Nasal Steroid Therapy Research Articles

Effects of Corticosteroid Treatment on Olfactory Dysfunction in LATY136F Knock-In Mice.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory condition affecting multiple organs, including the pancreas, salivary glands, lungs, kidneys, skin, and lymph nodes. Clinically, it is characterized by elevated serum IgG and IgG4 levels and tissue infiltration by IgG4-positive plasma cells, lymphocytes, fibrosis, and phlebitis obliterans. IgG4-RD is linked to increased Th2-dominant cytokines, contributing to eosinophilia, elevated serum IgG4, and fibrosis. A notable feature is its good response to corticosteroid therapy. To investigate the effects of corticosteroid treatment on olfactory dysfunction in LATY136F knock-in mice, which exhibited increased production of Th2-type IgG1 (the murine homolog of human IgG4) and developed multiorgan tissue lesions similar to those observed in IgG4-RD patients. LATY136F knock-in mice (n=24) were divided into groups that received prednisolone or saline at different ages. Olfactory function was assessed using a behavioral test with cycloheximide. Histological and immunohistochemical analyses were performed to evaluate the olfactory epithelium thickness as well as the presence of mature and immature olfactory neurons. Corticosteroid-treated mice exhibited significantly improved olfactory function compared to the controls. Histological analysis revealed a significant increase in olfactory epithelium thickness and mature (olfactory marker protein-positive) and immature (growth-associated protein 43-positive) olfactory neurons in the treated groups compared with the control group. Corticosteroid treatment effectively improved olfactory dysfunction and promoted olfactory epithelium regeneration in LATY136F knock-in mice, suggesting the potential therapeutic benefits of corticosteroid treatment for patients with IgG4-RD experiencing olfactory dysfunction. However, further research on topical nasal steroid therapy in untreated patients is warranted. The results support further investigation into topical nasal steroid therapies for treating olfactory dysfunction in untreated patients, potentially influencing clinical practice and patient management strategies for IgG4-RD globally.

Therapeutic Efficacy of Nasal Corticosteroids in COVID-19-Related Olfactory Dysfunction: A Comprehensive Systematic Review and Meta-analysis.

Olfactory disturbance is one of the main symptoms of coronavirus disease-2019 (COVID-19). Various olfactory disorders caused by viral infections are treated with nasal corticosteroids. This study aimed to evaluate the safety and efficacy of nasal corticosteroids in the treatment of olfactory disorders caused by the severe acute respiratory syndrome coronavirus 2. We searched the Web of Science, Embase, PubMed, and Cochrane Library databases for clinical trials of nasal corticosteroids for treating COVID-19 olfactory dysfunction. We assessed the effect of nasal corticosteroids on olfactory function in COVID-19-affected individuals using a Meta-analysis of published studies, considering the number of patients who fully recovered from olfactory dysfunction, olfactory scores following treatment, and olfactory recovery time. Seven studies involving 930 patients were analyzed. The Meta-analysis results revealed that the olfactory score of the experimental group was 1.40 points higher than that of the control group (standardized mean difference [MD]: 1.40, 95% confidence interval [95% CI]: 0.34-2.47, P < .00001). However, the differences in the outcomes of cure rate (risk ratio: 1.18, 95% CI: 0.89-1.69, P = .21) and recovery time (MD: -1.78, 95% CI: -7.36 to 3.81, P = .53) were not statistically significant. Only 1 study reported adverse effects of nasal steroid treatment, namely tension, anger, and stomach irritation. Although nasal steroid therapy does not result in significant adverse effects, it proves ineffective in the treatment of COVID-19 olfactory dysfunction.

The “real life” efficacy of dupilumab is independent of initial polyp size and concomitant steroids in CRSwNP

BackgroundDupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated.Methods97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires.ResultsSignificant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy.ConclusionsPolyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.

Nasal eosinophilia as a preliminary discriminative biomarker of non-allergic rhinitis in every day clinical pediatric practice.

