How Effective are Oral Corticosteroids for Chronic Rhinosinusitis?

December 31, 2006

I have heard that a trial of prednisone is effective in some patients with recurrent rhinosinusitis.

I have heard that a trial of prednisone is effective in somepatients with recurrent rhinosinusitis. How much support isthere for this approach? When (if ever) would you considerrecommending this?---- MDAtrial of a corticosteroid is very useful in thetreatment of chronic rhinosinusitis. Corticosteroidsreduce mucosal hyperreactivity andedema. In many cases, intranasal corticosteroidsare used initially. If they cannot reachthe involved site, systemic corticosteroids are of greatvalue, especially in managing or preventing recurrent disease.Short courses of prednisone or methylprednisolonein tapered dosage regimens, with or without antibiotics, areimportant in the management of symptoms and the underlyingpathology.Some cases of chronic rhinosinusitis are accompaniedby nasal and sinus polyps that may be related to chronic infection,allergy, and/or aspirin sensitivity. I have found thatcorticosteroids are useful in managing polyps of any etiology.The polyps, especially those caused by aspirin sensitivity,respond by shrinking. In addition, the edematous mucosamay shrink, allowing the sinus ostia to open.In many patients with chronic rhinosinusitis, medicaltreatment is successful and surgery is not necessary.1However, if rhinosinusitis has been present for an extendedtime, corticosteroid treatment alone may not suffice,and surgery may be necessary.2 Nonetheless, an addedbenefit of corticosteroid therapy is that the surgery is usuallyless extensive.It is important to determine the cause of chronic rhinosinusitis.If allergy is the cause, the disease usually recursno matter what medical or surgical treatment is used.A depressed immune system, whatever the cause, must beevaluated and treated. In patients with mechanical obstructioncaused by septal disease, hypertrophied adenoids, orinjury, the defect must be identified and corrected. Inthese latter cases, corticosteroid treatment is of no help.For patients who require prolonged corticosteroidtherapy, the potential side effects must be considered, andbone density determination and ophthalmic evaluation forsubcapsular cataracts should be performed.---- Helen Fox Krause, MD
Associate Professor of Medicine
Department of Otolaryngology
University of Pittsburgh School of Medicine

References:

REFERENCES:
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Gwaltney JM Jr, Jones JG, Kennedy DW. Medical management of sinusitis:educational goals and management guidelines. The International Conference onSinus Disease.

Ann Otol Rhinol Laryngol Suppl.

1995;167:22-30.

2.

Kennedy DW, Wall SJ. The diagnosis and management of rhinosinusitis.

niversity of Pennsylvania Reports on Respiratory Infections.

2000;1(3):1-8.