Oral steroids for nasal polyps

Benign nasal polyps are lesions that arise from the mucosa of the nasal cavity or one or more of the nasal sinuses. The presenting symptoms of nasal polyps are nasal obstruction, watery anterior rhinorrhoea (excessive nasal secretions) or mucopurulent postnasal drip (or both), hyposmia and anosmia (reduced or absent sense of smell) with a concomitant alteration in taste and infrequently pain over the dorsum of the nose, forehead and cheeks. The main aim of treatment is to relieve these symptoms. Because of their uncertain aetiology treatment options differ, consisting of a combination of medical and surgical management. Medical therapy is mainly in the form of steroids, administered topically or systemically via the oral route.

To assess the effects of oral steroids in patients with multiple nasal polyps.

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (January 1950 to April 2006), EMBASE (January 1974 to April 2006), CINAHL, LILACS, MEDCARIB, KOREAMED, INDMED, PAKMEDINET, SAMED, PANTELEIMON, ZETOC, Cambridge Scientific Abstracts, mRCT (metaRegister of Clinical Trials), NRR (National Research Register), ISI Web of Science and the reference lists of relevant articles. We also contacted leading experts in the field. The date of the most recent search was April 2006.

Randomised controlled trials and controlled clinical trials comparing oral steroids with no intervention, or placebo, or comparing doses or schedules of oral steroids in patients with multiple nasal polyps.

Two authors independently extracted data and assessed study quality. Study authors were contacted for additional information.

Only one trial was identified which met the inclusion criteria. This trial showed a significant improvement in quality of life and nasal symptom scores (comprising nasal obstruction and loss of smell scores) and a significant reduction in polyp size after two weeks of treatment with oral steroids compared to no steroid treatment. However the trial was small and of low methodological quality.

The authors found one small randomised controlled trial, albeit of poor quality, that suggests a short-term effect of oral steroids in patients with multiple nasal polyps. To address the issue more thoroughly a well designed, prospective randomised controlled trial is needed.