Hostname: page-component-77f85d65b8-2tv5m Total loading time: 0 Render date: 2026-03-27T21:55:11.157Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of budesonide intrapolyp injection in the management of type 2 chronic rhinosinusitis with nasal polyps: a randomised clinical trial

Published online by Cambridge University Press:  02 October 2023

Saad Elzayat ,
Ahmed Elgendy ,
Hesham Lasheen ,
Mohamed E El-Deeb Open the ORCID record for Mohamed E El-Deeb [Opens in a new window] ,
Mohammad Mahmoud Aouf Open the ORCID record for Mohammad Mahmoud Aouf [Opens in a new window]  and
Ibrahim Gehad Open the ORCID record for Ibrahim Gehad [Opens in a new window]
Saad Elzayat
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Kafrelsheikh University, Kafr ElSheikh, Egypt
Ahmed Elgendy
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Kafrelsheikh University, Kafr ElSheikh, Egypt
Hesham Lasheen
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Cairo University, Cairo, Egypt.
Mohamed E El-Deeb
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Kafrelsheikh University, Kafr ElSheikh, Egypt
Mohammad Mahmoud Aouf
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Kafrelsheikh University, Kafr ElSheikh, Egypt
Ibrahim Gehad*
Affiliation:
Otorhinolaryngology Department, Faculty of Medicine – Kafrelsheikh University, Kafr ElSheikh, Egypt
*
Corresponding author: Ibrahim Mahmoud Gehad; Email: ibrahimgehad94@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Problem

To assess the efficacy of budesonide intrapolyp injection in chronic rhinosinusitis with nasal polyps.

Method

Ninety patients were divided into three groups; group A was given oral prednisolone, group B was given budesonide intrapolyp injection weekly for five consecutive weeks and group C was given budesonide as nasal irrigation for one month. Patients were assessed using Sino-Nasal Outcome Test 22 score, total nasal polyp score, serum immunoglobulin E, absolute eosinophilic count, and morning cortisol level before treatment, one week and three months after completing their treatment.

Results

Total nasal polyp score decreased significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was greater than the wash group (p2 = 0.004), (p3 < 0.001), and the same trend concerning Sino-Nasal Outcome Test 22 score (p2 < 0.001), (p3 < 0.001).

Conclusion

Budesonide is an effective agent used in intrapolyp injection with no documented systemic or visual side effects that has comparable results with oral steroids.

Keywords

Nasal obstructionnasal polypsbudesonidesinusitiscorticosteroids

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 4 , April 2024 , pp. 416 - 424
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Ibrahim Mahmoud Gehad takes responsibility for the integrity of the content of the paper

