Skip to main content
SpringerLink
Log in

Budesonide nasal irrigation improved Lund–Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Budesonide improves the prognosis of chronic rhinosinusitis (CRS). However, few reports have examined whether its use for nasal irrigation, compared to normal saline, improves the prognosis of patients after endoscopic sinus surgery (ESS). We compared the effects of nasal irrigation with budesonide and normal saline in CRS patients after ESS.

Methods

Sixty CRS patients who had undergone ESS were randomly divided into an experimental group (30 patients), which used budesonide nasal irrigation, and a control group (30 patients), which used normal saline nasal irrigation. All patients received regular follow-up evaluations and were assessed via questionnaires, including the Lund–Kennedy endoscopic score (LKES), the symptom visual analog scale (VAS), the 22-item Sino-Nasal Outcome Test (SNOT-22), the Short-Form 36-Item Questionnaire (SF-36), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS) and a side effects scale.

Results

Scores of polyposis, mucosal edema, secretions and total score of LKES; VAS scores of nasal blockage, hyposmia and rhinorrhea; and SNOT-22 results in both groups were significantly improved 3 months after ESS. Scores of polyposis, mucosal edema, secretions and scarring and total score of LKES in experimental group were significantly better than in control group 3 months after ESS. No significant differences were observed in SF-36, SAS or SDS before or 3 months after ESS within or between the two groups. The side effects of the two groups were not significantly different.

Conclusions

Nasal irrigation improved the prognosis of CRS patients after ESS. Budesonide nasal irrigation had a better effect than normal saline nasal irrigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:1–298

    Google Scholar 

  2. Shi JB, Fu QL, Zhang H, Cheng L, Wang YJ, Zhu DD et al (2015) Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy 70:533–539

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hastan D, Fokkens W, Bachert C, Newson RB, Bislimovska J, Bockelbrink A et al (2011) Chronic rhinosinusitis in Europe—an underestimated disease. A GA2LEN study. Allergy 66:1216–1223

    Article  CAS  PubMed  Google Scholar 

  4. Blackwell DL, Lucas JW, Clarke TC (2014) Summary health statistics for US adults: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat 10:1–161

    Google Scholar 

  5. Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T et al (2012) Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy 67:91–98

    Article  CAS  PubMed  Google Scholar 

  6. Alobid I, Benitez P, Bernal-Sprekelsen M, Roca J, Alonso J, Picado C et al (2005) Nasal polyposis and its impact on quality of life: comparison between the effects of medical and surgical treatments. Allergy 60:452–458

    Article  CAS  PubMed  Google Scholar 

  7. Sahlstrand-Johnson P, Ohlsson B, Von Buchwald C, Jannert M, Ahlner-Elmqvist M (2011) A multi-centre study on quality of life and absenteeism in patients with CRS referred for endoscopic surgery. Rhinology 49:420–428

    CAS  PubMed  Google Scholar 

  8. Anand VK (2004) Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl 193:3–5

    Article  PubMed  Google Scholar 

  9. Chen XZ, Feng SY, Chang LH, Lai Xiaoping C, Xiaohong L Xia, et al. The effects of nasal irrigation with different solutions after endoscopic sinus surgery: a systematic review and meta-analysis. J Laryngol Otol 2018; 1–7

  10. Jang DW, Lachanas VA, Segel J, Kountakis SE (2013) Budesonide nasal irrigations in the postoperative management of chronic rhinosinusitis. Int Forum Allergy Rhinol 3:708–711

    Article  PubMed  Google Scholar 

  11. Soudry E, Wang J, Vaezeafshar R, Katznelson L, Hwang PH (2016) Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery. Int Forum Allergy Rhinol 6:568–572

    Article  PubMed  Google Scholar 

  12. Bhalla RK, Payton K, Wright ED (2008) Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression. J Otolaryngol Head Neck Surg 37:821–825

    PubMed  Google Scholar 

  13. Sachanandani NS, Piccirillo JF, Kramper MA, Thawley SE, Vlahiotis A (2009) The effect of nasally administered budesonide respules on adrenal cortex function in patients with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 135:303–307

    Article  PubMed  PubMed Central  Google Scholar 

  14. Welch KC, Thaler ER, Doghramji LL, Palmer JN, Chiu AG (2010) The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery. Am J Rhinol Allergy 24:26–28

    Article  PubMed  Google Scholar 

  15. Fokkens W, Lund V, Mullol J (2007) European position paper on rhinosinusitis and nasal polyps group. EP3OS 2007: European position paper on rhinosinusitis and nasal polyps 2007. A summary for otorhinolaryngologists. Rhinology 45:97–101