Non-allergic rhinitis (NAR) in children, named local allergic rhinitis (LAR) and non-allergic rhinitis with eosinophilia syndrome (NARES), are recently termed entities in childhood characterized by symptoms suggestive of allergic rhinitis in the absence of systemic atopy. Nasal eosinophils (nEo) are the principal cells involved in the allergy inflammation and nasal allergen provocation test is the gold standard method for the diagnosis, albeit with several limitations. The aim of this study was to validate the presence of nEo in combination with the therapeutic response to nasal steroids, as a preliminary discriminator of NAR in real life data. In a prospective cohort study, 128 children (63.3% male, aged 72 ± 42m) with history of NAR were enrolled and followed up for 52 ± 32m. Nasal cytology was performed and nasal steroids trial was recommended initially in all and repeatedly in relapsing cases. Response to therapy was clinically evaluated using 10-VAS. Significant nEo was found in 59.3% of the cases and was related to reported dyspnea episodes. 23.4% had no response to therapy, whereas 51.5% were constantly good responders. Response to therapy was related to nEo and a cutoff point of 20% was defined as the most reliable biological marker with 94% sensitivity and 77% specificity. In children with symptoms of NAR, the presence of nEo > 20% constantly responding to nasal steroid therapy, is a clear indicator of atopy. In an everyday clinical setting, it emerged as an easy, preliminary, cell biomarker suggestive of further investigation such as NAPT, to discriminate LAR from NARES.

Comparative Results of Eustachian Balloon Dilatation and Nasal Steroid Therapy in the Eustachian Tube Dysfunction

Comparative Results of Eustachian Balloon Dilatation and Nasal Steroid Therapy in the Eustachian Tube Dysfunction

A Pilot Study Investigating the Impact of Topical Nasal Steroid Spray in Allergic Rhinitis Patients with Dry Eye

Objective: The aim of this study is to demonstrate the effect of nasal steroid treatment on intraocular pressure and dry eye in allergic rhinitis patients with dry eye. Materials and Methods: Twenty-nine patients with a diagnosis of allergic rhinitis and dry eye were included. Symptoms and findings of patients before and after nasal steroid therapy were compared. Result: Ocular Surface Disease Index scores for dry eye symptoms showed significant improvement after nasal steroid treatment (p = 0.003). In the Schirmer test, no significant change was observed in the right or left eye (p = 0.167 and p = 0.489). For the tear film break-up time, no significant change was observed in the right or left eye (p = 0.076 and (p = 0.170). No significant change was observed in the right eye or the left eye in an intraocular pressure test (p = 0.893 and p = 0.495). Conclusion: In our study, symptoms of dry eye with allergic rhinitis were significantly improved with nasal steroid therapy, without affecting the intraocular pressure.

Comparison of the Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis Patients.

Objectives:In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP).Methods:All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment.Results:Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant.Conclusion:All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed.

Role of adenoidectomy in chronic nasal obstruction after nasal steroid therapy failure

ObjectiveTo identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients. DesignRetrospective chart review. SettingTertiary care academic center. SubjectsAnalysis was performed on children that underwent adenoidectomy between 2011 and 2015 for chronic nasal obstruction refractory to nasal steroids. ResultsSeventy-four cases were identified. Average age of presentation was 3.6years. Pre-operatively, 25.7% of patients had known asthma, 16.2% reported respiratory allergies, and 20.3% reported use of systemic antihistamines. The most common pre-operative symptoms included mouth breathing (82.4%), nasal congestion (81.1%), snoring (71.6%), and rhinorrhea (37.8%). Average adenoid size was 68% pre-operatively. Ninety-eight percent of patients experienced improvement or resolution of their symptoms following adenoidectomy. ConclusionsThis study demonstrates average rates of respiratory allergies, but high rates of asthma among patients that fail nasal steroid therapy for chronic nasal obstruction. Adenoidectomy is a highly efficacious intervention in this subset of patients.

May Hyperbaric Oxygen Therapy Play a Role in the Treatment of Allergic Rhinitis? A Double- Blind Experimental Study in Rat Model Hyperbaric Oxygen Therapy on Allergic Rhinitis

