Polipos Nasales PDF

Oral steroids for nasal polyps (Review)
Martinez-Devesa P, Patiar S
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011, Issue 7
http://www.thecochranelibrary.com

Copyright 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . .
ABSTRACT . . . . . . . . . . . . . . . . .
PLAIN LANGUAGE SUMMARY . . . . . . . . .
BACKGROUND . . . . . . . . . . . . . . .
OBJECTIVES . . . . . . . . . . . . . . . .
METHODS . . . . . . . . . . . . . . . . .
RESULTS . . . . . . . . . . . . . . . . . .
DISCUSSION . . . . . . . . . . . . . . . .
AUTHORS CONCLUSIONS . . . . . . . . . .
ACKNOWLEDGEMENTS
. . . . . . . . . . .
REFERENCES . . . . . . . . . . . . . . . .
CHARACTERISTICS OF STUDIES . . . . . . . .
DATA AND ANALYSES . . . . . . . . . . . . .
APPENDICES . . . . . . . . . . . . . . . .
WHATS NEW . . . . . . . . . . . . . . . .
HISTORY . . . . . . . . . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS . . . . . . . .
DECLARATIONS OF INTEREST . . . . . . . . .
SOURCES OF SUPPORT . . . . . . . . . . . .
DIFFERENCES BETWEEN PROTOCOL AND REVIEW
INDEX TERMS
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[Intervention Review]
Oral steroids for nasal polyps

Pablo Martinez-Devesa1 , Shalini Patiar2
1 ENT
Department, John Radcliffe Hospital - West Wing, Oxford, UK. 2 Cancer Research UK, Molecular Oncology Laboratories,
Oxford, UK
Contact address: Pablo Martinez-Devesa, ENT Department, John Radcliffe Hospital - West Wing, Headley Way, Oxford, OX3 9DU,
UK. devesa@doctors.org.uk.
Editorial group: Cochrane Ear, Nose and Throat Disorders Group.
Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 7, 2011.
Review content assessed as up-to-date: 11 October 2010.
Citation: Martinez-Devesa P, Patiar S. Oral steroids for nasal polyps. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.:
CD005232. DOI: 10.1002/14651858.CD005232.pub3.
ABSTRACT
Background
This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2007.
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 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. The aetiology of polyps is uncertain, therefore
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.
Objectives
To assess the effects of oral steroids in patients with multiple nasal polyps.
Search methods
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled
Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and
additional sources for published and unpublished trials. The date of the most recent search was 12 October 2010, following a previous
search in April 2006.
Selection criteria
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.
Data collection and analysis
Two authors independently assessed study quality. We contacted study authors for additional information.
Main results
Three trials (166 patients) met our inclusion criteria and showed a short-term benefit of a short (two to four-week) course of oral
steroids of variable doses and duration when compared to placebo. There was an objective reduction of polyp size and a subjective
improvement of nasal symptoms and quality of life. However, due to the moderate to low quality of these trials it was not possible to
quantify the overall size of this effect.
There was no report of significant adverse effects of treatment with a short course of steroids.
Authors conclusions
The authors found three randomised controlled trials, albeit of moderate to poor quality, that suggest a short-term benefit of oral
steroids in patients with multiple nasal polyps. To address the issue more thoroughly well-designed, prospective, randomised controlled
trials are still needed.
PLAIN LANGUAGE SUMMARY