References

Fokkens, WJ, Lund, VJ, Hopkins, C, Hellings, PW, Kern, R, Reitsma, S et al. European Position paper on rhinosinusitis and nasal polyps 2020. Rhinology 2020;58(suppl S29):1–464CrossRefGoogle ScholarPubMed
Moss, WJ, Kjos, KB, Karnezis, TT, Lebovits, MJ. Intranasal steroid injections and blindness: our personal experience and a review of the past 60 years. Laryngoscope 2015;125:796–800CrossRefGoogle Scholar
Hansen, MB, Alanin, MC. Injection of steroid in nasal polyps: a systematic review. Am J Rhinol Allergy 2020;34:838–45CrossRefGoogle ScholarPubMed
Dingsør, G, Kramer, J, Olsholt, R, Søderstrøm, T. Flunisolide nasal spray 0.025% in the prophylactic treatment of nasal polyposis after polypectomy. A randomized, double blind, parallel, placebo controlled study. Rhinology 1985;23:49–58Google ScholarPubMed
Rimmer, J, Fokkens, W, Chong, LY, Hopkins, C. Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev 2014;(12):CD006991.CrossRefGoogle ScholarPubMed
Kirtsreesakul, V, Wongsritrang, K, Ruttanaphol, S. Clinical efficacy of a short course of systemic steroids in nasal polyposis. Rhinology 2011;49:525–32CrossRefGoogle Scholar
Hopkins, C, Slack, R, Lund, V, Brown, P, Copley, L, Browne, J. Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 2009;119:2459–65CrossRefGoogle ScholarPubMed
Loftus, CA, Soler, ZM, Koochakzadeh, S, Desiato, VM, Yoo, F, Nguyen, SA et al. Revision surgery rates in chronic rhinosinusitis with nasal polyps: meta-analysis of risk factors. Int Forum Allergy Rhinol 2020;10:199–207CrossRefGoogle ScholarPubMed
Kang, TW, Chung, JH, Cho, SH, Lee, SH, Kim, KR, Jeong, JH. The effectiveness of budesonide nasal irrigation after endoscopic sinus surgery in chronic rhinosinusitis with asthma. Clin Exp Otorhinolaryngol 2017;10:91–6CrossRefGoogle ScholarPubMed
Schulz, KF, Altman, DG, Moher, D, for the CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. In: https://www.equator-network.org/reporting-guidelines/consort/ [23 August 2023]CrossRefGoogle Scholar
Kapucu, B, Cekin, E, Erkul, BE, Cincik, H, Gungor, A, Berber, U. The effects of systemic, topical, and intralesional steroid treatments on apoptosis level of nasal polyps. Otolaryngol Head Neck Surg 2012;147:563–7CrossRefGoogle ScholarPubMed
Hopkins, C, Gillett, S, Slack, R, Lund, VJ, Browne, JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 2009;34:447–54CrossRefGoogle ScholarPubMed
Asiri, M, Alokby, G. Validation and cross-cultural adaptation of the Sinonasal Outcome Test (SNOT)-22 for the Arabian patient population. Cureus 2019;11:e4447Google ScholarPubMed
Hopkins, C, Browne, JP, Slack, R, Lund, V, Brown, P. The Lund–Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg 2007;137:555–61CrossRefGoogle Scholar
Kırıs, M, Muderris, T, Yalçıner, G, Bercin, S, Sevil, E, Gul, F. Intrapolyp steroid injection for nasal polyposis: randomized trial of safety and efficacy. Laryngoscope 2016;126:1730–5CrossRefGoogle ScholarPubMed
Hamilos, DL. Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol 2011;128:693–707CrossRefGoogle ScholarPubMed
McCormick, JP, Thompson, HM, Cho, D-Y, Woodworth, BA, Grayson, JW. Phenotypes in chronic rhinosinusitis. Curr Allergy Asthma Rep 2020;20:20CrossRefGoogle ScholarPubMed
Chin, D, Harvey, RJ. Nasal polyposis: an inflammatory condition requiring effective anti-inflammatory treatment. Curr Opin Otolaryngol Head Neck Surg 2013;21:23–30CrossRefGoogle ScholarPubMed
Huang, Z-Z, Chen, X-Z, Huang, J-C, Wang, Z-Y, Li, X, Chen, X-H et al. Budesonide nasal irrigation improved Lund-Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2019;276:1397–403CrossRefGoogle ScholarPubMed
Alobid, I, Mullol, J. Role of medical therapy in the management of nasal polyps. Curr Allergy Asthma Rep 2012;12:144–53CrossRefGoogle ScholarPubMed
Joe, SA, Thambi, R, Huang, J. A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis. Otolaryngol Head Neck Surg 2008;139:340–7CrossRefGoogle ScholarPubMed
