Topical Gel Therapy for Sinonasal Polyposis in Samter's Triad: Preliminary Report

Objectives: Rhinosinusitis and polyposis are difficult to treat in patients with Samter's triad; they commonly recur despite sinus surgery, antibiotics, and/or nasal steroids. The present study assesses the efficacy of a multimodal regimen that includes topical corticosteroids and antibiotics d...

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Bibliographic Details
Published in:Annals of otology, rhinology & laryngology rhinology & laryngology, 2012-11, Vol.121 (11), p.719-724
Main Authors: Shikani, Alan H., Kourelis, Konstantinos, Rohayem, Ziad, Basaraba, Randall J., Leid, Jeff G.
Format: Article
Language:English
Subjects:
Administration, Topical
Adult
Aged
Anti-Bacterial Agents - administration & dosage
Anti-Inflammatory Agents - administration & dosage
Aspirin
Asthma
Asthma - etiology
Asthma - pathology
Biological and medical sciences
Bones, joints and connective tissue. Antiinflammatory agents
Debridement
Drug Hypersensitivity - etiology
Drug Hypersensitivity - pathology
Endoscopy
Female
Gels
Humans
Male
Medical sciences
Metabolic disorders
Middle Aged
Mometasone Furoate
Nasal Polyps - microbiology
Nasal Polyps - pathology
Nasal Polyps - therapy
Otorhinolaryngology. Stomatology
Pharmacology. Drug treatments
Pregnadienediols - administration & dosage
Rhinitis - microbiology
Rhinitis - pathology
Rhinitis - therapy
Sinuses
Sinusitis - microbiology
Sinusitis - pathology
Sinusitis - therapy
Syndrome
Treatment Outcome
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Summary:Objectives: Rhinosinusitis and polyposis are difficult to treat in patients with Samter's triad; they commonly recur despite sinus surgery, antibiotics, and/or nasal steroids. The present study assesses the efficacy of a multimodal regimen that includes topical corticosteroids and antibiotics delivered through a hydroxyethyl cellulose gel and by nebulization. Methods: Eleven patients with Samter's triad who had polyposis and rhinosinusitis that recurred despite endoscopic sinus surgery were treated with a 6-week course of multimodal topical therapy consisting of a hydroxyethyl cellulose gel that releases corticosteroids and antibiotics, topical nebulization of corticosteroids and antibiotics, saline solution rinses, and sinus debridement. Clinical outcomes were evaluated by Lund-Kennedy endoscopic and symptom scores. Histologic assessment was evaluated by hematoxylin and eosin staining before and after treatment. Results: Both Lund-Kennedy symptom and endoscopic scores showed a progressive and statistically significant decline throughout the course of treatment, reaching at 6 weeks 42% of the pretreatment values (p = 0.005) for the Lund-Kennedy symptom score and 34% (p = 0.002) for the endoscopic score, respectively; however, the significance of the improvement was lost with time. Conclusions: Topical gel therapy improves clinical symptoms, endoscopic findings, and sinus membrane histologic features in patients with refractory Samter's triad, but the improvement is transient, suggesting that a longer therapeutic period might be needed.
ISSN:0003-4894
1943-572X
DOI:10.1177/000348941212101104