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Introduction: Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. Objective: To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. Methods: Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1 mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. Results: Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p = 0.006) and Lund-Kennedy mean scores (8.8-5.1; p = 0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. Conclusion: High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.
Kosugi, E. M., Moussalem, G. F., Simões, J. C., de Souza, R. de P. e. S. F., Chen, V. G., Saraceni Neto, P., & Mendes Neto, J. A. (2016). Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis. Brazilian Journal of Otorhinolaryngology, 82(2), 191–197. https://doi.org/10.1016/j.bjorl.2015.03.014