Navigation Links
For Severe Sinusitis, Oral Steroids an Option, Study Says
Date:2/28/2011

By Madonna Behen
HealthDay Reporter

MONDAY, Feb. 28 (HealthDay News) -- An estimated 32 million Americans suffer from chronic rhinosinusitis, in which inflammation of the lining of the nose and sinuses leads to congestion, pain and loss of smell. In the most severe cases, patients develop nasal polyps that can make the symptoms even worse.

The standard therapy is to begin with a steroid nasal spray and then move on to a more powerful steroid pill if topical steroids don't work. That's because although oral steroids are more effective at reducing inflammation, they can also carry serious side effects, such as an increased risk for osteoporosis, insomnia or worsening of asthma.

But a new study by researchers in Scotland suggests that starting with a short course of oral steroids can safely improve symptoms and may help avoid the need for surgery.

"The principal problem with nasal polyps is that the plumbing of the sinuses is jammed, so merely taking nasal steroid sprays if you have medium to large polyps will not unblock this," said lead author Dr. Sriram Vaidyanathan, a sinus and allergy specialist at Ninewells Hospital and the University of Dundee. "An initial short course of oral steroids under the supervision of your doctor may help the nasal sprays to penetrate into the sinus openings."

"To give an analogy, the initial 'mowing of the lawn' is needed before the 'weedkillers' are sprayed," Vaidyanathan added.

For the study, published March 1 in the Annals of Internal Medicine, Vaidyanathan and his colleagues followed 60 patients who had chronic rhinosinusitis with nasal polyps. For the first two weeks of treatment, half took an oral steroid pill once a day, while the other half took a placebo. After that, both groups received the same treatment: eight weeks of steroid nose drops, taken twice a day, followed by 26 weeks of a twice-daily steroid nasal spray.

Over the course of therapy, the patients who took oral steroids experienced a greater reduction in the size of their polyps and a greater improvement in their sense of smell than those in the placebo group. Athough blood tests after the first two weeks showed evidence of adverse effects among the patients taking oral steroids, those tests returned to normal by 10 weeks, the study authors said.

"We believe that using oral steroids safely and under supervision of a physician can act as a 'medical polypectomy' and prevent unnecessary surgery," said Vaidyanathan. "Moreover, patients are amazed that they can smell again, which is something that nasal sprays can't achieve on their own."

The authors of an editorial accompanying the study called the study "a welcome addition to the evidence about strategies to manage patients who have chronic rhinosinusitis with nasal polyps."

But they cautioned that doctors should temper their enthusiasm for oral steroid therapy due to the potential side effects, which they noted are likely to be "greatest among elderly patients, postmenopausal women and those who receive repeated courses of oral therapy."

In light of the potential risks associated with oral therapy, the study authors said oral steroid therapy should be initiated only when patients with chronic rhinosinusitis with nasal polyps have an unsatisfactory response to at least three months of treatment with intranasal corticosteroids."

"Since rhinosinusitis with nasal polyps is a chronic disease, severe patients will probably need several courses of oral steroids during their lifetime or even in a single year," said the editorial's co-author, Dr. Joaquim Mullol, of the University of Barcelona's Rhinology Unit and Smell Clinic. Starting with the most conservative treatment approach, he said, helps ensure that side effects are kept to a minimum.

One U.S. sinusitis researcher endorsed the study's design, but agreed with the editorial authors' conservative approach.

"This study is helpful to primary-care physicians as well as to patients because it very nicely demonstrates that if you're caught between a rock and a hard place and you have to go on a short-term course of oral steroids, the risks may not be so harmful," said Dr. Jean Kim, assistant professor of allergy and clinical immunology and otolaryngology, head and neck surgery at Johns Hopkins Medicine in Baltimore. "But it's important to globally assess what the overall risks and benefits are to a patient."

"In many causes, these are patients who also have asthma, and so they're subject to repeated courses of oral steroids," Kim added. "People with asthma do need to take an oral steroid, because if they don't take it, they don't breathe."

More information

For more on sinusitis, visit the American Rhinologic Society.

SOURCES: Sriram Vaidyanathan, M.B.B.S., Asthma & Allergy Research Group, Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, Ninewells Hospital and University of Dundee, Scotland; Joaquim Mullol, M.D., Ph.D., Rhinology Unit and Smell Clinic, University of Barcelona, Spain; Jean Kim, M.D., Ph.D., assistant professor, departments of allergy and clinical immunology and otolaryngology, Head & Neck Surgery, Johns Hopkins Medicine, Baltimore; March 1, 2011, Annals of Internal Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Severe Heart Attack No More Deadly to Women Than Men
2. Anti-clotting agent does not improve outcomes of patients with severe pneumonia
3. TV Reporters Severe Migraine Mimicked a Stroke
4. Fluctuating Hormones Linked to More Severe Bipolar Symptoms
5. Weight Guidelines May Be High for Severely Obese Moms-to-Be
6. Fetal Surgery Could Boost Outcomes in Severe Spina Bifida
7. Minorities With Severe Leg Blockages at Higher Risk of Amputation
8. Severe Mental Health Disorders Untreated in Many U.S. Teens
9. Study suggests possible new treatment for severe 2009 H1N1 infection
10. Children with severe asthma experience premature loss of lung function during adolescence
11. Adolescents with severe mental disorders have never received treatment
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/24/2017)... ... ... Yisrayl Hawkins, Pastor and Overseer at The House of Yahweh, has published a ... an astounding statement when he says that the entire Bible was written for the ... times so plainly that anyone should be able to see the time period. He ...
(Date:2/24/2017)... ... February 24, 2017 , ... ... which specializes in thought leadership , media relations, social media, content marketing ... that will be powered through Act-On, an intuitive marketing automation platform. , Rosica ...
(Date:2/23/2017)... ... February 23, 2017 , ... On February 22, ... a letter to withdraw previous guidance issued by the Obama Administration requiring ... issued in May 2016 by the Obama Administration came in response to a ...
(Date:2/23/2017)... ... February 23, 2017 , ... The American Cleft Palate-Craniofacial Association (ACPA) is pleased ... KLS is a longtime supporter of the event. , "We are pleased that KLS ... Dr. Bob Havlik, 2017 ACPA President. "KLS Martin has a long track record of ...
(Date:2/23/2017)... ... February 23, 2017 , ... EBSCO Information Services ... Institute for Health and Care Excellence (NICE) framework. The agreement allows purchasers ... (NHS) to search, order and purchase medical and healthcare-related content through GOBI ...
Breaking Medicine News(10 mins):
(Date:2/24/2017)... Md. , Feb. 23, 2017 ... marketing of the PhenoTest BC Kit, performed on ... to identify organisms that cause bloodstream infections and ... likely to respond to (antibiotic sensitivity). The test ... to provide this important information, which can guide ...
(Date:2/24/2017)... 24 février 2017 ITL Limited, ( ASX : ITD ), ... ravie d,annoncer les excellents résultats semestriels clos le 31 ... Une présentation complète « Résultats et mise à jour sur ... . Faits marquants ... 1,04 million $ ; en hausse de 104 %) ...
(Date:2/24/2017)... 23, 2017 Non-alcoholic steatohepataitis (NASH) ... various drugs being developed for the treatment ... drugs that are in various phases of ... focuses on novel pharmacologic drugs & regenerative ... therapies, recombinant proteins and RNA-based therapeutics, but ...
Breaking Medicine Technology: