Topical Nasal Corticosteroids Research Articles

Delivering Therapy to the Olfactory Cleft: A Comparison of the Various Methods of Administering Topical Nasal Medications.

Background and objective Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the nasal mucosa, and it causes olfactory dysfunction (OD) in up to 78.2% of patients. Corticosteroids are the mainstay of treatmentto shrink nasal polyposis, reduce inflammation, and improve olfactory function. While many delivery methods for topical nasal corticosteroids exist, there is scarce data on the efficacy of the various medication delivery methods to the olfactory cleft (OC). In light of this, this study aimed to compare the following delivery methods to the OC: conventional nasal spray (NS), nasal drops in the Kaiteki position (KP), and exhalation delivery system (EDS). Methods We evaluated 16 sinonasal cavities from eight cadaver specimens in this study. Each sinonasal cavity was administered fluorescein dye solution via NS, KP, and EDS. Following administration, nasal endoscopy was employed to capturestaining patterns in the OC. OC staining was rated with scores ranging from 0 (no staining) to 3 (heavy staining) after each administration of dye solution. Mean OC staining ratings were calculated and compared using the Kruskal-Wallis rank sum test and the Wilcoxon signed-rank test. Results The mean OC staining scorefor the different delivery methods was as follows - NS: 1.095 ± 1.008, EDS: 0.670 ± 0.674, and KP: 2.038 ± 1.097. Nasal drops in the KP had a significantly higher staining score compared to NS (p=0.041) and EDS (p=0.003). However, there was no significant difference in staining scores between NS and EDS. Conclusions Nasal drops in the KP are more effective at reaching the OC than NS or EDS and should be considered as a first-line modality for administering topical medications when treating OD.

The Efficacy of Double-Dose Mometasone Furoate Nasal Spray in Postoperative Management of Nasal Polyps: A Randomized Controlled Trial

Background: Nasal polyps are benign growths of nasal mucosa associated with inflammation and topical nasal corticosteroids are the medical treatment of choice. Surgical removal is indicated for patients not responding adequately to medical treatment. There is little evidence on the efficacy of double-dose mometasone furoate nasal spray and conventional dose to prevent the recurrence of nasal polyps and decrease nasal symptom score following endoscopic sinus surgery. Objective: To compare the efficacy of double-dose mometasone furoate and conventional dose to prevent the recurrence of postoperative nasal polyps. Materials and Methods: The present study was a randomized controlled trial. Thirty patients who met the inclusion criteria were randomly divided into two groups, 15 patients in each group. Group I patients were given mometasone furoate two sprays in each nostril twice a day (400 μg) and Group II received mometasone furoate two sprays in each nostril once a day (200 μg) as a conventional dose for six months. Grading of nasal polyps and nasal symptom score were recorded before and after treatment at the first, second, fourth, twelfth and twenty-four weeks. Results: After six months of the endoscopic sinus surgery, Meltzer clinical scoring system of nasal polyps showed an average score of 0.67±0.72 in the conventional dose, which was significantly reduced to 0.07±0.26 (p<0.01) in the double dose of mometasone furoate. The average nasal symptom score in the conventional dose was 0.70±0.70, which was not significantly decreased to 0.30±0.50 (p=0.25) in the double dose. There were no side effects in both groups. Conclusion: Double-dose of mometasone furoate nasal spray might be recommended for preventing the recurrence of nasal polyps and decreasing nasal symptom score following surgery. Keywords: Nasal polyps; Intranasal corticosteroid; Endoscopic sinus surgery; Mometasone furoate; Recurrent nasal polyps; Nasal spray; Nasal symptom score; Randomized controlled trial; Postoperative management

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis.

To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). A significant reduction in the CARATkids score occurred in the RAD (-4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them. In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.

