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

e 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.

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