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

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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

List of references:

Ryabova MA, Ulupov MYu, Pestakova LV, Malkova ME. Nasal irrigation with Dioxydin for treatment of chronic rhinosinusitis exacerbations. Folia Otorhinolaryngologiae et Pathologiae Respiratoriae. 2017;23(4):117-127. Accessed May 15, 2020 (In Russ.). https://elib.pstu.ru/vufind/EdsRecord/edselr,edselr.30779586
Kalyapin DD. A variety of approaches to the treatment of chronic rhinosinusitis polyposa. Russkij Mediinskij Jurnal. 2018;3(II):67-70. Accessed May 15, 2020 (In Russ.). https://www.rmj.ru/articles/otorinolaringologiya/Raznoobrazie_podhodov_pri_lechenii_hronicheskogo_polipoznogo_rinosinusita/
Ryazantsev SV, Budkovaya MA. Taktika lecheniya polipoznogo rinosinusita. Rossiiskaya otorinolaringologiya. 2017;2(87):162-169. Accessed May 15, 2020 (In Russ.). https://entru.org/2017-2.html
Budkovaya MA. A comprehensive approach to the treatment of newly detected and recurrent polypous rhinosinusitis. Rossiyskaya otorinolaringologiya. 2015;1(74):140-146. Accessed May 15, 2020. (In Russ.). https://entru.org/2015-1.html
Likhanova MA, Bondarev OI, Mingalev NV, Lebedeva RN. Polipoznyi rinosinusit — voprosy etiopatogeneza. Omskii nauchuj vestnik. 2014;2(134):56-59. Accessed May 15, 2020. (In Russ.). https://cyberleninka.ru/article/n/polipoznym-rinosinusit-voprosy-etiopatogeneza/viewer
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O’Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu C-C, Searyoh K, Rhee C-S, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Snidvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CP. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(suppl 29):1-464. https://doi.org/10.4193/rhin20.600
Kozlov VS, Savlevich EL. Chronic rhinosinusitis with nasal polyps. The recent trend in the studies of the pathogenesis, diagnosis and treatment of this disease. Vestnik otorinolaringologii. 2015; 4:96-99. (In Russ.). https://doi.org/10.17116/otorino201580495-99
Ryazantsev SV, Budkovaya MA. Current view of the treatment of chronic rhinosinusitis with nasal polyps. Rossiiskaya rinologiya. 2017;25(1):54-59. (In Russ.). https://doi.org/10.17116/rosrino201725154-59
Kasper L, Sladek K, Duplaga M, Bochenek G, Liebhart J, Gladysz U, Malolepszy J, Szczeklik A. Prevalence of asthma with aspirin hypersensitivity in the adult population of Poland. Allergy. 2003; 58:1064-1066. https://doi.org/10.1034/j.1398-9995.2003.00267.x
Lamblin C, Tillie-Leblond I, Darras J, Dubrulle F, Chevalier D, Cardot E, Perez T, Wallaert B, Piquet JJ, Tonnel AB. Sequential evaluation of pulmonary function and bronchial hyperresponsiveness in patients with nasal polyps: a prospective study. American Journal of Respiratory and Critical Care Medicine. 1997; 155:99-103. https://doi.org/10.1164/ajrccm.155.1.9001296
Karpishchenko SA, Ryabova MA, Shumilova NA. Efficacy of Nasonex in Treatment of Patients with Chronic Polypous Rhinosinusitis. Effektivnaya farmakoterapiya. Pul’monologiya i otorinolaringologiya. 2016;20(1):6-9. Accessed May 15, 2020. (In Russ.). https://umedp.ru/articles/konservativnoe_lechenie_pri_polipoznom_rinosinusite_.html
Kornkiat Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. Topical steroids for nasal polyps. Cochrane Systematic Review-Intervention (Online). 2016;4. https://doi.org/10.1002/14651858.CD006549.pub3
Cope D, Bova R. Steroids in otolaryngology. Laryngoscope. 2008;118(9):1556-1560. https://doi.org/10.1097/MLG.0b013e31817c0b4d
Martinez-Devesa P, Patiar S. Oral Steroids for Nasal Polyps. Cochrane Database System Review. 2011;7:CD005232. https://doi.org/10.1002/14651858.CD005232.pub3
Glyukokortikoidnaya terapiya: kak dobit’sya bol’shei effektivnosti i bezopasnosti. Metod. rek. dlya vrachei. Ed. by Vertkin A.L., Gorodetskii V.V., Topolyanskii A.V. M. 1998. Accessed May 15, 2020. (In Russ.). https://b-ok.cc/book/3151095/6e09e8
Huppertz HI, Pfüller H. Transient suppression of endogenous cortisol production after intraarticular steroid therapy for chronic arthritis in children. Rheumatology. 1997;24(9):1833-1837. Accessed May 15, 2020. https://pubmed.ncbi.nlm.nih.gov/?term=Transient+suppression+of+endogenous+cortisol+production+after+intraarticular+steroid+therapy+for+chronic+arthritis+in+children
Vogt K, Bachmann-Harildstad G, Lintermann A, Nechyporenko A, Peters F, Wernecke KD. The New Agreement of the International RIGA Consensus Conference on Nasal Airway Function Tests. Rhinology. 2018;56(2):133-143. https://doi.org/10.4193/Rhin17.084
Ryazantsev S.V., Budkovaya M.A., Nacharov P.V. Sposob otsenki bezopasnosti primeneniya sistemnykh kortikosteroidov. Patent RF na izobretenie № 2 578 972/2014.12.12. Byul. № 9. Accessed May 15, 2020. (In Russ.). https://yandex.ru/patents/doc/RU2578972C1_20160327

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