كرسي ابحاث الأنف و الجيوب الأنفية وقاع الجمجمة

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When are we operating for chronic rhinosinusitis?A systematic review ofmaximal medical therapy protocols prior to endoscopic sinus surgery

 Jon F. Dautremont, MD and Luke Rudmik, MD, MSc

 

 Conclusion

A minority of studies explicitly report MMT criteria before considering a patient with CRS a candidate for ESS.

When reported, the MMT criteria varied widely with the majority of protocols involving a minimum 8-week course of topical intranasal corticosteroids and 3-week course of oral antibiotics.

A 2-week course of systemic corticosteroids was also included as part of MMT in more than one-half of the reviewed studies

 

J Allergy Clin Immunol. 2010 May;125(5):1069-1076.e4. doi: 10.1016/j.jaci.2010.02.020.

Oral steroids and doxycycline: two different approaches to treat nasal polyps.

Van Zele T1, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, Hens G, Hellings P, Ebbens FA, Fokkens W, Van Cauwenberge P, Bachert C

 

Randomly assigned 47 patients with bilateral nasal polyps to receive either (for 20 days)

 

Materials and methods

Patients were followed for 12 weeks and were assessed for:

Symptoms and signs by nasal endoscopy.

Nasal peak inspiratory flow.

Markers of inflammation in nasal secretions (eosinophilic cationic protein (ECP), IL-5, myeloperoxidase, matrix metalloproteinase 9, and IgE).

Peripheral blood level concentrations of (eosinophils, ECP, and soluble IL-5 receptor)

 

Results

Methylprednisolone Group:

Significant reduction of polyp size after one week compared to placebo p= 0.002

Maximal reduction was after two weeks P< 0.0001

 

Significant decrease in nasal congestion , PND and hyposmia after 1 week until 4 week.

Symptoms scores worsened progressively after week 4 and returned to baseline values.

No significant effect on rhinorrhea

 

Significant decrease of eosinophils in blood samples compared with placebo starting at week 1, with a maximal decrease at 2 weeks.

Blood eosinophils counts returned to baseline levels at month 1.

Rebound eosinophilia (above baseline level) observed levels at month 2 and 3.

Significant reduction in IL-5 and IgE at weeks 1,2,and 4.

No change in MMP-9 levels in nasal secretion

 

Doxycycline Group:

1. Significant reduction in polyp size starting at week two compared with placebo and

remained significantly reduced upto 3 months after dosing.

 

2.Significant reduction in PND at week 2 and

3. significant reduction in rhinorrhea at week 8.

 

4. No effect on eosinophils level in blood samples.

5. No effect on IL-5 level in nasal secretions.

6. Significant reduction in IgE at weeks 1,2,and 4.

7. Significant decrease in levels of myeloperoxidase and MMP-9 in nasal secretions.

 

conclusion

 

1. Methylprednisolone and doxycycline each significantly decreased nasal polyp size compared with placebo.

2. Oral doxycycline causes a long-term reduction in nasal polyp size (lasting for 12 weeks), whereas methylprednisolone causes an initial reduction in polyp size (maximal after week 2) but complete recurrence after 2 months.

3. Treatment of CRSwNP with oral corticosteroids is of limited value unless it is associated with surgery or therapy with intra nasal corticosteroids.

 

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