Objectives: Medical treatments may be inadequate for the management of allergic rhinitis. Therefore, it requires different treatment options. We aimed to evaluate the effects of nasal steroid and hyperbaric oxygen (HBO) treatments on the nasal mucosa of an allergic rhinitis of a (AR) rat model. Methods: Group 1 (control group); Group 2 toluene diisocyanate (TDI) group; Group 3 was exposed to TDI and treated with HBO; Group 4 was exposed to TDI and treated with intranasalmometasone furoate. After the sacrification, the sections were then evaluated semi-quantitatively and parameters of histopathological inflammation, fibrosis and eosinophilia were assessed. Results: The level of inflammation in the control group was significantly less severe than Group 2. There were statistically significant differences between Groups 2, 3 and 4. Evaluation of thefibrosis scores showed that the scores of Group 4 were significantly higher. Group 1 has significantly lower eosinophil counts than the other groups. Group 2 has significantly higher eosinophil counts than group 4. Conclusion: Anti-inflammatory effects of both nasal steroid and HBO treatments were found to be similar in our study. Nasal steroid therapy combined with HBO therapy may be used on treatmentresistant patients with persistent AR.

Does oxymetazoline increase the efficacy of nasal steroids in treating nasal polyposis?

Although nasal steroids are the mainstay treatments in nasal polyposis, up to one-half of patients do not respond and need surgical treatment. This study aimed to evaluate whether oxymetazoline administration produces any additive effect on nasal steroid therapy and whether rebound congestion develops after oxymetazoline treatment. Sixty-eight patients with nasal polyposis were randomly assigned in a 1:1 ratio to receive either oxymetazoline plus mometasone furoate nasal spray (MFNS) or placebo plus MFNS, 2 sprays per nostril twice daily, with an interval of 5 minutes between each medication for 4 weeks. All the patients were then treated with MFNS, 2 sprays per nostril twice daily for 2 weeks. The nasal symptoms score, peak inspiratory flow index, nasal mucociliary clearance time (NMCCT), and total nasal polyps score were used to evaluate treatment outcomes. An intention-to-treat analysis was performed, and a worst case sensitivity analysis was applied to missing cases. Thirty-four patients were allocated to the oxymetazoline-MFNS group, and 34 to the placebo-MFNS group. One patient in each group was lost to last-visit follow-up. At 4 weeks after beginning treatment, the oxymetazoline-MFNS group showed significantly greater improvement in blocked nose, hyposmia, peak flow, NMCCT, and total nasal polyps score than the placebo-MFNS group. During the nasal steroid phase, both groups showed continuing improvement in all outcome variables. However, the oxymetazoline-MFNS group still showed significantly greater improvement in blocked nose, hyposmia, NMCCT, and total nasal polyps score, but not peak flow, than the placebo-MFNS group at the end of the study. The use of nasal steroids with oxymetazoline was more effective over 6 weeks than nasal steroids alone in improving blocked nose, hyposmia, nasal mucociliary clearance, and polyp size in treatment of nasal polyposis. There was no evidence of rebound congestion after 4 weeks of oxymetazoline treatment.

Clinical efficacy of nasal steroids on nonallergic rhinitis and the associated inflammatory cell phenotypes.

Although good response to nasal steroid therapy has been documented in allergic rhinitis (AR), the efficacy of this treatment in non-AR, and the associated inflammatory cell phenotypes has not been fully investigated. To compare the response to steroids in non-AR versus AR and to assess the impact of inflammatory cell phenotypes on non-AR treatment outcomes. A total of 149 patients with rhinitis were divided into non-AR and AR groups by using the allergy skin-prick test. Based on nasal cytology, the non-AR group was further divided into inflammatory non-AR (INAR) and noninflammatory non-AR (NINAR) groups, and the INAR groups were further subdivided into four phenotypes according to inflammatory cell type: non-AR with eosinophils (NARES), non-AR with mast cells (NARMA), non-AR with neutrophils (NARNE), and NARES and mast cells (NARESMA). All the patients were treated over 28 days with 220 μg of nasal triamcinolone acetonide once daily. Nasal symptom score, peak inspiratory flow index, and nasal mucociliary clearance time (NMCCT) were used to evaluate treatment outcomes. The initial screening found 67 patients with non-AR and 82 patients with AR. At 28 days after nasal steroid treatment, all nasal symptom score, peak inspiratory flow indexes, and NMCCTs were significantly improved within each group; however, the non-AR group recorded significantly lower levels of improvement in blocked nose, rhinorrhea, sneezing, nasal itching, peak flows, and NMCCTs than the AR group. The NINAR group overall indicated lower levels of improvement than the INAR group. Among the INAR subgroups, the NARESMA, NARES, and NARMA phenotypes had similar outcome improvements, all better than the NARNE phenotype. Although both patients with non-AR and those with AR had good steroid response, the patients with non-AR had less improvement than the patients with AR. Patients with NINAR had the worst treatment outcome among the non-AR phenotypes.

