Damm M, Jungehülsing M, Eckel H E, Schmidt M, Theissen P
ENT Department, University of Cologne, Germany.
Otolaryngol Head Neck Surg. 1999 Apr;120(4):517-23. doi: 10.1053/hn.1999.v120.a88844.
The aim of this prospective study was to evaluate the efficacy of a combined (local and systemic) steroid therapy on the extent of chronic polypoid rhinosinusitis and patient symptoms.
Subjects of this study were 20 patients with severe chronic polypoid rhinosinusitis with total or subtotal narrowing of the all sinuses. A nasal budesonide spray (2 x 0.1 mg/day) and an oral fluocortolone medication with a daily reduction during a 12-day period (total dose: 560 mg = group 1) and a 20-day period (total dose: 715 mg = group 2), respectively, were administered. Before and after the steroid treatment we evaluated the extent of the sinusitis with MRI and patient symptoms with symptom-related questionnaires.
A significant reduction (> 30%) of the chronic polypoid rhinosinusitis was observed in 50% of MRI findings. The steroid effect on polypoid masses was heterogeneous in different anatomic areas (maxillary sinus 40%, anterior ethmoid 19%, posterior ethmoid 33%, sphenoidal sinus 61%, frontal sinus 46%). Most sinusitis-related symptoms were distinctly diminished in most patients (80%). No major side effects were observed.
A combined short-term steroid therapy is highly effective in chronic polypoid rhinosinusitis, reducing the mucosal inflammation mainly in the large sinuses and reducing the incidence of symptoms significantly. However, this therapy was insufficient in the anterior ethmoid and cannot replace the current surgical treatment concept of the osteomeatal complex in CPR. The indication for such a short-term steroid therapy is the preoperative treatment. It facilitates functional endoscopic sinus surgery by reducing the extent of surgical procedures, the time, and thereby the risks of sinus surgery.
本前瞻性研究的目的是评估联合（局部和全身）类固醇疗法对慢性息肉样鼻窦炎范围及患者症状的疗效。
本研究的受试者为20例患有严重慢性息肉样鼻窦炎且所有鼻窦完全或部分狭窄的患者。分别给予鼻用布地奈德喷雾剂（2×0.1毫克/天）和口服氟可的龙药物，在12天期间（总剂量：560毫克 = 第1组）和20天期间（总剂量：715毫克 = 第2组）每日递减剂量。在类固醇治疗前后，我们通过MRI评估鼻窦炎的范围，并通过与症状相关的问卷评估患者症状。
在50%的MRI检查结果中观察到慢性息肉样鼻窦炎有显著减轻（>30%）。类固醇对息肉样肿物的作用在不同解剖区域存在差异（上颌窦40%，前筛窦19%，后筛窦33%，蝶窦61%，额窦46%）。大多数患者（80%）的大多数与鼻窦炎相关的症状明显减轻。未观察到重大副作用。
联合短期类固醇疗法对慢性息肉样鼻窦炎非常有效，主要减少大鼻窦中的黏膜炎症并显著降低症状发生率。然而，这种疗法对前筛窦效果不佳，不能替代目前慢性息肉样鼻窦炎中针对鼻窦复合体的手术治疗理念。这种短期类固醇疗法的适应证是术前治疗。它通过减少手术操作范围、时间，从而降低鼻窦手术风险，有助于功能性鼻内镜鼻窦手术。
