scholarly journals Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis

2021 ◽  
pp. 014556132199852
Author(s):  
Pawina Jiramongkolchai ◽  
Siddharth Patel ◽  
John S. Schneider
Keyword(s):  
Chronic Rhinosinusitis ◽  
Response To Treatment ◽  
Topical Steroids ◽  
Patient Response ◽  
Off Label ◽  
Nasal Irrigation ◽  
Nasal Steroids ◽  
Nasal Steroid ◽  
Sinonasal Mucosa

Objective: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. Methods: A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. Results: Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. Conclusions: Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.

scholarly journals Long-term low-dose antibiotics in recalcitrant chronic rhinosinusitis: a retrospective analysis

2012 ◽  
Vol 50 (1) ◽  
pp. 45-55
Author(s):  
W.J.M. Videler ◽  
K. van Hee ◽  
S.M. Reinartz ◽  
C. Georgalas ◽  
F.W. van der Meulen ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Outpatient Clinic ◽  
Low Dose ◽  
Group Discussion ◽  
Sinus Surgery ◽  
Dose Treatment ◽  
Intranasal Corticosteroids ◽  
Significant Difference ◽  
Sinonasal Mucosa

Introduction: In recalcitrant Chronic RhinoSinusitis (CRS) treatment with intranasal corticosteroids, short-term antibiotics and even sinus surgery is frequently insufficient. Long-term low-dose administration of antibiotics has been suggested as a treatment option in these patients. We analysed the outpatient clinic population treated with different long-term low-dose antibiotics at the AMC Amsterdam. Patients and methods: Eligible patients, who were treated with trimethoprim-sulfamethoxazole or macrolides, were retrospectively identified from our outpatient clinic in 2009. The two main outcome measures were sinonasal complaints and nasal endoscopic findings. A 5-point grading scale was used to score the results compared with the pre-treatment situation. This was measured at several time-points during, and after the antibiotic course, and at the end of the follow-up term. Results: Seventy-six patients were included, 53 per cent had asthma and all of them had undergone sinus surgery. Seventy-eight per cent showed improvement of the symptoms, and 84 per cent demonstrated improvement of the sinonasal mucosa at the end of the course. No significant difference was found between the trimethoprim-sulfamethoxazole and macrolide group. Discussion: Long-term low-dose treatment with antibiotics seems to improve CRS symptoms and the appearance of the sinonasal mucosa on nasal endoscopy. However, at this stage, strong conclusions are immature because no placebo-group has been included. Despite increasing use of long-term low-dose treatment of recalcitrant CRS in referral centres, hard clinical evidence is lacking. More research is urgently required.

scholarly journals The Effect of Nasal Steroid Administration on Intraocular Pressure

2007 ◽  
Vol 86 (7) ◽  
pp. 394-395 ◽  
Author(s):  
Christos Spiliotopoulos ◽  
Nicholas S. Mastronikolis ◽  
Ioannis K. Petropoulos ◽  
Ephigenia K. Mela ◽  
Panos D. Goumas ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Systemic Steroid ◽  
Long Term Effects ◽  
Steroid Administration ◽  
Nasal Steroids ◽  
Term Administration ◽  
Nasal Steroid ◽  
Iop Elevation

The effect of systemic steroid administration on intraocular pressure (IOP) is well established. However, less attention has been paid to the effect of steroids when administered in a nasal spray. We conducted a study to investigate a possible association between nasal steroids and elevated IOP in 54 patients who were being treated for allergic rhinitis. IOP was measured before the patients started therapy and thereafter every 5 days during that therapy. Follow-up ranged from 27 to 35 days (mean: 31). Statistical analysis revealed no significant elevation in IOP after nasal steroid administration. It seems that short-term administration of nasal steroids does not cause significant IOP elevation. Nevertheless, their long-term effects on this pressure should be investigated.

scholarly journals A review of significant pharmacokinetic drug interactions with antidepressants and their management

2016 ◽  
Vol 6 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Charity Hoffelt ◽  
Tonya Gross
Keyword(s):  
Adverse Events ◽  
Drug Interactions ◽  
Response To Treatment ◽  
Patient Response ◽  
Pharmacokinetic Profiles ◽  
Drug Classes ◽  
Treatment Of Depression ◽  
Term Management ◽  
Pharmacokinetic Drug

Abstract Treatment of depression often requires long-term management with medication. Practitioners should be aware of potentially significant drug interactions with the use of antidepressants in order to effectively prevent or manage adverse events while optimizing patient response to treatment. Most antidepressants are metabolized by the liver, primarily via the CYP450 system. Pharmacokinetic profiles of the most recently approved antidepressants are reviewed in addition to evidence supporting potentially significant interactions. In addition, pharmacokinetic interactions between multiple antidepressants and other drug classes, including opiates, antineoplastics, antiepileptics, and antipsychotics, are discussed. This article provides recommendations for the monitoring and management of drug interactions. In addition, limitations of the evidence are reviewed.

scholarly journals Short Term Pre-Operative Oral Corticosteroids—Tissue Remodeling in Chronic Rhinosinusitis with Nasal Polyps

2021 ◽  
Vol 10 (15) ◽  
pp. 3346
Author(s):  
Kamil Radajewski ◽  
Paulina Kalińczak-Górna ◽  
Marek Zdrenka ◽  
Paulina Antosik ◽  
Małgorzata Wierzchowska ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Nasal Polyps ◽  
Tissue Remodeling ◽  
Oral Steroid ◽  
Topical Steroids ◽  
Preoperative Period ◽  
Oral Corticosteroids ◽  
Nasal Steroid ◽  
Group 1

Chronic rhinosinusitis is a process involving a number of adverse changes in the mucosa of the paranasal sinuses and nasal polyps. The main histological features of tissue remodeling are changes in epithelial structure, oedema, degradation of ECM (extracellular matrix), angiogenesis, and subepithelial fibrosis. In this study, patients were divided into two groups: group 1—patients with CRSwNP (chronic rhinosinusitis with nasal polyps) taking a nasal steroid and an oral steroid in the preoperative period, and group 2—patients with CRSwNP taking only the nasal steroid in the preoperative period. All samples were subject to histopatologic evaluation. The aim of this study was to investigate the effect of oral corticosteroids and topical steroids on the tissue of paranasal sinuses. We have shown statistically significant decreases in tissue eosinophilia per 5HPF and decreased fibrosis in group 1. No significant differences were presented in the percentage of total tissue oedema, epithelium, neutrophils, basement membrane thickening and vessels. Using systemic administration of 40 mg of prednisone for seven days decreased the counts of eosinophils and decreased fibrosis in the nasal polyps tissue in CRSwNP.

Other Biological Approaches to OCD

2012 ◽  
Author(s):  
Nicole C. R. McLaughlin ◽  
Benjamin D. Greenberg
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Response To Treatment ◽  
History Of ◽  
Key Issues ◽  
Term Management ◽  
Deep Brain

Interest in psychiatric neurosurgery has waxed and waned since the 1930s. This chapter reviews the history of these methods, with a focus on OCD. This review of lesion procedures and deep brain stimulation includes neuropsychological and neuroimaging research in the context of putative neurocircuitry underlying symptoms and response to treatment. The chapter highlights how an abundance of caution is needed, as well as key issues in long-term management of patients so treated.

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