Does Oral Prednisolone Increase the Efficacy of Subsequent Nasal Steroids in Treating Nasal Polyposis?

Although combined oral and nasal steroid therapy is widely used in nasal polyposis, a subset of patients show an unfavorable therapeutic outcome. This study aimed to evaluate whether oral prednisolone produces any additive effects on subsequent nasal steroid therapy and to evaluate if any clinical variables can predict therapeutic outcome. Using a 3:2 randomization ratio, 67 patients with nasal polyposis received 50 mg of prednisolone and 47 patients received placebo daily for 2 weeks, followed by mometasone furoate nasal spray (MFNS) at 200 micrograms twice daily for 10 weeks. Clinical response was evaluated by nasal symptom score (NSS), peak expiratory flow index (PEFI), and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test, and sinus radiography. At the end of the 2-week oral steroid phase, the prednisolone group showed significantly greater improvements in all nasal symptoms, nasal airflow, and polyp size than the placebo group. In the nasal steroid phase, while the MFNS maintained the outcome improvements in the prednisolone group, all outcome variables in the placebo group showed continuing improvements. At the end of the nasal steroid phase, there were no significant differences of most outcome improvements between the two groups, except in hyposmia, PEFI, and TNPS (p = 0.049, p = 0.029, and p = 0.005, respectively). In the prednisolone group, patients with polyps grade 3 and endoscopic signs of meatal discharge showed significantly less improvement in total NSS, PEFI, and TNPS than patients with grade 1-2 size and negative metal discharge. In the 12-week treatment evaluation of nasal polyposis, pretreatment with oral steroids had no significant advantage for most nasal symptoms other than earlier relief; however, combined oral and nasal steroid therapy more effectively improved hyposmia, polyps size, and nasal airflow. Polyps size grade 3 and/or endoscopic signs of meatal discharge predisposed to a poorer treatment outcome.

Topical therapies in the management of chronic rhinosinusitis: an evidence‐based review with recommendations

Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS. A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review. This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations). Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations).

Combined Medical and Surgical Therapy Improves Olfaction in Patients with Nasal Polyposis

Objective: The aim of the present study was to evaluate the outcomes of combined oral steroid, nasal steroid and surgical therapy in patients with impaired olfaction due to nasal polyposis. Patients and Methods: This prospective observational study was undertaken in the otolaryngology department of a university hospital. During the study, 19 nasal polyposis patients were evaluated three times, i.e. before oral steroid therapy, before surgery (after steroid therapy) and after surgery, with smell identification tests, acoustic rhinometry, subjective smell score, endoscopic grading and a visual analog scale for nasal obstruction. Results: All subjective and objective measures were significantly improved after medical and surgical therapy (p < 0.01). The median smell identification score improved from 2 (interquartile range 0–4) to 5 (interquartile range 4–7) after combined therapy. Smell identification scores were found to be modestly correlated with all other examination findings. Conclusion: Combined therapy seems efficient in improving smell identification scores of nasal polyposis patients.

Impact of topical nasal steroid therapy on symptoms of nasal polyposis

Topical steroid therapy is an important strategy in the management of chronic rhinosinusitis (CRS) with nasal polyposis. The objective of this study was to determine the impact of topical steroid therapy on nasal symptoms in patients with nasal polyposis. Systematic review with meta-analysis using standardized methodology. Study inclusion criteria included: randomized, placebo controlled trials, nasal polyposis, and topical steroid therapy. Exclusion criteria included: failure to report at least one symptom-based outcome measure, concurrent use of systemic steroids, or mixed CRS cohorts (polyp and nonpolyp patients). Quantitative analysis was performed using a random effect model. The PRISMA guidelines for meta-analysis reporting were followed. A total of 19 studies fulfilled eligibility. Seven studies were excluded from the meta-analysis due to significant heterogeneity in outcome reporting. A total of 12 studies were combined for quantitative analysis and demonstrated a pooled risk ratio of 1.72 (95% confidence interval, 1.41-2.09), indicating a significant improvement in nasal symptoms. All three topical steroid preparations (fluticasone, mometasone, and budesonide) resulted in symptom improvement. All seven studies excluded from the meta-analysis qualitatively confirmed the overall findings. Topical nasal steroid therapy improves nasal symptoms in CRS patients with nasal polyposis. Future studies will need to evaluate the impact on quality of life, preferably using validated disease-specific instruments.

