Evolution of symptoms associated to nasal polyposis following oral steroid treatment and nasalization of the ethmoid--radical ethmoidectomy is functional surgery for NPS

Abstract

Purpose: The effects on the symptoms of nasal polyposis (NPS) of 1) a 7-day systemic steroid treatment and 2) radical ethmoidectomy (nasalisation) were compared.

Patients and methods: Twenty-four patients with NPS whose symptoms failed to respond to medical treatment were included in the study. Symptoms were recorded on Visual Analog Scales (VAS) before (Q1) and the day (Q2) after a 7-day treatment of oral prednisolone (60 mg/day), and a few weeks later the day before surgery (Q3). All patients were operated on bilaterally according to the nasalization principles, i.e. endoscopic radical ethmoidectomy without mucosal preservation, with middle turbinate resection, antrostomy, sphenoidotomy and frontal ostium exposure, and a depot injection of triamcinolone 80 mg the day after surgery. The fourth questionnaire (Q4) was fulfilled one month after surgery, the day of the first postop visit. The following questionnaires were returned by mail at 3 months (Q5), 6 months (Q6), 9 months (Q7), and 12 months (Q8) post-operatively. Patients stayed on topical steroids throughout the study.

Results: Nasal obstruction was a major complaint at entry in the study. Following the short-systemic steroid course the obstruction score improved significantly. However, at 2 months after the oral steroid treatment the obstruction score had deteriorated again. Following surgery, obstruction scores ameliorated again and remained stable over the full year of follow-up. Similar results were observed for anterior and posterior rhinorrhea, sneezing and itching. None of the patients reported any intake of systemic steroids during follow-up.

Conclusion: These data show that 'nasalization' i.e. radical ethmoidectomy with middle turbinate resection and mucosa removal is effective functional surgery for patients with nasal polyposis if medical treatment fails. The subjective effects on the sense of smell are reported in a separate paper published in this issue.