The Effect of Three Forms of Local Corticosteroids on Sinonasal Polyposis

Document Type : Original


Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.



Since sinonasal polyposis (SNP) has a high recurrence rate after surgery, various studies have investigated the effect of corticosteroid medications to prevent disease recurrence. The present study was designed to compare the effect of three forms of local corticosteroids on preventing SNP recurrence post-operatively.
Materials and Methods:
This double-blind, randomized clinical trial study was conducted on 108 patients with SNP who underwent functional endoscopic sinus surgery (FESS). Permuted Block Randomization randomly assigned patients into three groups of 36 people: budesonide spray, betamethasone drop, and budesonide nebulizing suspension groups. One and six months after surgery, the patients were evaluated for recurrence of SNP by nasal endoscopy. SNOT 22 questionnaire was used to assess patients’ subjective improvement rate pre- and post-operatively.
According to the scores obtained in the Modified Lund-Kennedy Scoring, budesonide nebulizing suspension showed better effects on preventing the recurrence of sino-nasal polyps after FESS compared with betamethasone nasal drops. The score was significantly lower in the budesonide nebulizing suspension group compared to the betamethasone drop group (P=0.043). There was no statistically significant difference in the scores between the budesonide nebulizing suspension group and the betamethasone spray group (P=0.178). Also, we observed significant improvement in facial fullness in patients who received Budesonide nebulizing suspension.
Budesonide nebulizing suspension, compared to betamethasone nasal drops, showed better effects on preventing the recurrence of SNP after FESS.


Main Subjects

  1. Alobid I, Benítez P, Cardelús S, de Borja Callejas F, Lehrer-Coriat E, Pujols L, et al. Oral plus nasal corticosteroids improve smell, nasal congestion, and inflammation in sino-nasal polyposis. Laryngoscope. 2014;124(1):50-6.
  2. Lotfi AR, Shahidi N, Halimi M, Hosseini SNE-H. Frequency of inflammatory cell types in polyps of patients with  diffuse  sinonasal   polyposis   and


association with effective factors in recurrence. Iranian Red Crescent Medical Journal. 2020;22(11).

  1. Ismail HH, Mekhemar SM, Mostafs SY, Hafez MR. Impacts of sinonasal polyposis on pulmonary function pre and post function endoscopic surgery. Journal of Recent Advances in Medicine. 2022;3(1):45-52.
  2. Brescia G, Barion U, Pedruzzi B, Cinetto F, Giacomelli L, Pendolino AL, et al. Sinonasal polyposis in the elderly. Am J Rhinol Allergy. 2016;30(5):153-6.
  3. Wynn R, Har-El G. Recurrence rates after endoscopic sinus surgery for massive sinus polyposis. Laryngoscope. 2004;114(5):811-3.
  4. Poetker DM, Mendolia-Loffredo S, Smith TL. Outcomes of endoscopic sinus surgery for chronic rhinosinusitis associated with sinonasal polyposis. Am J Rhinol. 2007;21(1):84-8.
  5. Forwith KD, Han JK, Stolovitzky JP, Yen DM, Chandra RK, Karanfilov B, et al. RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study. Int Forum Allergy Rhinol. 2016;6(6):573-81.
  6. Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg. 2007;137(4):555-61.
  7. Psaltis AJ, Li G, Vaezeafshar R, Cho KS, Hwang PH. Modification of the Lund-Kennedy endoscopic scoring system improves its reliability and correlation with patient-reported outcome measures. Laryngoscope. 2014;124(10):2216-23.
  8. Rawal RB, Deal AM, Ebert CS, Jr., Dhandha VH, Mitchell CA, Hang AX, et al. Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial. Rhinology. 2015;53(3):227-34.
  9. Wang C, Lou H, Wang X, Wang Y, Fan E, Li Y, et al. Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol. 2015;135(4):922-9.e6.
  10. Thanneru M, Lanke S, Kolavali S. The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Allergic Rhinosinusitis with Polyps. Indian J Otolaryngol Head Neck Surg. 2020;72(3):350-4.