Early intervention for Japanese cedar and cypress pollinosis

SummaryIt is considered that early intervention for pollinosis relieves symptoms during the pollen season in Japan. Therefore, initiating medication prior to pollen dispersal has recently become a popular trend under the influence of the mass media. However, the actual benefits of this kind of early intervention during the peak of the pollen season have not been evaluated enough. We review a randomized placebo‐controlled trial that was conducted to examine the efficacy of early intervention (before pollen dispersal) with the oral cysteinyl leukotriene receptor antagonist (LTRA) pranlukast against pollinosis symptoms in patients with allergy to Japanese cedar and cypress pollens in 2007. The subjects were treated with pranlukast or placebo for 4 weeks at the beginning of the cedar pollen dispersal season. Subsequently, all the patients received nasal steroid therapy concomitantly with pranlukast throughout the remaining period of the pollen dispersal season. The effects were evaluated by symptom scores based on allergy diaries and quality of life (QOL) scores as determined by the Japan Rhinoconjunctivitis Quality of Life Questionnaire. In the pranlukast‐pre‐treated patients, the nasal symptoms (paroxysmal sneezing, runny nose and nasal congestion) were improved during the early Japanese cedar pollen dispersal season. Subsequently, concomitant therapy with pranlukast plus nasal steroids for the rest of the pollen season significantly improved the symptom and QOL scores compared with the placebo‐pre‐treated patients. This study shows that LTRA administration to Japanese cedar and cypress pollinosis patients starting just before and continuing throughout the pollen dispersion season in high‐risk communities is effective for improving the clinical symptoms and indicators of pollinosis. Further assessment of the efficacy of early intervention with an LTRA is required in comparison with other drug therapies, with consideration of the associated cost–benefit effectiveness.

Nasal endothelial interleukin‐10 expression is negatively correlated with nasal symptoms after allergen provocation

Despite major efforts, factors that predict or correspond to the level of allergic symptoms remain elusive. Given our previous observations of mucosal interleukin-10 (IL-10) expression by local tissue cells and its described role as immune modulator, we hypothesized that, in allergic rhinitis, nasal mucosal IL-10 expression could influence the severity of symptoms. In this study, we investigated endothelial IL-10 expression in nasal mucosa of healthy- and house dust mite allergic patients, both before and after provocation, and under nasal steroid therapy. Nasal turbinate biopsies were taken from healthy individuals as well as from house dust mite allergic patients, both before and after provocation. Allergic patients received fluticasone proprionate aqueous nasal spray or control treatment. In the allergic patients, endothelial IL-10 scores based on immunohistochemical stainings were correlated with allergic symptoms, measured by visual analog scores. At baseline, variable levels of endothelial IL-10 were detected in nasal biopsies. After nasal provocation, but not at baseline, endothelial IL-10 expression corresponded very closely to the allergic symptoms after allergen provocation. Low symptom scores were correlated with high endothelial IL-10 scores. This correlation disappeared after fluticason propionate treatment. There is a large variation in the level of endothelial IL-10 expression both in healthy individuals and in house dust mite allergic patients. Endothelial IL-10 expression may affect local immune reactions resulting in reduced levels of allergic symptoms.

Cedar and Cypress Pollinosis and Allergic Rhinitis: Quality of Life Effects of Early Intervention with Leukotriene Receptor Antagonists

