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J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 40-43
Original Article

The Effect of Preoperative Short Course of Oral Steroids followed by Postoperative
Topical Nasal Steroids Sprays on Nasal Polyp Recurrence after Endoscopic Nasal
Dr. Khaled Mahmud1, Prof.M.N.Faruque2, Dr. K. A. Faisal3
1 Assistant Professor, ENT, Dhaka National Medical College Hospital, 2Professor ENT, Dhaka National Medical College Hospital. 3Registrat ENT, Dhaka National Medical College Hospital. Abstract:
Objective: To evaluate the effect of preoperative short course of oral steroids followed
by postoperative topical nasal steroids sprays on nasal polyp recurrence after
endoscopic nasal polypectomy.
Methods: Forty eight patients of both genders with symptoms and signs of nasal polyps
were included in this prospective study between January 2006 and December 2009.
Their ages ranged between 18 and 60 years. The sample was divided into two groups.
Group I constituted 24 patients treated by endoscopic nasal polypectomy without oral
and local steroid therapy. Group II consisted of 24 patients also treated by endoscopic
nasal polypectomy but received preoperatively 60mg prednisolone tablets daily for one
week and postoperatively topical nasal steroid spray (Mometasone furoate suspension)
for three months. All patients were followed up for at least one year. Recurrence of
nasal polyps was assessed endoscopically at three, six and 12 months after surgery. Any
evidence of nasal polyps-formation of whatever size was considered as recurrence.
Results: Forty eight patients (32 males and 16 females) with sinonasal polyposis were
included in this study. Male to female ratio was 2:1. Patients’ age ranged from 18 to 60
years; median age was 42 years. Recurrence rates at three, six and 12 months after
surgery for the first group of patients were 8.33% (2 patients), 25% (6 patients) and
41.6% (10 patients) accordingly, while the recurrence rates for the second group were
4.1% (1 patient), 8.3% (2 patients) and 12.5% (3 patients) accordingly.
Conclusions: Preoperative short course of oral steroid followed by postoperative nasal
steroid spray show significant reduction in the recurrence rate of nasal polyps after
endoscopic nasal polypectomy.
Key words: Endoscopic nasal polypectomy, Local steroids, Nasal polyps, Oral steroid

therapeutic choice,followed by surgery for resistant or Nasal polyps are oedematous soft tissue outgrowths of the recurrent cases.(3) The prevalence of nasal polyposis in the
nasal mucosa and paranasal sinuses.(1) They are characterized
general population varies from 1% to 5%.(4) Nasal polyps are
macroscopically by a smooth, shiny, pink or grey surface, and usually manifested after the age of 20 years. Male to female microscopically by an oedematous stroma covered by ratio is 2 : 1.(5) Seventy-one percent of patients with nasal
respiratory or metaplastic squamous celepithelium.(2) Sinonasal
polyps have bronchial asthma,(6) although the mechanisms of
polyposis is a chronic disorder with major effects on the nasal polyp formation and growth are still unclear and the role quality of life of the affected individuals. The management of allergy is controversial.(7) Nasal polyposis can be
options for sinonasal polyposis are medical treatment, surgery accompanied by troublesome or agonizing symptoms that or combined medical and surgical treatment. It is a common markedly impair one's quality of life; they even can cause practice to use systemic or topical corticosteroids as the first serious orbital and cerebral complication.(8) The main
J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 40-43
presenting symptoms are nasal blockage, rhinorrhea, sneezing, (Mometasone furoatesuspension) of two 50 micrograms hyposmia, postnasal discharge and sometimes anosomia. metered doses in each nostril twice daily (total daily dose 400 Hypoxia, hypercapnia, snoring, sleep disorders and an mcg) for one month then reduced to two metered doses in each increased risk of hypertension may develop in patients with nostril once daily (total daily dose 200mcg) for two months. All patients were followed up for at least one year. Recurrence nasal polyposis.(9) Nasal polyps can cause obstruction of the
of nasal polyps was assessed endoscopically at three, six and sinuses resulting in sinusitis and further polyp growth.(5, 10)
12 months after surgery. Any evidence of nasal polyp Corticosteroids reduce inflammation by decreasing the formation of any size was considered as a recurrence. All infiltration of inflammatory cells, especially mast cells and patients underwent full medical examination including upper eosinophills. They also diminish the hyper-reactivity and airway endoscopy, chest X-ray,pulmonary function tests, vascular permeability of the nasal mucosa, and they might coronal and axial CTscans for sinuses. Patients with history of decrease the reactive mediators from the mast cells.(10, 11) A
previous nasal polypectomy, hypertension, gastric problems, short course of preoperative oral steroids greatly facilitates diabetes mellitus, cystic fibrosis, allergic fungal sinusitis, functional endoscopic sinus surgery by reduction of polyp aspirin intolerance, herpes keratitis, glaucoma, psychiatric size.(12,13) Recurrence of nasal polyps after endoscopic sinus
disorders, advanced osteoporoses and tuberculosis were surgery may be the result of severe inflammatory reactions excluded from this study. Endoscopic nasal polypectomy was during the mucosal healing period. (14) Therefore, postoperative
performed under general anesthesia in a standard anterior to topical nasal steroid sprays are used to suppress these reactions posterior approach. Anterior nasal packing was removed on the next day and all patients were discharged on oral and allow the reestablishment of the normal epithelial antibiotics of one week course. architecture and local defenses.(15,16) They are also frequently
used to manage persistent sinonasal symptoms after surgery (17)
and to decrease the recovery rate of bacteria from sinus cavity 48 patients (32 males and 16 females) with sinonasal polyposis following functional endoscopic sinus surgery (FESS) were included in this study.