Role of Topical Intranasal Corticosteroid for Treatment of Post-COVID Olfactory Dysfunction – Our Experiences

Background: The coronavirus disease 2019 (COVID-19) is a highly contagious acute respiratory disease caused by a novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 infection presents with respiratory illness and even respiratory failure and death. Olfactory dysfunction is an important clinical manifestation that has an impact on quality of life. Objective: This study is designed to analyze the role of the topical nasal corticosteroid in post-COVID olfactory dysfunction. Materials and Methods: This is a prospective and descriptive study on 72 COVID-19 patients who were administered topical intranasal corticosteroids and olfactory training. All of them were diagnosed with COVID-19 infection by reverse transcription–polymerase chain reaction of the nasopharyngeal swab. The detailed clinical examination and treatment with intranasal corticosteroid and its outcome were analyzed. Results: In this study, 46 (63.88%) patients were male and 26 (36.11%) were female with a male-to-female ratio of 1.76:1. The age ranges from 18 to 58 years. There were 30 (41.66%) patients in the age range of 18–30 years and 42 (58.33%) patients in the age range of 31–58 years. Out of 72 patients, 11 (15.27%) patients recovered after 2 weeks, 34 (47.22%) patients recovered after 3 weeks, and 20 (27.77%) recovered after 4 weeks. Three patients lost to follow-up during the treatment period. Conclusion: COVID-19 infection is spreading quickly all the continents of the world. Olfactory dysfunction is an important symptom of the COVID-19 infection. Intranasal mometasone spray and olfactory training are useful treatment options for post-COVID olfactory dysfunction.

Topical nasal corticosteroids in the complex treatment of drug rhinitis

Topical nasal corticosteroids in the complex treatment of drug rhinitis

Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.

Diagnosis and Management of Allergic Rhinitis in Children

Allergic rhinitis which is the most common pediatric allergic disease has a significant negative impact on quality of life in affected children. Further, overall poor control can lead to ‘allergic march’ and later development of bronchial asthma. The main symptoms of allergic rhinitis include nasal discharge, blockage and itchiness of nose, and sneezing. Clinical history focused on identification of nature and severity of symptoms, trigger factors and clinical features of non-allergic rhinitis is crucial for early and accurate diagnosis.The mainstay of non-pharmacological management of allergic rhinitis is allergen avoidance.Second-line antihistamines used either locally or orally are first-line treatment of mild to moderate allergic rhinitis whereas topical nasal corticosteroids are the first line treatment for moderate to severe disease, in whom the control of symptoms is not achieved with antihistamine and those with severe nasal obstruction.Combination therapy with antihistamines and intranasal steroids is more effective than either alone and is second line treatment for children who have poorly controlled rhinitis while on monotherapy. Oral steroids may be indicated in children with significant nasal obstruction and routine use of oral steroids should be avoided.Referral to specialist allergy clinic should be considered for those who are symptomatic despite optimal local and oral therapy. Consideration should be given for specialist otorhinolaryngologist evaluation of children who have features of non-allergic rhinitis and pharmacotherapy resistant nasal obstruction.International Journal of Human and Health Sciences Vol. 05 No. 02 April’21 Page: 159-162

Insuficiencia suprarrenal secundaria a uso crónico de corticoides tópicos por vía nasal

El sindrome de Cushing iatrogenico es comun por el uso de corticoides por via oral, topica o inhalada, pero es extremadamente raro por la via intranasal. El riesgo de desarrollar insuficiencia suprarrenal secundaria al uso topico de corticoides es raro, pero siempre esta presente. Presentamos el caso de una paciente con sintomas de Cushing y laboratorio compatible con insuficiencia suprarrenal secundaria al uso de corticoides por via intranasal.

Intrapolyp Corticosteroid Injection versus Oral Corticosteroid versus Topical Nasal Corticosteroid Spray in Treatment of Allergic Nasal Polyposis: Comparative Study