Background: Allergic rhinitis involves inflammation of the nasal passages. The use of nasal steroids is generally very effective in providing significant symptom relief. However, compliance for their use is sometimes poor. Methods: To examine the efficacy of early intervention (before pollen dispersal) with oral cysteinyl leukotriene receptor antagonists (LTRA) on pollinosis in patients with allergy to cedar and Japanese cypress pollens, groups of subjects were treated with LTRA or a placebo for 4 weeks at the beginning of the cedar pollen dispersal season. Subsequently, all patients received nasal steroid therapy concomitantly with LTRA throughout the remaining period of the pollen dispersal season. The effects of such early treatment with LTRA on pollinosis were investigated using symptom scores from an allergy diary and quality of life (QOL) scores. Results: Sneezing and nasal congestion scores were significantly lower in the LTRA-pretreated subjects than observed in the placebo-pretreated patients between weeks 4 and 6 and weeks 3 and 5, respectively. QOL scores improved significantly in all domains after concomitant therapy with nasal steroids. The percent improvement in the nasal congestion score after the concomitant therapy was significantly higher in the LTRA group (69%) than in the placebo group (41%). Conclusion: Significant differences observed in symptoms and in QOL effects between LTRA- and placebo-pretreated patients and the absence of major adverse effects noted in these studies suggest that early intervention with LTRA is beneficial and safe and should be considered in the management of pollinosis-associated allergic rhinitis.

Ocena wyników leczenia polipów nosa i zatok przynosowych metodą endoskopową

This work aimed at the analysis of results of the treatment of nasal and paranasal sinus polyps by the endoscopic method. The tests were conducted on 142 patients, including 75 women and 67 men at the age of 17-68, who underwent the endoscopic surgical treatment due to nasal polyps and paranasal sinus polyps between 2006-2007. In all the patients we conducted functional surgical procedures of the nose and paranasal sinuses by the endoscopic method. In the post-operative treatment we applied the nasal steroid therapy and guided antibiotic therapy. The efficiency of the treatment was assessed 6 months after the procedure. All in all, we conducted 278 polipectomies (163 repolipectomies) of the nose, 278 ethmoidectomies (56 reethmoidectomies), 188 ostium-ductal complex operations, 43 maxillary sinus operations, 21 sphenoid sinus operations and 64 surgical dilatations of the sphenoid sinus ostinum, 49 surgical dilations of the frontal sinuses. In 7 cases the nasal septum operation was conducted simultaneously. Six months following the operation, the endoscopic test showed a correct patency in the ostinum of the paranasal sinuses, sphenoid and frontal sinuses, and no inflammatory traits like reddening, swelling of the nasal mucosa or any pathological secretion. Four times we noticed reddening and swelling of the nasal mucosa, and the mucopurpulent secretion accompanying correct patency of the ostinum in the paranasal sinuses. The control examination carried out 6 months after the surgical treatment showed, according to the patients, the appropriate nasal patency in 93.7%, sensation of the blood flowing down the throat in 20.4%, mucorrhoea in 2.8%, smell impairment in 17.6% and headache in 2.8%. In the majority of the cases we conducted nasal and paranasal sinus re-operations after the prior traditional procedures, which are still used in many institutions not equipped with endoscopic surgery appliances.

Efficacy of Montelukast in the Treatment of Nasal Polyposis

Twenty-four consecutive patients with symptomatic nasal polyposis and nonallergic or perennial rhinitis who were undergoing chronic nasal steroid therapy were prospectively evaluated for response to adjunctive oral montelukast sodium therapy. The patients were undergoing daily intranasal steroid sprays for a minimum of 6 months before being started on montelukast sodium 10 mg by mouth per day for 3 months while intranasal steroids were continued. The patients were given a validated symptom score survey at the start and end of therapy, with a lower score indicating fewer symptoms. The nasal polyps were submitted to biopsy before and after treatment to determine their degree of eosinophilia. Eosinophilia was graded in a blinded fashion by an independent pathologist on a scale of 0 to 3, with 3 being severe. Patients with seasonal allergies were excluded, and the studied patients were treated during the winter season to avoid confounding by potential seasonal allergic responses. The patients tended to improve on montelukast therapy in terms of their symptom scores and polyp eosinophil counts. The symptoms improved in 17 patients (71%) and remained the same or worsened in 7 patients (29%). The symptom score for the group improved from a pretreatment value of 33.4 (SD, 7.73) to a posttreatment value of 23.3 (SD, 13.73; p < .001). In addition, the eosinophilia score improved from 2.3 (SD, 0.68) to 1.5 (SD, 0.82; p < .01). The improvement was most noticeable in the patients with perennial allergies. These results suggest that montelukast appears to be beneficial for some patients with nasal polyposis. Patients with perennial allergies and nasal polyposis seem more likely to respond to the treatment than those with nonallergic nasal polyposis.