Oral steroids for nasal polyps
Benign nasal polyps are bags of watery tissue arising from the lining (mucosa) of the nasal cavity or the nasal sinuses that protrude into
the nasal passages, often on both sides of the nose. The symptoms are nasal obstruction, poor sinus drainage, loss of smell that affects a
persons ability to taste, runny nose or nasal congestion. These can be troublesome or limit daily activities and ability to sleep so that wellbeing and quality of life are reduced. Nasal polyps can be removed surgically or treated with steroid medication, given by nasal sprays
or drops (topically) or by mouth (orally). Treatment is either aimed at treating the initial problem or is aimed at preventing recurrence
of polyps. No single surgical technique has proved entirely curative and people often undergo repeat procedures. Oral steroids may
reduce the need for surgery but there are concerns about possible side effects with long-term oral steroid use. The side effects of short
courses of oral steroids are less clearly defined.
We found three trials, with a total of 166 patients, that met the inclusion criteria for the review. In these trials the 96 patients who were
randomised to receive oral prednisone showed an improvement in quality of life and nasal symptom scores and a significant reduction
in polyp size after two to four weeks of treatment compared to no steroid treatment. However, the trials were of moderate to low
methodological quality.
BACKGROUND
This is an update of a Cochrane Review first published in The
Cochrane Library in Issue 1, 2007.
Benign nasal polyps are lesions (abnormal changes in structure)
that arise from the mucosa of the nasal cavity or one or more of
the nasal sinuses, often at the outflow tract of the sinuses. Their
aetiology is uncertain, therefore treatment options differ and no
one treatment has been found to be universally effective.
Prevalence and incidence
There is a higher incidence of polyps in males, with a male-tofemale ratio of between 2:1 and 4:1. They are found in all ethnic
groups although the comparative incidence has not been documented. They predominantly affect adults and usually present in
patients over the age of 20 years. In asthmatic patients aged over

40 the prevalence is four times greater than in asthmatic patients
under 40 (12.4% versus 3.1%, P < 0.01) (Settipane 1977). They
are rare in children under 10 years of age and may be the presenting feature or indicative of cystic fibrosis.
The true incidence of nasal polyps is difficult to assess but seems to
be far more common in autopsy studies than clinical studies have
shown. Endoscopic examination of cadavers revealed nasal polyps
in 22 out of 69 autopsies without a history of previous sinonasal
disease, with most of the polyps originating from the mucosa of
the ostia, clefts and recesses in the osteomeatal complex (the region
that drains the sinuses) (Larsen 2004). This is where the initial
stage of sinonasal polyposis seems to take place.

Aetiology
Treatment
The aetiology of nasal polyps is unknown. Most theories consider

