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Steroid Therapy Comparable to Surgery for Patients with CRS with Nasal Polyps

by Linda Kossoff •

What are the dynamics of olfaction in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS) in relation to the effect of preoperative administration of glucocorticosteroids (GCS)?

Bottom Line: Preoperatively administered GCS improved olfaction in CRSwNP patients is comparable to surgery, and changes in steroids predicted olfactory outcome postoperatively.

Background: Olfactory dysfunction affects 65% to 80% of patients with CRS, and CRSwNP is associated with a higher frequency/degree of olfactory impairment. If conservative treatment fails to relieve symptoms, ESS should be considered. However, olfactory outcome after ESS is difficult to predict.

Study Design: Prospective study with treatment group and control group.

Setting: Smell and Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Dresden.

Synopsis: Fifty-two adult CRSwNP patients were randomly divided into a control group of 31 and a treatment group of 21. The treatment group received a short course of oral prednisolone therapy preoperatively. All patients underwent birhinal, orthonasal olfactory assessment to determine a threshold, discrimination, and identification (TDI) score, and rated their olfactory function. Fifty-one of the patients underwent ESS and received standard postoperative therapy. Olfactory function was evaluated preoperatively and at two weeks, one month, and three months postoperatively. Olfactory function improved in 47% of all patients one month after ESS. Twelve treatment group patients experienced improved olfactory function from preoperative GCS and maintained improvements at one and three months, and the nine patients for whom preoperative GCS was ineffective showed no postoperative change. Study limitations include a small cohort, short follow-up period, and missing stratification regarding CRS severity and phenotype.

Citation: Bogdanov V, Walliczek-Dworschak U, Whitcroft KL, et al. Response to glucocorticosteroids predicts olfactory outcome after ESS in chronic rhinosinusitis. Laryngoscope. 2020;130:1616-1621. doi:10.1002/lary.28233.