FDA approves dupixent® (dupilumab) for chronic rhinosinusitis with nasal polyposis. Regeneron Pharmaceuticals Inc. In: https://investor.regeneron.com/news-releases/news-release-details/fda-approves-dupixentr-dupilumab-chronic-rhinosinusitis-nasal [15 August 2022]Google Scholar
Gevaert, P, Van Bruaene, N, Cattaert, T, Van Steen, K, Van Zele, T, Acke, F et al. Mepolizumab, a humanized anti-IL-5 mAb, as a treatment option for severe nasal polyposis. J Allergy Clin Immunol 2011;128:989–95CrossRefGoogle ScholarPubMed
Snidvongs, K, Pratt, E, Chin, D, Sacks, R, Earls, P, Harvey, RJ. Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2012;2:415–21CrossRefGoogle ScholarPubMed
Wall, JW, Shure, N. Intranasal cortisone; preliminary study. AMA Arch Otolaryngol 1952;56:172–6CrossRefGoogle ScholarPubMed
Hager, G, Heise, G. A severe complication with permanent practical blindness of one eye following intranasal injection. HNO 1962;10:325–8Google Scholar
Mabry, RL. Visual loss after intranasal corticosteroid injection. Incidence, causes, and prevention. Arch Otolaryngol 1981;107:484–6CrossRefGoogle ScholarPubMed
Antunes, MB, Becker, SS. The role of local steroid injection for nasal polyposis. Curr Allergy Asthma Rep 2010;10:175–80CrossRefGoogle ScholarPubMed
Becker, SS, Rasamny, JK, Han, JK, Patrie, J, Gross, CW. Steroid injection for sinonasal polyps: the University of Virginia experience. Am J Rhinol 2007;21:64–9CrossRefGoogle ScholarPubMed
Pynnonen, MA, Mukerji, SS, Kim, HM, Adams, ME, Terrell, JE. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg 2007;133:1115–20CrossRefGoogle ScholarPubMed
Shah, SR, Miller, C, Pethick, N, Uryniak, T, Jones, MKC, O'Dowd, L. Two multicenter, randomized, single-blind, single-dose, crossover studies of specific sensory attributes of budesonide aqueous nasal spray and fluticasone propionate nasal spray. Clin Ther 2003;25:2198–214CrossRefGoogle ScholarPubMed
Neubauer, PD, Schwam, ZG, Manes, RP. Comparison of intranasal fluticasone spray, budesonide atomizer, and budesonide respules in patients with chronic rhinosinusitis with polyposis after endoscopic sinus surgery. Int Forum Allergy Rhinol 2016;6:233–7CrossRefGoogle ScholarPubMed
Xu, Z, Luo, X, Xu, L, Deng, J, Gao, W, Jiang, L et al. Effect of short-course glucocorticoid application on patients with chronic rhinosinusitis with nasal polyps. World Allergy Organ J 2020;13:100131CrossRefGoogle ScholarPubMed
Edsbäcker, S, Andersson, T. Pharmacokinetics of budesonide (Entocort EC) capsules for Crohn's disease. Clin Pharmacokinet 2004;43:803–21Google ScholarPubMed
Li, X, Li, Y, Xu, B, Zhang, P, Wang, Y, Wang, Z et al. Pharmacokinetics and bioequivalence of a generic and a branded budesonide nasal spray in healthy Chinese subjects. Clin Pharmacol Drug Dev 2022;11:516–22CrossRefGoogle Scholar
Baker, DE. Budesonide modified-release capsules. Rev Gastroenterol Disord 2001;1:147–55Google ScholarPubMed
Silverman, J, Otley, A. Budesonide in the treatment of inflammatory bowel disease. Expert Rev Clin Immunol 2011;7:419–28CrossRefGoogle ScholarPubMed
Iborra, M, Alvarez-Sotomayor, D, Nos, P. Long-term safety and efficacy of budesonide in the treatment of ulcerative colitis. Clin Exp Gastroenterol: 2014;7:39–46Google ScholarPubMed
Sun, RX, Zhao, Y, Liu, J. Intratympatic budesonide injection for treatment of refractorysudden sensorineural hearing loss [in Chinese]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016;30:972–7Google ScholarPubMed
Liu, X, Xiao, X, Liu, D, Tan, C. A meta-analysis on randomized controlled trials of treating eosinophilic esophagitis with budesonide. Ann Med 2022;54:2078–88CrossRefGoogle ScholarPubMed
Sachanandani, NS, Piccirillo, JF, Kramper, MA, Thawley, SE, Vlahiotis, A. The effect of nasally administered budesonide respules on adrenal cortex function in patients with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 2009;135:303–7CrossRefGoogle ScholarPubMed