polyps a consequence of chronic inflammation and therefore conditions leading to chronic inflammation in the nasal cavity can
lead to nasal polyps. The medical conditions most notably associated with polyps are non-allergic asthma, aspirin hypersensitivity and cystic fibrosis. Nasal polyps are found in 36% of patients
with aspirin intolerance, 7% of those with asthma and about 20%
of those with cystic fibrosis (Settipane 1996). No evidence exists,
however, for an allergic origin (Drake-Lee 1984). In allergic rhinitis the prevalence of symptomatic nasal polyps is low (1.5%) and
similar to that in the normal population (1%) (Lund 1995). Polyps
are statistically more common in non-allergic asthma than allergic
asthma (13% versus 5%, P < 0.01) (Settipane 1996). There is a
well-recognised subgroup of patients with aspirin hypersensitivity
and asthma, this subgroup comprising 5% to 10% of patients with
nasal polyps.
Treatment of nasal polyps is a combination of medical and surgical management dependent on individual patient assessment.
The aims of treatment are to relieve nasal obstruction, restore olfaction, improve sinus drainage and to treat any accompanying
rhinitic symptoms (Scadding 2002). Treatment may be divided
into two areas: primary (inducing remission) and secondary (preventing recurrence). No single surgical technique has proved entirely curative and patients often undergo repeat procedures and
receive long-term medical treatment. Recurrence is common and
between 5% and 10% of patients have recurrent severe disease
(Drake-Lee 2004). About 60% of patients will require a further
polypectomy in a five-year period, the rest having less frequent
recurrences (Larsen 1997). There are few direct comparisons of
medical and surgical treatment in the literature. Those that exist suggest that most patients should be treated medically, with
surgery reserved for patients who respond poorly.
The surgical management of nasal polyps has changed over the last
two decades with the advent of endoscopic sinus surgery. Intranasal
surgery for nasal polyps ranges from simple snare polypectomy
(surgical removal of nasal polyps using a snare with or without
an endoscope) to radical ethmo-fronto-sphenoidectomy (opening
and ventilating the frontal, ethmoid and sphenoid sinuses). Major
complications of endoscopic surgery are rare but can be devastating, including loss of vision and entering the skull base causing
leakage of fluid from around the brain (cerebrospinal fluid leak)
(Stammberger 1999).
Corticosteroids are the only medical therapy to have a proven effect on the symptoms and signs of nasal polyps and can be used
topically or systemically. The therapeutic modality that has been
best studied in controlled trials is that of topically applied steroids.
This reduces rhinitis symptoms, improves nasal breathing, reduces
the size of polyps and the recurrence rate, but has a negligible
effect on the sense of smell and on any sinus pathology. Topical
steroids can, as maintenance therapy, be used alone in mild cases,
or combined with systemic steroids/surgery in severe cases. Systemic steroids, which are less well studied, have an effect on all
types of symptoms and pathology, including the sense of smell.
This type of treatment is only used for short-term improvement
due to the risk of adverse effects (Mygind 1996). The adverse effects of short-term steroid use are said to include glucose intolerance, hypertension, adrenal suppression, gastrointestinal bleeding
and altered mental states. However, there are few or no published
data on the frequency of these effects. Adverse effects associated
with long-term use of oral steroids include gastrointestinal complications, growth suppression, diabetes mellitus, hypertension,
psychotropic effects (e.g. mood changes), glaucoma, osteoporosis
and avascular osteonecrosis (bone death resulting from poor blood
supply to an area of bone).
In a recent retrospective review of litigation trends related to the
administration of corticosteroids and the reported complications
(Nash 2011) it was advised that physicians should obtain informed
Diagnosis
Macroscopically polyps appear as pale bags of oedematous tissue
arising most commonly from the middle meatus and prolapsing
into the nasal cavity. The pale colour is due to poor blood supply
but with repeated trauma and inflammation polyps may become
reddened and the surface becomes squamous rather than respiratory in type. They are most often bilateral and when unilateral
require histological examination to exclude the transitional cell
papilloma (also known as Ringerts tumour or inverted papilloma)
or malignancy (Drake-Lee 2004).
Histologically polyps are characterised by ciliated columnar epithelium, thickening of the basement membrane, a loose avascular
grossly oedematous stroma and an infiltrate of plasma cells and
many eosinophils. Eosinophils are found in 85% to 90% of polyps.
The majority of the remaining cells in polyps are neutrophils.
The main presenting symptom of nasal polyps is nasal obstruction,
which is constant, although it will vary with the size and position of
polyps. Patients may also complain of 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 are characteristic symptoms
of nasal polyps. Pain is an infrequent feature but does occur in
patients with polyps and is usually over the dorsum of the nose,
forehead and cheeks. It is worse when the nose is congested and
there is secondary infection of the sinuses (Drake-Lee 1997).
The diagnosis is made by rhinoscopy, anterior and posterior. The
diagnosis is often easier if a small probe is used for gentle palpation
as polyps are insensitive and are mobile on their pedicles.
Plain radiographs of the paranasal sinuses are of no value in the
diagnosis of nasal polyps although they may confirm opacification
of the sinuses. A computed tomogram (CT) shows the anatomical
variations and the extent of the disease.

