118(1):128–33.

    Article  PubMed  CAS  Google Scholar 

  21. Alobid I, Benitez P, Pujols L, et al. Severe nasal polyposis and its impact on quality of life. the effect of a short course of oral steroids followed by long-term intranasal steroid treatment. Rhinology. 2006;44(1):8–13.

    PubMed  Google Scholar 

  22. Van Zele T, Gevaert P, Holtappels G, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125(5):1069–1076.e4.

    Article  PubMed  Google Scholar 

  23. •• Poetker DM, Jakubowski LA, Lal D et al. Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2012. Epub ahead of print. Comprehensive systematic review on the use of oral corticosteroid in the treatment of CRS. Includes critical evaluation of published studies and establishes evidence-based recommendations for the utilization of oral corticosteroids in the management of CRS subtypes.

  24. • Kirtsreesakul V, Wongsritrang K, Ruttanaphol S. Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology. 2011;49(5):525–32. Randomized double-blind placebo-controlled trial evaluating the efficacy of short course of oral steroid in CRSwNP. Concluded that steroid therapy provided short term subjective and objective improvement.

    PubMed  Google Scholar 

  25. • Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med. 2011;154(5):293–302. Randomized double-blind placebo-controlled trial evaluating the efficacy of short course of oral steroid in CRSwNP. Found that oral corticosteroid therapy provided short term subjective and objective improvement however no significant difference compared to placebo by 28 weeks of follow-up.

    PubMed  Google Scholar 

  26. Bent 3rd JP, Kuhn FA. Diagnosis of allergic fungal sinusitis. Otolaryngol Head Neck Surg. 1994;111(5):580–8.

    Article  PubMed  Google Scholar 

  27. • Rupa V, Jacob M, Mathews MS, Seshadri MS. A prospective, randomised, placebo-controlled trial of postoperative oral steroid in allergic fungal sinusitis. Eur Arch Otorhinolaryngol. 2010;267(2):233–8. Only randomized double-blind placebo-controlled trial evaluating the efficacy of short course of oral steroid in the perioperative management of AFS. Found complete resolution of disease on subjective and objective assessment in steroid-treated group.

    Article  PubMed  CAS  Google Scholar 

  28. Ikram M, Abbas A, Suhail A, Onali MA, Akhtar S, Iqbal M. Management of allergic fungal sinusitis with postoperative oral and nasal steroids: a controlled study. Ear Nose Throat J. 2009;88(4):E8–E11.

    PubMed  Google Scholar 

  29. Landsberg R, Segev Y, DeRowe A, Landau T, Khafif A, Fliss DM. Systemic corticosteroids for allergic fungal rhinosinusitis and chronic rhinosinusitis with nasal polyposis: a comparative study. Otolaryngol Head Neck Surg. 2007;136(2):252–7.

    Article  PubMed  Google Scholar 

  30. Wright ED, Agrawal S. Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: evaluation with the novel perioperative sinus endoscopy (POSE) scoring system. Laryngoscope. 2007;117(11 Pt 2 Suppl 115):1–28.

    Article  PubMed  CAS  Google Scholar 

  31. Sieskiewicz A, Olszewska E, Rogowski M, Grycz E. Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: a preliminary investigation. Ann Otol Rhinol Laryngol. 2006;115(7):490–4.

    PubMed  Google Scholar 

  32. Giordano J, Darras J, Chevalier D, Mortuaire G. Preoperative corticosteroid treatment and nasal polyposis. Ann Otolaryngol Chir Cervicofac. 2009;126(3):120–4.

    Article  PubMed  CAS  Google Scholar 

  33. Collins JG. Prevalence of selected chronic conditions: United States, 1990–1992. Vital Health Stat. 1997;194:1–89.

    Google Scholar 

  34. Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113(1):104–9.

    Article  PubMed  CAS  Google Scholar 

  35. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71–2.

    Article  PubMed  CAS  Google Scholar 

  36. •• Poetker DM, Smith TL. What rhinologists and allergists should know about the medico-legal implications of corticosteroid use: a review of the literature. Int Forum Allergy Rhinol. 2012;2:95–103. Systematic review of the literature for complications and legal actions related to systemic steroid therapy. Potential practice changing recommendations regarding prescription of oral corticosteroids and sample informational patient handout.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA

    Brittany E. Howard & Devyani Lal

  2. Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Devyani Lal

Authors
  1. Brittany E. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devyani Lal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Devyani Lal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Howard, B.E., Lal, D. Oral Steroid Therapy in Chronic Rhinosinusitis with and without Nasal Polyposis. Curr Allergy Asthma Rep 13, 236–243 (2013). https://doi.org/10.1007/s11882-012-0329-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-012-0329-5

Keywords

Search

Navigation