Topical furosemide versus oral steroid in preoperative management of nasal polyposis

  • Bozidar Kroflic
  • Andrej Coer
  • Tomislav Baudoin
  • Livije Kalogjera


The efficacy of topical nasal furosemide treatment has been shown in the protection of nasal polyp recurrence. The aim of the study was to compare the effect of oral steroid, as standard preoperative treatment, and inhaled furosemide, as alternative treatment, for 7 days preoperatively in terms of subjective improvement of nasal symptoms, polyp size reduction, inflammation in the polyp tissue, and intraoperative blood loss. A group of 40 patients with nasal polyposis entered the study and they were randomly allocated to 7-day preoperative treatment with either oral methylprednisolon (1 mg/kg/day) or topical furosemide by inhalation (6.6 mmol/l solution). Subjective scores of rhinosinusitis symptoms, polyp scores at endoscopy, and biopsy of the most superficial polyp were taken at inclusion. All procedures were repeated on day 7. Intraoperative blood loss was estimated (scores 0–10) by the surgeon at the operation. Eosinophils, mastocytes, and oedema were quantified by histomorphometry. Subjective symptoms and endoscopy scores did not differ significantly between the groups after the treatment although improvement of olfaction was insignificantly better in the steroid group. Steroid treatment significantly reduced eosinophil count, with no effect on mastocytes and oedema. Furosemide treatment did not affect inflammatory cells count significantly, but it has significantly reduced oedema in previously unoperated patients. No difference in intraoperative bleeding was observed between the groups.