Background: Nasal Polyposis are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Local and systemic steroid treatment is the mainstay of therapy for nasal polyposis. Objectives: The aim of this study was to evaluate the role of intrapolyp steroid injection in the treatment of nasal polyposis and its efficiency, and to compare these results with that of oral and topical nasal spray corticosteroid. Patients and Methods: This study involved 60 patients presented at ENT Outpatient Clinic, Al-Zahraa University Hospital and diagnosed as nasal polyposis. Their age ranged between (18-60) years. They were randomly divided according to type of treatment (nasal corticosteroid spray, oral corticosteroid and intranasal injection of corticosteroid) into 3 groups, each consisted of 20 patients. Results: There were statistically significant differences in total nasal symptom score (TNSS), nasal polyp score (TNPS) and endoscopic analysis. It has been noted that in nasal spray group, Improvement of symptoms with No Regression of Polypis observed in 13 patients (65%) and no change at all in 7 patients (35%). While in oral steroids group, complete regression is observed in 4 patients (20%), partial improvement in 11 patients (55 %), and no response in 5 patients (25%) and in injection group, complete regression of polyps is observed in 2 patients (10%), partial improvement in 13 patients (65%), and no change at all in 5 patients (25%). Conclusion: It could be concluded that intrapolyp steroid injection could be considered one of the alternative treatments of sinonasal polyposis as it is effective, easy, and safe procedure and its effect lasts for at least 3 months.

Intrapolyp Corticosteroid Injection versus Oral Corticosteroid versus Topical Nasal Corticosteroid Spray in Treatment of Allergic Nasal Polyposis: Comparative Study

Intrapolyp Corticosteroid Injection versus Oral Corticosteroid versus Topical Nasal Corticosteroid Spray in Treatment of Allergic Nasal Polyposis: Comparative Study

Hypertrophy of adenoid vegetation: causes and methods of treatment

Topicality: Nasal congestion, nasal breathing disorders and nasal discharge are the most common complaints that parents of ill children refer to an otolaryngologist and pediatrician. The prevalence of allergic pathology in patients with adenoid vegetation hypertrophy (AН) varies from 22 to 73% according to various authors. Aim: To determine the prevalence of allergic rhinitis among patients with hypertrophy of adenoid vegetations, a prospective study was conducted. Materials and methods: 50 children with hypertrophy of adenoid vegetation aged 4 to 14 years were examined. A comprehensive screening study to detect specific IgE sensitization to the most common inhalation and food allergens. Results: Sensitization to inhaled allergens was detected in 48% of cases. In 8% of cases it coincided with food with food allergy. Only food allergy was detected in 1 child (2%). Timely etiopathogenetic therapy with topical nasal corticosteroids in patients with AN will avoid relapses after adenoidectomy and normalize nasal breathing, and in some cases, avoid surgery.

Is septoplasty effective rhinogenic headache in patients with isolated contact point between inferior turbinate and septal spur?

Rhinogenic headache is a painful sensation in the head and face due to intranasal contact point without any mass or inflammatory findings. Surgery is recommended in patients with nasal obstruction; however the approach in case of isolated mucosal contact point that does not cause obstruction is controversial. Our aim is to observe changes in the severity of headache in patients with isolated mucosal contact point and headache who do not complain of nasal obstruction. Our study included patients with unilateral headache without any nasal and/or paranasal sinus pathology. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography (CT). One hundred patients with isolated mucosal contact point without any problem in breathing were included in this study. All participants were treated by topical nasal corticosteroid for a month. Surgery was recommended to the patients with no satisfactory relieve of headache. Visual Analog Scales (VAS) were used to evaluate the severity of headache in patients at time of diagnosis (0 month), after a medical treatment (1st month) and after a surgical or medical treatment (6th month). The results were compared with each other statistically. There was a decrease in VAS values after a month of medical treatment in all patients with isolated contact point (Z = -8.352; p = 0.0). VAS values significantly improved after surgical treatment group (Z = -4.97; p = 0.0). However, VAS values of patients increased at 6th month in medical treatment group (Z = -5341 p = 0.0). After a successful surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with surgical treatment group than in the patients with medical treatment group (Z = -8.441; p = 0.0). Surgical correction provides a more effective outcome in patients with rhinogenic headache. However, it is difficult to convince that headache may improve with surgery in these patients especially with isolated mucosal contact point and without nasal obstruction. In order to prove the benefit of surgery, we believe that medical treatment can be used as a guide.

