Cortisone Therapy in Nasal Polyposis

Perioperative systemic corticosteroids are frequently utilized in patients with nasal polyps. Preoperative steroids reduce blood loss and facilitate sinus surgery. Most, but not all, nasal polyps respond to corticosteroids. Steroid therapy helps a lot in a temporary “medical polypectomy” in some responsive patients, but the disease usually recurs with the cessation of steroid therapy. However, patients with nasal polyps should use preoperatively both topical and systemic steroids. The reason for that is the fact that a great majority of the nasal polyps promptly and obviously react to this drug in the sense of a significant diminution of their volume. Therefore, before the unavoidable surgical approach to this disease, the volume of the polyps will be remarkably diminished, thus offering the surgeon good chances to go very deep into the operating field, practically to the “roots” of the polyps themselves. One should think of the fact that the recurrences of the nasal polyps are quite rarely seen once a radical, but still precisely done polypectomy is performed. Regarding topical drug administration, attention should be paid first to the form of the local treatment since some physicians recommend inhalations, balneotherapy, and nasal sprays, and some of them still advocate simple nasal drops. The latest, however, teach their patients; they explain to the patient in an understandable way how to use nasal drops properly. The administration of nasal drops has strict rules on how to be applied; otherwise, their use is senseless. The first and most important rule is to apply the drops as much as possible over the lateral nasal wall. One of the most frequent physical barriers to the comfort distribution of the nasal drops over the mucosa of the lateral nasal wall is the morphology of the nasal septum, particularly since some types of septal deformities do not allow the topical administration of the intranasal steroids in the form of the nasal spray and only the nasal drop administration, at least in the beginning of the treatment of the voluminous, obstructive polyps, can help. In addition, the possible simultaneous existence of cob-web rhinitis (arachnoidal rhinitis) in the nasal cavities should be taken into consideration since mycotoxins (fumonisins, trichothecenes, and paecilotoxins) that develop within the intranasal molds that form the arachnoidal rhinitis (cob-web rhinitis) can at least physically block the steroids! Nasal polyposis seems to be a specific manifestation of the chronic inflammation of the paranasal sinus mucosa. It appears as such a terrain to some people, but to others, it is not. The question is, what could be the reason? Maybe molecular biology will be able to answer this question from a genetic point of view. Chronic inflammation of the paranasal sinus mucosa seems to be closely connected to the concomitant inflammation of its underlying bone. If so, not only the corticosteroids should be considered in the polyposis treatment, but also the antibiotics, but only those capable of penetrating the bone tissue.