Intrapolyp Steroid Injection Versus Systemic Steroid Therapy for Nasal Polyposis Associated with Chronic Rhinosinusitis

Osama Awaad  Ali

doi:10.51699/cajmns.v7i1.3015

Osama Awaad Ali Department of Surgery, College of Medicine, Wasit University, Wasit, Iraq

DOI: https://doi.org/10.51699/cajmns.v7i1.3015

Keywords: CRSwNP, Intrapolyp Steroid Injection, Systemic Steroids, Nasal Polyposis, Lund-Mackay Score

Abstract

Intrapolyp Steroid injection (IPSI) involves injection of corticosteroids inside the sinonasal polyposis for treating conditions of chronic rhinosinusitis with nasal polyps (CRSwNP). IPSI varies from the systemic steroid (SCs) administration in providing steroids locally into the nasal polyps without resulting in side effects associated with the use of SCs. This study compares the effectiveness and the clinical outcomes of IPSI versus SCs administration in patients with CRSwNP. The study recruited 100 patients diagnosed with CRSwNP. Patients with CRSwNP were randomly assigned into two treatment groups. Group 1 received intrapolyp steroid injection (IPSI) of budesonide at a final concentration of 250 µg/ml/sinus for every fortnight and for a total of three times. Group 2 was treated with oral prednisolone 1 mg/kg/day for three days, then tapering the dose by 5 mg/day for 2 weeks. Patients were then followed up for three months to assess the impact of the treatment on polyp size, olfactory function, serum cortisol levels, and quality of life. Both IPSI and SCs treatment plans demonstrated efficacy in improving clinical outcomes in patients with CRSwNP. SCs resulted in a greater reduction in nasal polyp size (8.67 ± 2.6 vs. 10.15 ± 3.01, p < 0.001), greater improvement in olfactory function (27.32 ± 10.68 vs. 23.32 ± 10.05, p < 0.001), and a more significant reduction in SNOT-22 scores (36.32 ± 9.13 vs. 45.7 ± 12.66, p < 0.001) compared to IPSI. However, serum cortisol levels were found significantly higher in the SCs group (15.57 ± 5.35 vs. 13.22 ± 5.78, p = 0.001). Regression analysis revealed a significant impact of SCs on reducing polyp size (β = -0.26, p = 0.01) and improving the quality of life (β = -0.39, p < 0.001). SCs were more effective in treating signs and symptoms associated with CRSwNP compared to IPSI. However, systemic cortisol was significantly higher. Treatment selection should consider both efficacy and potential adverse effects.

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