Topikal Mometazon Furoat Kullanımının Adenoid Doku Üzerindeki Histopatolojik Etkisi

Objective: Pediatric sleep disordered breathing (SDB) is a common childhood disease with a potential risk of several comorbidities. The most common cause of SDB in childhood is upper airway obstruction due to adenotonsillar hypertrophy and the classical treatment is adenotonsillectomy. However, it carries a risk of many complications and persistent apnea. Topical nasal steroid treatment may be an alternative to surgery in the treatment of pediatric SDB. However, histopathological effects of topical nasal steroids are mostly understudied. Methods: A retrospective controlled clinical study in an academic tertiary referral center. A total of 110 children were involved in the study who underwent adenoidectomy for the treatment of SDB. The study group (51-children) was treated with topical nasal mometasone furoate monohydrate 100 mcg/day. The control group (59-children) was selected randomly and all had no history of topical nasal steroid pre-operatively. Post-operative adenoidectomy specimens were reviewed according to acute/chronic inflammation findings, follicular hyperplasia, goblet cell hyperplasia, squamous metaplasia, fibrosis, atrophy, ulcer and hemorrhage. The findings were scored semiquantitatively for statistical analysis. Results: Chronic inflammation findings, follicular hyperplasia and goblet cell hyperplasia were significantly decreased in the study group in addition fibrosis, atrophy and ulcer findings were significantly increased in the study group. However, there was no statistical difference between the groups according to acute inflammation and hemorrhage. Conclusion: Topical nasal corticosteroids significantly suppress the nasopharyngeal inflammatory process in SDB. This treatment may be an alternative to surgery at least in patients with mild and moderate disease.

Rhinitis and rhinosinusitis: When to think allergy and what to do

Rhinitis and sinusitis are very common conditions seen in primary care. Most sufferers can be helped by accurate diagnosis and medical treatment. Simple measures include douching the nose with saline and avoiding provoking factors such as allergens and pollutants, including environmental tobacco smoke. Additionally, pharmacotherapy can be useful for allergic rhinitis, and involves topical nasal corticosteroids, antihistamines or a combination of the two intranasally. Immunotherapy is reserved for those whose symptoms remain uncontrolled despite pharmacotherapy, and who have one or two major allergens driving their disease. Rhinosinusitis, whether acute or chronic, involves impaired sinus ventilation and drainage due to inflammation, which can be eosinophilic, neutrophilic or a combination of the two. Medical treatment should be tried initially, unless the patient has orbital cellulitis or intracranial signs in which case urgent surgical attention is needed. Few patients need referral to secondary care, but it is important to be able to identify them correctly. Rhinitis and rhinosinusitis are commonly seen in primary care. Practice nurses are well placed to diagnose and treat both conditions effectively in most patients. Glenis Scadding provides an overview of both conditions

BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; First edition 2007)

This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.

Botulinum Toxin for Rhinitis.

Rhinitis is a common clinical entity. Besides nasal obstruction, itching, and sneezing, one of the most important symptoms of rhinitis is nasal hypersecretion produced by nasal glands and exudate from the nasal vascular bed. Allergic rhinitis is an IgE-mediated inflammatory reaction of nasal mucosa after exposure to environmental allergens. Idiopathic rhinitis describes rhinitis symptoms that occur after non-allergic, noninfectious irritants. Specific allergen avoidance, topical nasal decongestants, nasal corticosteroids, immunotherapy, and sinonasal surgery are the main treatment options. Because the current treatment modalities are not enough for reducing rhinorrhea in some patients, novel treatment options are required to solve this problem. Botulinum toxin is an exotoxin generated by Clostridium botulinum. It disturbs the signal transmission at the neuromuscular and neuroglandular junction by inhibiting the acetylcholine release from the presynaptic nerve terminal. It has been widely used in neuromuscular, hypersecretory, and autonomic nerve system disorders. There have been a lot of published articles concerning the effect of this toxin on rhinitis symptoms. Based on the results of these reports, intranasal botulinum toxin A administration appears to be a safe and effective treatment method for decreasing rhinitis symptoms in rhinitis patients with a long-lasting effect. Botulinum toxin type A will be a good treatment option for the chronic rhinitis patients who are resistant to other treatment methods.

