Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

Kosugi, Eduardo Macoto; Moussalem, Guilherme Figner; Simões, Juliana Caminha; Souza, Rafael de Paula e Silva Felici de; Chen, Vitor Guo; Saraceni Neto, Paulo; Mendes Neto, José Arruda

doi:10.1016/j.bjorl.2015.03.014

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Brazilian Journal of Otorhinolaryngology

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ORIGINAL ARTICLES • Braz. j. otorhinolaryngol. 82 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.bjorl.2015.03.014 copy

Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis ^{^☆} ☆ Please cite this article as: Kosugi EM, Moussalem GF, Simões JC, de Souza RPSF, Chen VG, Saraceni-Neto P, et al. Topical therapy of nasal irrigation with high-volume budesonide solution in difficult to treat chronic rhinosinusitis. Braz J Otorhinolaryngol. 2016;82: 191-7.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment.

OBJECTIVE:

To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS.

METHODS:

Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1 mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed.

RESULTS:

Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p = 0.006) and Lund-Kennedy mean scores (8.8-5.1; p = 0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations.

CONCLUSION:

High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.

Keywords:
Sinusitis; Nasal polyps; Therapeutic irrigations; Corticosteroids; Endoscopy

Patient	Gender	Age	Diagnosis	Asthma	Intolerance to ASA	Rhinitis	Commorbities	Previous surgery	Main complaint	Subjective improvement	Satisfaction
1	F	52	CRSwNP	Yes	No	No	Woakes	5	Post. Rhin.	Partial	No
2	F	61	CRSwNP	No	No	Yes	Hypothyroidism	1	Post. Rhin.	Total	Yes
3	M	50	CRSwNP	Yes	No	Yes	Without	1	Post. Rhin.	Partial	Yes
4	M	60	CRSwNP	No	No	Yes	Without	1	Obstruction	Total	Yes
5	F	29	CRSwNP	Yes	No	No	Without	3	Post. Rhin.	Partial	Yes
6	F	56	CRSw/oNP	No	No	No	Churg–Strauss	2	Obstruction	Total	Yes
7	F	59	CRSwNP	Yes	No	No	Without	1	Ant. Rhin.	Total	Yes
8	F	37	CRSw/oNP	No	No	No	VCID	1	Ant. Rhin.	Partial	Yes
9	M	47	CRSwNP	No	No	No	Intol. Dipirone	1	Hiposmia	Partial	Yes
10	M	64	CRSwNP	No	No	No	Renal Tx	1	Ant. Rhin.	Partial	No
11	F	58	CRSwNP	Yes	Yes	No	Without	1	Ant./Post. Rhin.	Partial	Yes
12	F	53	CRSwNP	Yes	Yes	No	Without	2	Ant. Rhin.	Partial	Yes
13	F	47	CRSw/oNP	No	No	No	Without	2	Post. Rhin.	Total	Yes
14	F	62	CRSw/oNP	No	No	No	Without	2	Obstruction	Without improvement	No
15	F	40	CRSwNP	Yes	No	No	Without	2	Ant. Rhin.	Partial	Yes
16	F	39	CRSw/oNP	No	No	No	Renal Tx	2	Post. Rhin.	Total	Yes

Data		Groups
		With satisfactory improvement	Without satisfactory improvement	Total	Test	p-value
Patients, total	n (%)	13 (81.3)	3 (18.7)	16 (100)
Female gender	n (%)	10 (76.9)	2 (66.6)	12 (75)	Fisher	1
Age (years)	Mean (SD)	48.9 (10.2)	59.3 (6.4)	50.9 (10.3)	T	0.11
Nasosinusal polyposis	n (%)	9 (69.2)	2 (66.6)	11 (68.8)	Fisher	1
Asthma	n (%)	6 (46.2)	1 (33.3)	7 (53.8)	Fisher	1
ASA intolerance	n (%)	2 (15.4)	0 (0.0)	2 (12.5)	Fisher	1
Rhinitis	n (%)	3 (18.8)	0 (0.0)	3 (18.8)	Fisher	1
Previous surgeries	Mean (SD)	1.5 (0.6)	2.7 (2.1)	1.8 (1.1)	T	0.09

Data		Groups
		With satisfactory improvement	Without satisfactory improvement	Total	t test p-value
					With vs. without improvement
Patients, total	n (%)	13 (81.3)	3 (18.7)	16 (100)

SNOT-22 pre	Mean (SD)	47.7 (19.6)	61.0 (16.4)	50.2 (19.3)	0.31
SNOT-22 post	Mean (SD)	25.3 (19.3)	48.0 (16.5)	29.6 (20.4)	0.13
Difference SNOT-22	Mean (SD)	22.4 (23.4)	13.0 (4.4)	20.6 (21.6)	0.19
Pre vs. post t test p-value		0.007^a	0.39	0.006^a

Lund–Kennedy pre	Mean (SD)	8.5 (3.5)	10.3 (1.5)	8.8 (3.3)	0.19
Lund–Kennedy post	Mean (SD)	4.2 (4.3)	9.3 (1.2)	5.1 (4.4)	0.002^a
Difference Lund–Kennedy	Mean (SD)	4.3 (4.0)	1.0 (1.0)	3.7 (3.8)	0.02^a
Pre vs. post t test p-value		0.009^a	0.42	0.01^a

Patient	Gender	Age	Diagnostic	SNOT-22 pre	SNOT-22 post	Post-pre difference	Objective improvement SNOT-22	Lund–Kennedy pre	Lund–Kennedy post	Post-pre difference	Objective improvement Lund–Kennedy
1	F	52	CRSwNP	79	64	-15	Improvement	10	10	0	Without improvement
2	F	61	CRSwNP	61	12	-49	Improvement	10	7	-3	Improvement
3	M	50	CRSwNP	75	0	-75	Total improvement	9	0	-9	Total improvement
4	M	60	CRSwNP	27	15	-12	Improvement	10	0	-10	Total improvement
5	F	29	CRSwNP	67	17	-50	Improvement	10	9	-1	Improvement
6	F	56	CRSw/oNP	52	34	-18	Improvement	5	0	-5	Total improvement
7	F	59	CRSwNP	6	8	2	Without improvement	5	0	-5	Total improvement
8	F	37	CRSw/oNP	65	40	-25	Improvement	11	0	-11	Total improvement
9	M	47	CRSwNP	27	11	-16	Improvement	6	6	0	Without improvement
10	M	64	CRSwNP	47	31	-16	Improvement	12	10	-2	Improvement
11	F	58	CRSwNP	33	17	-16	Improvement	12	10	-2	Improvement
12	F	53	CRSwNP	54	61	7	Without improvement	10	10	0	Without improvement
13	F	47	CRSw/oNP	51	39	-12	Improvement	0	0	0	Without improvement
14	F	62	CRSw/oNP	51	49	-2	Without improvement	9	8	-1	Improvement
15	F	40	CRSwNP	58	58	0	Without improvement	10	8	-2	Improvement
16	F	39	CRSw/oNP	44	17	-27	Improvement	12	4	-8	Improvement

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:edumacoto@uol.com.br (E.M. Kosugi).