Reversible nasal airway obstruction: does change in nasal peak inspiratory flow following decongestion predict response to topical steroids in chronic rhinosinusitis patients?

Background:Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery.Aim:To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test.Methods:Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated.Results:Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps.Conclusion:The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.