Bacteriology of Adenoids in Children with Adenoid Hypertrophy despite Mometasone Furoate Administration

Introduction: Topical nasal corticosteroids have been reported to be an effective nonsurgical alternative treatment to control nasal symptoms related to adenoid hypertrophy, but not in all patients. The current study investigates the bacteriology of adenoids in children with non-reduced adenoid size despite mometasone furoate (MMF) administration. Methods: The patients were randomly divided into two groups: the MMF-administered group and the non-MMF administered group (N-MMFA) afterwards, the MMFadministered group was classified into subgroups according to endoscopic grading as reduced and non-reduced adenoid size. N-MMFA and MMF-administered with non-reduced adenoid size groups (MMF-A/N-RAS) underwent adenoidectomy and the deep bacterial flora of adenoid core specimens taken from these patients were cultured. Results: No significant differences were detected in terms of the mean number of organisms isolated per patient in MMF-administered but non-reduced adenoid size group and non-MMF administered group. On the other hand, the variety of bacterial species was decreased in MMFadministered but non-reduced adenoid size group when compared to non-MMF administered group. The study groups did not differ in the occurrence of semi quantitative growth. This study demonstrates that MMF has no significant effect on reducing the bacterial load of adenoids in children with MMF-A/N-RAS.

When are we operating for chronic rhinosinusitis? A systematic review of maximal medical therapy protocols prior to endoscopic sinus surgery.

Endoscopic sinus surgery (ESS) is considered a therapeutic option after failure of maximal medical therapy (MMT) for chronic rhinosinusitis (CRS). There is currently no consensus on the definition of MMT. The objective of this systematic review is to describe the various MMT criteria employed prior to considering ESS. A systematic review was performed using the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were adults with CRS based on guideline diagnostic criteria, enrolled to undergo ESS, and study publication within the last 5 years (January 1, 2009, to December 30, 2014). Studies were excluded if the study population included non-CRS indications for ESS. Primary outcome was the MMT criteria employed prior to considering a patient a candidate for ESS. A subgroup analysis was performed based on polyp status. Of 387 reviewed studies, 21% reported MMT criteria. When reported, criteria included topical nasal corticosteroids (91% of studies) for a mean of 8 ± 8 weeks, oral antibiotics (89%) for 23 ± 8 days, systemic corticosteroids (61%) for 18 ± 12 days, saline irrigations (39%), oral antihistamines (11%), oral mucolytics (10%), and topical/oral decongestants (10%). A minority of studies report MMT criteria used as the indication for ESS. When reported, the majority included an 8-week course of topical intranasal corticosteroids and 3-week course of oral antibiotics. Use of systemic corticosteroids did not differ based on polyp status. Because of variation in current MMT criteria, there is a need to develop standardized indications for ESS that will work to improve the appropriateness of care for patients with.

Efficiacy of injection specific immunotherapy for grass pollen seasonal allergic rhinitis

Background Allergy to pollen grass causes significant morbidity in Poland. Allergic rhinitis is a common condition which, at its most severe, can significantly impair quality of life despite treatment with antihistamines and topical nasal corticosteroids. The aim of the study was to evaluate the efficiacy of injection specific immunotherapy (SIT) mixture grass pollen allergoide at 20 000 AUM/ml for seasonal allegic rhinitis.

English

Nasal polyposis is a disease entity characterized by development of benign growths arising either from the nasal mucosa or from any of the Para-nasal sinuses alone or in combination. These out growths are associated with oedema, fibrosis, reduced vascularization, decreased number of glands as well as nerve endings and damaged epithelium. The cause of nasal polyposis is not completely understood; however, it is frequently associated with asthma and intolerance to aspirin. The condition is characterized by eosinophil inflammation: approximately65% to 90% of polyps is classified histologically as eosinophilic. The symptoms of nasal polyposis include nasal obstruction, watery discharge and impairment of sense of smell. The objectives for the management of the condition include elimination or reduction in the size of polyps followed by reestablishment of an open nasal airway and nasal breathing, improvement or restoration of sense of smell and ultimately prevention of polyp recurrence. In nasal polyposis, topical nasal corticosteroids are considered the medical treatment of choice and several different intranasal corticosteroids in combination with antihistamines have been investigated with regard to both effect on symptoms and reduction in polyp size. These benefits maybe attributed at least in part, to the effect of topical corticosteroids on decreasing eosinophilic infiltration in the nasal mucosa. The objective of the present study is to evaluate the comparative efficacy of local nasal steroids alone and in combination with an