Thanneru Maheshbabu, Lanke Sowmya, Kolavali Shanti
Santhi Ram Medical College and General Hospital, Nandyal, Andhra Pradesh India.
Indian J Otolaryngol Head Neck Surg. 2020 Sep;72(3):350-354. doi: 10.1007/s12070-020-01878-x. Epub 2020 May 7.
Nasal polyposis is one of the most common chronic upper airway diseases. Management of allergic rhinosinusitis with polyps is to control the disease process and the local immune response of the nasal mucosa. This is achieved by surgical removal of polypoid mucosa of all sinuses by functional endoscopic sinus surgery (FESS) followed by suppression of local immune response by using steroids. Budesonide nasal douching was introduced recently for postoperative management of patients with allergic rhinosinusitis. The therapeutic effectiveness and safety of this procedure are becoming accepted by many physicians. Evaluation of the efficacy of budesonide nasal irrigation in the postoperative management of chronic allergic rhinosinusitis with polyps. A total of 60 postoperative chronic allergic rhinosinusitis with polyps patients were randomly divided into two groups. Both groups received routine post-FESS medication as per the institute protocol. One group of patients received budesonide nasal douching in addition to regular care. Both groups were evaluated endoscopically at 1, 2, 6 and 10 weeks after surgery. Pre and postoperative quality of life change, the patient complaints, need for revision surgery were evaluated. Endoscopic Lund-Kennedy scoring (objective measurement) and Sino-Nasal Outcome Test-22 (subjective analysis) were used to compare the two postoperative groups. The average preoperative Sino-Nasal Outcome Test 22 score was 52.2. It was reduced to an average of 29.4 in patients who used the standard postoperative regimen and to 15.8 postoperatively in patients who had budesonide added to their douching solutions. The average endoscopy score was 2.2 for patients who did receive budesonide as compared to 2.9 for patients who did not receive budesonide nasal douching. Budesonide nasal douching can offer a safe and effective tool in managing local inflammatory response in allergic rhinosinusitis. It leads to a significantly better quality of life and has an adequate response on nasal mucosa-leading to less mucosal oedema and lower incidence of polypoidal changes postoperatively.
鼻息肉病是最常见的慢性上呼吸道疾病之一。伴息肉的变应性鼻-鼻窦炎的治疗是控制疾病进程和鼻黏膜的局部免疫反应。这通过功能性鼻内镜鼻窦手术（FESS）手术切除所有鼻窦的息肉样黏膜，随后使用类固醇抑制局部免疫反应来实现。布地奈德鼻腔冲洗最近被引入用于变应性鼻-鼻窦炎患者的术后管理。该方法的治疗有效性和安全性正被许多医生所接受。评估布地奈德鼻腔冲洗在伴息肉的慢性变应性鼻-鼻窦炎术后管理中的疗效。总共60例伴息肉的慢性变应性鼻-鼻窦炎术后患者被随机分为两组。两组均按照研究所方案接受FESS术后常规用药。一组患者在常规护理之外还接受布地奈德鼻腔冲洗。两组均在术后1、2、6和10周进行内镜评估。评估术前和术后生活质量的变化、患者主诉、再次手术的必要性。采用内镜Lund-Kennedy评分（客观测量）和鼻窦结局测试-22（主观分析）来比较两个术后组。术前鼻窦结局测试-22的平均评分为52.2。在使用标准术后方案的患者中，该评分平均降至29.4，而在冲洗液中添加布地奈德的患者术后降至15.8。接受布地奈德治疗的患者内镜平均评分为2.2，而未接受布地奈德鼻腔冲洗的患者为2.9。布地奈德鼻腔冲洗可为变应性鼻-鼻窦炎局部炎症反应的管理提供一种安全有效的工具。它能显著改善生活质量，对鼻黏膜有充分的反应，导致术后黏膜水肿减轻，息肉样改变的发生率降低。
