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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, th
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