    PubMed  Google Scholar 

  16. Joe SA, Thambi R, Huang J (2008) A systematic review of the use of intranasal steroids in the treatment of chronic rhinosinusitis. Otolaryngol Head Neck Surg 139:340–347

    Article  PubMed  Google Scholar 

  17. Harvey RJ, Goddard JC, Wiase SK, Schlosser RJ (2008) Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg 139:137–142

    Article  PubMed  Google Scholar 

  18. Snidvongs K, Chaowanapanja P, Aeumjaturapat S, Chusakul S, Praweswararat P (2008) Does nasal irrigation enter paranasal sinuses in chronic rhinosinusitis? Am J Rhinol 22:483–486

    Article  PubMed  Google Scholar 

  19. Hyo N, Takano H, Hyo Y (1989) Particle deposition efficiency of therapeutic aerosols in the human maxillary sinus. Rhinology 27:17–26

    CAS  PubMed  Google Scholar 

  20. Wormald PJ, Cain T, Oates L, Hawke L, Wong I (2004) A comparative study of three methods of nasal irrigation. Laryngoscope 114:2224–2227

    Article  PubMed  Google Scholar 

  21. Olson DE, Rasgon BM, Hilsinger RL Jr (2002) Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope 112:1394–1398

    Article  PubMed  Google Scholar 

  22. Valentine R, Athanasiadis T, Thwin M, Singhal D, Weitzel EK, Wormald PJ (2008) A prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers. Am J Rhinol 22:390–394

    Article  PubMed  Google Scholar 

  23. Grobler A, Weitzel EK, Buele A, Jardeleza C, Cheong YC, Field J et al (2008) Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope 118:2078–2081

    Article  PubMed  Google Scholar 

  24. Merkus P, Ebbens FA, Muller B, Fokkens WJ (2006) The ‘best method’ of topical nasal drug delivery: comparison of seven techniques. Rhinology 44:102–107

    CAS  PubMed  Google Scholar 

  25. Beule A, Athanasiadis T, Athanasiadis E, Field J, Wormald PJ (2009) Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure. Am J Rhinol Allergy 23:85–90

    Article  PubMed  Google Scholar 

  26. Neubauer PD, Schwam ZG, Manes RP (2016) Comparison of intranasal fluticasone spray, budesonide atomizer, and budesonide respules in patients with chronic rhinosinusitis with polyposis after endoscopic sinus surgery. Int Forum Allergy Rhinol 6:233–237

    Article  PubMed  Google Scholar 

  27. Rotenberg BW, Zhang I, Arra I, Payton KB (2011) Postoperative care for Samter’s triad patients undergoing endoscopic sinus surgery: a double-blinded, randomized controlled trial. Laryngoscope 121:2702–2705

    Article  PubMed  Google Scholar 

  28. Snidvongs K, Pratt E, Chin D, Sacks R, Earls P, Harvey RJ (2012) Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2:415–421

    Article  PubMed  Google Scholar 

  29. Yoon HY, Lee HS, Kim IH, Hwang SH (2018) Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis. Clin Otolaryngol 43:525–532

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Xi-fu Wu, Luo-ying Yang and Shuai-xiang Li for their help in collecting and processing clinical specimens.

Funding

This study was supported by the Program of the National Natural Science Foundation of China (NSFC 81371073, 81670913), the Science and Technology Planning Project of Tianhe District, Guangzhou, Guangdong Province, China (201409KW027), and Medical Scientific Research Foundation of Guangdong Province (A2015312).

Author information

Author notes

  1. Zi-zhen Huang and Xian-zhen Chen contributed equally to this article.

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, Guangdong, People’s Republic of China

    Zi-zhen Huang, Jian-cong Huang, Zhi-yuan Wang, Xia Li, Xiao-hong Chen, Xiao-ping Lai, Li-hong Chang & Ge-hua Zhang

  2. Department of Otolaryngology-Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519020, Guangdong, People’s Republic of China

    Xian-zhen Chen

Authors
  1. Zi-zhen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xian-zhen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jian-cong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhi-yuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao-hong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiao-ping Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Li-hong Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ge-hua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Li-hong Chang or Ge-hua Zhang.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, Zz., Chen, Xz., Huang, Jc. et al. Budesonide nasal irrigation improved Lund–Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery. Eur Arch Otorhinolaryngol 276, 1397–1403 (2019). https://doi.org/10.1007/s00405-019-05327-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05327-6

Keywords

Search

Navigation