Intranasal Steroids and the Myth of Mucosal Atrophy: A Systematic Review of Original Histological Assessments

Verkerk, Misha; Bhatia, Daman D. S.; Rimmer, Janet; Earls, Peter; Sacks, Raymond; Harvey, Richard J.

doi:10.2500/ajra.2015.29.4111

Cited by 24 publications

(14 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This review demonstrated that from 34 studies that assessed the nasal mucosa via biopsy, including 11 randomized controlled trials, 5 cohorts, and 20 case series (with a duration of treatment ranging from 5 days to 5.5 years), no atrophic changes were observed. There were 2 studies that demonstrated the protective effects of INCS against remodeling changes such as squamous metaplasia 1584 . This protection against mucosal remodeling 1584 is relevant as such changes have been implicated in poorer clinical outcomes 1585 …”

Section: Chronic Rhinosinusitis With Nasal Polyps (Crswnp)mentioning

confidence: 99%

See 1 more Smart Citation

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

518

479

View full text Add to dashboard Cite

I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

show abstract

Section: Chronic Rhinosinusitis With Nasal Polyps (Crswnp)mentioning

confidence: 99%

“…There were 2 studies that demonstrated the protective effects of INCS against remodeling changes such as squamous metaplasia 1584 . This protection against mucosal remodeling 1584 is relevant as such changes have been implicated in poorer clinical outcomes 1585 …”

Section: Chronic Rhinosinusitis With Nasal Polyps (Crswnp)mentioning

confidence: 99%

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Orlandi

Kingdom

Smith

et al. 2021

Int Forum Allergy Rhinol

Self Cite

518

479

View full text Add to dashboard Cite

show abstract

“…A review of histological assessments of nasal mucosa after intranasal steroids reported that there was no evidence for mucosal atrophy, while increased glandular hyperplasia and squamous metaplasia may represent a reversal of the remodeling, rather than atrophy, of the nasal airway. 28,29 Steroids act through multiple molecular pathways and mechanisms that make a consensus difficult. Research on the action of different steroids in the field of rhinology may lead to a systematic use focused on more specific pre-or postoperative indications.…”

Section: Discussionmentioning

confidence: 99%

Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

et al. 2019

View full text Add to dashboard Cite

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic ''INC users'' represented the treated group, while ''INC nonusers'' formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre-and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups (P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users (P ¼ .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers.Keywords steroids, nasal polyps, surgical bleeding, fess, functional endoscopic sinus surgery, topical corticosteroids the symptoms of CRS, 6 the role of INCs is not clear in the preoperative setting, once the decision has been made for FESS. 7 During our multiyear experience, the surgeon retrospectively investigated patients without risk factors who

show abstract

“…При этом в большинстве случаев перфорация была выявлена у молодых женщин в течение первых 12 мес от начала терапии [8]. Авторы другого исследования [9] скептически относятся к возможности возникновения атрофии слизистой оболочки полости носа под влиянием ИКС. Отмечено, что из 34 соответствующих публикаций термин «атрофия» слизистой оболочки полости носа упоминался в 17 статьях.…”

unclassified

“…При этом определение термина приводилось только в 10 публикациях, а в остальных оно значительно варьировало, отсутствовали также четкие гистологические доказательства повреждающего влияния ИКС на слизистую оболочку полости носа. Авторы отмечают, что связь между использованием ИКС и возникновением атрофии слизистой оболочки полости носа является мифом независимо от показаний, типа препарата, его дозы и длительности применения [9]. Такие же данные были получены в двух других независимых исследованиях.…”

unclassified

The risk of development of the adverse reactions to the application of intranasal corticosteroids

Perich¹,

Perić²

2017

Ross. rinol.

View full text Add to dashboard Cite

Intranasal Steroids and the Myth of Mucosal Atrophy: A Systematic Review of Original Histological Assessments

Abstract: The concept of nasal mucosal atrophy is poorly defined and there is no histological evidence for deleterious effects from INCS use on human nasal mucosa.

Cited by 24 publications

References 75 publications

International consensus statement on allergy and rhinology: rhinosinusitis 2021

International consensus statement on allergy and rhinology: rhinosinusitis 2021

Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

The risk of development of the adverse reactions to the application of intranasal corticosteroids

Contact Info

Product

Resources

About