Comprehensive assessment of the effectiveness and safety of conservative treatment of chronic rhinosinusitis

Budkovaia M.A.; Ryazantsev S.V.

doi:https://doi.org/10.17116/rosrino202028031125

Budkovaia M.A.

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

Ryazantsev S.V.

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

Comprehensive assessment of the effectiveness and safety of conservative treatment of chronic rhinosinusitis

Authors:

Budkovaia M.A., Ryazantsev S.V.

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Journal: Russian Rhinology. 2020;28(3): 125‑131

DOI: 10.17116/rosrino202028031125

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Budkovaia MA, Ryazantsev SV. Comprehensive assessment of the effectiveness and safety of conservative treatment of chronic rhinosinusitis. Russian Rhinology. 2020;28(3):125‑131. (In Russ.)
https://doi.org/10.17116/rosrino202028031125

Подписка 2026 Российская ринология (Russian Rhinology)

Использование инфографики авторами научных работ

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THE PURPOSE

Development of a comprehensive diagnostic and treatment approach to improve control over the effectiveness and safety of the use of systemic corticosteroids in the treatment of PRS.

MATERIAL AND METHODS

245 patients with PRS were examined and treated. The course of treatment included a 14-day intake of methylprednisolone in combination with long-term administration of mometasone furoate intranasally, irrigation therapy and proton pump blockers. Of these, 57 patients with latent polypous-purulent rhinosinusitis received an additional short course of systemic antibiotic therapy. The effectiveness of treatment was evaluated subjectively by the patient through questionnaires and objectively according to the results of endoscopic examination of the nasal cavity, computed tomography (CT) scan of the paranasal sinuses and anterior active rhinomanometry (AARM). To assess the safety of systemic corticosteroid therapy, an electrochemiluminescent immunoassay of changes in serum cortisol concentration and its free fraction in saliva was used.

RESULTS

In 168 (68.6%) patients, relief of the main nasal symptoms was established after a course of treatment. According to the results of AARM, restoration of nasal breathing was observed in 68 (27.8%) patients, positive dynamics according to CT data — in 227 (92.7%). Relapses of the polypous process were not observed for 1.5 years in 108 (57.2%) patients with PRS and in 28 (49.7%) patients with the polypous-purulent form of rhinosinusitis. A statistically significant decrease in the secretion of cortisol in the blood by 283.4 nmol/L and in saliva by 15.2 nmol/L was recorded in the middle of the course of treatment with methylprednisolone (p<0.05). The gradual restoration of physiological hormone secretion was established in a short time after the cancellation of methylprednisolone (p>0.05).

CONCLUSION

The combined regimen of corticosteroid therapy for PRS is an effective and safe treatment when performing dynamic monitoring of changes in the concentrations of free and bound forms of cortisol in saliva and blood.

Keywords:

polyps

rhinosinusitis

corticosteroids

cortisol

nasal obstruction

hormone concentration

Authors:

Budkovaia M.A.

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

Ryazantsev S.V.

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech

Received:

17.05.2020

Accepted:

10.06.2020

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References:

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