Nasal polyposis Furosemide Oral steroid Eosinophils Histomorphometry 


  1. 1.
    Bachert C, Gevaert P, Holtappels G, Cuvelier C, van Cauwenberge P (2000) Nasal polyposis: from cytokines to growth. Am J Rhinol 14(5):279–290PubMedCrossRefGoogle Scholar
  2. 2.
    Bianco S, Vaghi A, Robuschi M, Refini RM, Pieroni MG, Sestrin P (1995) Steroid-sparing effect of inhaled lysine acetylsalicylate and furosemide in high-dose beclomethasone-dependent asthma. J Allergy Clin Immunol 95:937–943PubMedCrossRefGoogle Scholar
  3. 3.
    van Camp C, Clement PA (1994) Results of oral steroid treatment in nasal polyposis. Rhinology 32(1):5–9PubMedGoogle Scholar
  4. 4.
    Damm M, Jungehulsing M, Eckel HE, Schmidt M, Theissen P (1999) Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging. Otolaryngol Head Neck Surg 120(4):517–523PubMedCrossRefGoogle Scholar
  5. 5.
    Eberhart LH, Folz BJ, Wulf H, Geldner G (2003) Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope 113(8):1369–1373PubMedCrossRefGoogle Scholar
  6. 6.
    Echazarreta AL, Gomez FP, Ribas J, Achaval M, Barbera JA, Roca J, Chung KF, Rodriguez-Roisin R (1999) Effects of inhaled furosemide on platelet-activating factor challenge in mild asthma. Eur Respir J 14(3):616–621PubMedCrossRefGoogle Scholar
  7. 7.
    Hamilos DL, Thawley SE, Kramper MA, Kamil A, Hamid QA (1999) Effect of intranasal fluticasone on cellular infiltration, endothelial adhesion molecule expression, and proinflammatory cytokine mRNA in nasal polyp disease. J Allergy Clin Immunol 103:79–87PubMedCrossRefGoogle Scholar
  8. 8.
    Hinton AE, Buckley GJ (1990) Blood loss and haematological consequences related to nasal surgery. Clin Otolaryngol 15:253–256CrossRefPubMedGoogle Scholar
  9. 9.
    Iwamoto LM, Fujiwara N, Nakamura KT, Wada RK (2004) Na−K−2Cl cotransporter inhibition impairs human lung cellular proliferation. Am J Physiol Lung Cell Mol Physiol 287(3):L510–L514PubMedCrossRefGoogle Scholar
  10. 10.
    Jahnsen FL, Haye R, Gran E, Brandtzaeg P, Johansen FE (1999) Glucocorticosteroids inhibit mRNA expression for eotaxin, eotaxin-2, and monocyte-chemotactic protein-4 in human airway inflammation with eosinophilia. J Immunol 163(3):1545–1551PubMedGoogle Scholar
  11. 11.
    Kountakis SE, Arango P, Bradley D, Wade ZK, Borish L (2004) Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope 114(11):1895–1905PubMedCrossRefGoogle Scholar
  12. 12.
    Lavallee SL, Iwamoto LM, Claybaugh JR, Dressel MV, Sato AK, Nakamura KT (1997) Furosemide-induced airway relaxation in guinea pigs: relation to Na-K-2Cl cotransporter function. Am J Physiol 273:L211–L216PubMedGoogle Scholar
  13. 13.
    Malm L (1997) Assessment and staging of nasal polyposis. Acta Otolaryngol 117(4):465–467PubMedCrossRefGoogle Scholar
  14. 14.
    Niven AS, Argyros G (2003) Alternate treatments in asthma. Chest 123(4):1254–1265PubMedCrossRefGoogle Scholar
  15. 15.
    Nonaka R, Nonaka M, Takanashi S, Jordana M, Dolovich J (1999) Eosinophil activation in the tissue: synthetic steroid, budesonide, effectively inhibits the survival of eosinophils isolated from peripheral blood but not nasal polyp tissues. J Clin Lab Immunol 51(1):39–53PubMedGoogle Scholar
  16. 16.
    Panet R, Eliash M, Pick M, Atlan H (2002) Na( + )/K( + )/Cl(-) cotransporter activates mitogen-activated protein kinase in fibroblasts and lymphocytes. J Cell Physiol 190(2):227–237PubMedCrossRefGoogle Scholar
  17. 17.
    Passali D, Bernstein JM, Passali FM, Damiani V, Passali GC, Bellussi L (2003) Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis. Arch Otolaryngol Head Neck Surg 129(6):656–659PubMedCrossRefGoogle Scholar
  18. 18.
    Prandota J (2002) Furosemide: progress in understanding its diuretic, anti-inflammatory, and bronchodilating mechanism of action, and use in the treatment of respiratory tract diseases. Am J Ther 9(4):317–328PubMedCrossRefGoogle Scholar
  19. 19.
    Rudack C, Bachert C, Stoll W (1999) Effect of prednisolone on cytokine synthesis in nasal polyps. J Interferon Cytokine Res 19(9):1031–1035PubMedCrossRefGoogle Scholar
  20. 20.
    Rudack C, Hauser U, Stoll W (1999) Effect of cytokines and fibroblasts on eosinophilic granulocyte survival in polyposis nasi. Laryngorhinootologie 78(7):378–381PubMedGoogle Scholar
  21. 21.
    Saunders MW, Wheatley AH, George SJ, Lai T, Birchall MA (1999) Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? In vivo and in vitro studies. Laryngoscope 109(5):785–790PubMedCrossRefGoogle Scholar
  22. 22.
    Watanabe K, Shirasaki H, Kanaizumi E, Himi T (2004) Effects of glucocorticoids on infiltrating cells and epithelial cells of nasal polyps. Ann Otol Rhinol Laryngol 113(6):465–473PubMedGoogle Scholar
  23. 23.
    Woodworth BA, Joseph K, Kaplan AP, Schlosser RJ (2004) Alterations in eotaxin, monocyte chemoattractant protein-4, interleukin-5, and interleukin-13 after systemic steroid treatment for nasal polyps. Otolaryngol Head Neck Surg 131(5):585–589PubMedCrossRefGoogle Scholar
  24. 24.
    Yuengsrigul A, Chin TW, Nussbaum E (1999) Immunosuppressive and cytotoxic effects of furosemide on human peripheral blood mononuclear cells. Ann Allergy Asthma Immunol 83(6):559–566PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Bozidar Kroflic
    • 1
  • Andrej Coer
    • 2
  • Tomislav Baudoin
    • 3
  • Livije Kalogjera
    • 3
  1. 1.Otorhinolaryngology/Head and Neck Surgery DepartmentGeneral HospitalCeljeSlovenia
  2. 2.Institute of HistologyMedical UniversityLjubljanaSlovenia
  3. 3.Otorhinolaryngology/Head and Neck Surgery DepartmentUniversity Hospital “Sestre milosrdnice”ZagrebCroatia

Personalised recommendations