Comparison of Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis Patients

Abstract

Comparison of the Oral Steroids, Macrolides and Combination Therapy in Nasal Polyposis PatientsN asal polyps (NP) are benign and are characterised by mucosal inflammation and expansion into the lumen of the nasal cavity. They are typically pale grey protrusions and are induced by multifactorial causes. The prevalence in the general population ranges between 1 and 4%, and they mostly affect adult individuals. [1] These polyps have been known since ancient times, and yet the pathogenesis and treatment of NP remain to be fully elucidated. In recent years, NP has been considered to represent a sub-group of chronic sinusitis. [2] The most important factors in the development of nasal polyps are viewed as chronic inflammation and mucosal oedema. Other factors that may play a Objectives: In this study, our aim was to compare oral steroid therapy with macrolide therapy and with oral steroid + macrolide (combine) therapy in patients with nasal polyposis (NP). Methods: All patients were treated with nasal steroid therapy for eight weeks and divided randomly into three groups as follows: Oral steroid group, oral macrolide group and combine group. All patients underwent endoscopic staging, radiological grading, odour testing and completed the sino-nasal outcome test-22 (SNOT-22) questionnaire before and after treatment. Results: Significant improvement was observed in all parameters after treatment in all three groups. All parameters were significantly better in the combined group than in the macrolide group. Comparison of the oral steroid group and macrolide group revealed significantly better radiological grading and odour test changes for the oral steroid group, but no statistically significant differences existed according to endoscopic staging and SNOT-22. The post-treatment SNOT-22 score was significantly better in the combined group than in the steroid group. A comparison of the combined and steroid groups showed better results for the combined group for all parameters, but the differences were not significant. Conclusion: All treatment protocols were effective and the successful use of macrolide indicates its potential as an alternative in patients with contraindications to oral steroid treatment. The combined treatment may demonstrate significantly better results than steroid treatment alone if larger studies with more patients are performed.

Role of Macrolides on Management of Sinonasal Polyposis

“…Steroid has the upper hand in management of patients with NP, but steroid therapy has many contraindication like Gastric ulcers, diabetic and hypertensive patients. Other medications could be offered to these patients with NP, such as topical anticholinergics, antileukotrienes or receptor blockers, antihistamines or saline nasal sprays, mucolytics, topical/systemic decongestants [10] . Antibiotic treatment has not been considered an important alternative to steroid treatment in patients with NP, who have been treated as a subgroup of chronic rhinosinusitis in recent years [11] .…”