surgery.(16) Nowadays, FESS is one of the most common
Table I. Symptoms of nasal polyps at presentation (N=48)
procedures performed by rhinologists.(18) The incidence of Patients %
serious complications of FESS has been reported to be 0.5% or
Patients %
less.(19) The most common complications include bleeding, Nasal obstruction
infection, orbital injury, cerebrospinal fluid leak, naso-lacrimal duct injury and carotid injury. The purpose of this study is to evaluate the benefit of a preoperative short course of oral steroids followed by postoperative topical nasal steroid sprays on decreasing the recurrence of nasal polyps after endoscopic This prospective study was conducted at the Ear, Nose, Throat Table II. Percentage of recurrence in both groups
(ENT) Department at Dhaka national medical college & 3 months 6 months 12 months
hospital from Jan 2006 to Dec-2009 .48 patients of both Patients % Patients % Patients %
genders with symptoms and signs of nasal polyps were
12 months
included in this study. The age of the patients ranged from 18 Patients
Patients % Patients
to 60 years (median age 42 years). Patients were divided into 1. Group I comprised 24 patients treated by endoscopic nasal Male to female ratio was 2 : 1. The patients’ age ranged from
preoperative oral and postoperative local steroid therapy. 18 to 60 years and median age was 42 years. Nasal obstruction 2. Group II comprised 24 patients treated by endoscopic nasal was the most common symptom present in 40 patients polypectomy who received preoperatively 60 mg prednisolone (83.3%), followed by rhinorrhea in 36 patients (75%), tablets daily in three equal divided doses (20 mg × 3) for one recurrent attacks of upper respiratory tract infection in 32 week and postoperatively by topicalnasal steroid spray patients (66.6%), sneezing in 30 patients (62.5%), postnasal J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 40-43
drip in 28 patients (58.33%), headache in 26 patients treatment of sinonasal polyposis. For example, Lildholdt et al. (54.16%), hyposmia in 18 patients (37.5%) and facial pain in studied the efficacy of topical corticosteroid powder 10 patients (20.8%) as shown in Table I. Out of 24 patients in (budesonide) for nasal polyps in 129 patients and showed Group I who were treated by endoscopic nasal polypectomy success in 82% of actively treated patients as opposed to about without pre- and postoperative steroids, recurrence was 43% in the placebo group.(22) Bross-Soriano et al. in their study
observed in 2 patients (8.33%) after three months of surgery
on 162 patients concluded that the use of topical intranasal compared with only one patient (4.1%) in the second group of steroid (fluticasone propionate) after endoscopic resection of patients who were given preoperative oral prednisolone and sinonasal polyps is not only effective in reducing recurrence postoperative topical nasal steroid spray (mometasone furoate (14% compared to 44.4% in control group), but also it is a safe suspension) twice daily. After six months of surgery the total and reliable and does not increase the prevalence of recurrence was detected in 6 patients (25%) in the first group infection.(1) Kang et al. reported that high-dose topical
and in 2 patents (8.3%) in the second group of patients. After corticosteroid therapy is more effective than lowdose topical one year of follow-up the total number of recurrences in the therapy in preventing recurrent nasal polyps (7.1% opposed to first group was 10 patients (41.6%) compared with only 3 44%).(10) Gulati et al. found that only patients who stopped
patients (12.5%) in the second group of patients. (Table II using postoperative nasal sprays (10%) developed recurrence demonstrate the follow-up results up to one year). These three months after surgery.(23) The results of the previous
results show a statically significant
studies strongly support the results of our study and emphasize reduction in the number of recurrences of nasal polyps after the importance of corticosteroid use to decrease the incidence one year in the second group in comparison with the first group. Even in patients with recurrence, there were important differences between the two groups. The npolyps’ size, Conclusions
number and speed of growth were smaller in Group II patients
Administration of preoperative short course of oral steroids which resulted in better nasal airways and more satisfaction followed by postoperative topical nasal steroid sprays is safe from operation in comparison with patients with recurrence in and reliable for preventing recurrence of nasal polyps after Group I. It has been noted, also, that preoperative steroids decrease the edema of nasal mucosa and shrink the size of nasal polyps which greatly facilitates the access and makes the References
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bleeding as expected (two patients in each group). No major Infections after endoscopic polypectomy using nasal steroids. complications were reported in both groups of patients. Minor Otolaryngol Head Neck Surg 2004; 130: 319-322. complications included periorbital fat exposure (four patients Diamantopoulos I, Jones N, Lowe L. All nasal polyps need
in the first group and three patients in the second group) and histological examination: an audit based appraisal of clinical postoperative bleeding (two patients in each group) without practice. The Journal of Laryngology and Otology 2000; 114: significant differences between the two groups. There was no increase of the usual side effects of prolonged use of intranasal Hissaria P, Smith W, Wormalled P, Taylor J, et al. Short
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sprays on decreasing the recurrence of nasal polyps after f nasal polyps. Current Opinion in Otolaryngology & Head endoscopic nasal polypectomy. It is well known that both medical and traditional surgical treatment methods of nasal Settipane GA, Chafee FH. Nasal polyps in asthma and
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safe and the benefits of their use outweigh their potential risks allergic and non-allergic patients and steroid therapy. in appropriate patients.(20,21) Many studies have been conducted
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