Short-term high-dose budesonide nasal spray for postoperative uncontrolled chronic rhinosinusitis: A randomized...

The goal of treatments for chronic rhinosinusitis (CRS) is to achieve and maintain clinical control. However, more than 40% of patients showed uncontrolled disease after endoscopic sinus surgery (ESS). To date, research guidance on optimal dosing regimens for intranasal corticosteroid spray (INCS) in uncontrolled CRS remains limited.

This prospective, randomized controlled trial enrolled 43 patients with uncontrolled CRS ≥6 months post-ESS. Participants received either high-dose (1024 μg/day) or control-dose (256 μg/day) budesonide nasal spray for 14 days in a non-blinded manner. Outcomes included symptom scores (TNSS, VAS), quality of life (SNOT-22), endoscopic findings. We also explored the subgroup analyses by comparing eosinophilic (ECRS) and non-eosinophilic CRS (NECRS). Intention-to-treat (ITT) analysis was used in this clinical trial.

The study recruited 43 patients (high-dose group = 21, control group = 22).The high-dose group exhibited significantly greater reductions in TNSS, endoscopic E score, and Lund-Kennedy score (P < 0.05), and improved nasal obstruction VAS (P = 0.027). Subgroup analysis revealed superior efficacy in ECRS patients (endoscopic score reduction: P < 0.05). Adverse events were mild and comparable between groups (high-dose group 2/21 [9.5%] vs. Control group 1/22 [4.5%], P > 0.05).

Short-term high-dose budesonide nasal spray is effective and safe for postoperative uncontrolled CRS, particularly in ECRS, offering a rapid therapeutic alternative.