consent prior to steroid therapy. However, only three of 83 cases

reviewed involved otolaryngologists and the indication and administration route of the steroid treatment was not the one for
nasal polyps or other nasal pathology.
There are few controlled trials on the effectiveness of oral steroids
in the treatment of nasal polyps. Oral steroids are most often used
in high dose for short duration in exacerbations of nasal polyposis.
There is however a lack of evidence regarding the optimal treatment regimen of oral steroids with respect to indication, dose and
duration. The optimum usage of steroids is clinically important as
it may reduce the need for surgery by providing good symptomatic
control.
The 2007 European Position Paper on Rhinosinusitis and Nasal
Polyps (EPOS 2007) supports the use of a short course of oral
steroids followed by topical steroids in patients with chronic rhinosinusitis with nasal polyps if the symptoms are severe (visual
analogue scale score > 7 on a 0 to 10 scale). This is based on evidence from open studies and two randomised controlled trials
(Benitez 2006; Hissaria 2006) (evidence level Ib).
Exclusion criteria
Children < 16 years

Antrochoanal polyps (benign polyps originating from the
mucosa of the maxillary sinus)
Cystic fibrosis
Surgery for nasal polyps within three months prior to study
period
Types of interventions
Oral steroids versus no intervention
Oral steroids versus placebo
Oral steroid versus other type of oral steroid, including:
low-dose (equivalent to less than 20 mg prednisolone)
versus high-dose oral steroids (equivalent to more than 40 mg
prednisolone)
short-course (less than two weeks) versus long-course
oral steroids (more than two weeks)
Topical steroids combined with intervention in both
treatment arms in all the above
OBJECTIVES
Types of outcome measures
To assess the effects of oral steroids in patients with multiple nasal
polyps.
Primary outcomes
METHODS
Criteria for considering studies for this review
Types of studies
All identified randomised controlled trials which fulfilled the criteria outlined below were included.
Types of participants
Reduction in validated nasal symptom scores.
Secondary outcomes
Change in nasal endoscopic findings

Change in radiological/CT appearance
Duration of effect
Improvement in validated quality of life measures*
Adverse effects
*We added this secondary outcome measure subsequent to publication of the protocol as we considered it to be an important
outcome measure which was overlooked at the time of writing the
protocol.
Inclusion criteria
Two or more of the criteria below.

Patients with benign bilateral nasal polyps diagnosed
clinically in an ENT department
Endoscopic evidence of nasal polyps
Radiological evidence of nasal polyps
Search methods for identification of studies

We conducted systematic searches for randomised controlled trials. There were no language, publication year or publication status restrictions. The date of the last search was 12 October 2010,
following a previous search update in April 2006.

Electronic searches
Assessment of risk of bias in included studies
We searched the following databases from their inception for published, unpublished and ongoing trials: the Cochrane Ear, Nose
and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4); PubMed; EMBASE; CINAHL; LILACS;
KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; CNKI; ISRCTN; ClinicalTrials.gov; ICTRP and Google.
We modelled subject strategies for databases on the search strategy
designed for CENTRAL. Where appropriate, we combined subject strategies with adaptations of the highly sensitive search strategy designed by the Cochrane Collaboration for identifying randomised controlled trials and controlled clinical trials (as described
in the Cochrane Handbook for Systematic Reviews of Interventions
Version 5.0.2, Box 6.4.b. (Handbook 2009)). Search strategies for
major databases including CENTRAL are provided in Appendix
1.
The two review authors assessed the quality of the included trials
independently and we resolved any differences in opinion by discussion. We used a modification of the method used by Chalmers
1990. We assessed the selected studies for the following characteristics:
1. the adequacy of the randomisation process;
2. the potential for selection bias after allocation to study
group, i.e. losses to follow up and whether analysis was by
intention-to-treat;
3. whether there was blinding of outcome assessors to the
participants study group; and
4. the quality of outcome assessment.
Studies were graded A, B or C for their overall methodological
quality:
A: minimisation of bias in all four categories above, i.e. adequate
randomisation; few losses to follow up and intention-to-treat analysis; blinding of outcome assessors; high quality outcome assessment;
B: each of the criteria in A partially met;
C: one or more of the criteria in A not met.
Searching other resources

We scanned the reference lists of identified publications for additional trials and contacted trial authors where necessary. In addition, we searched PubMed, TRIPdatabase, NHS Evidence - ENT
& Audiology, and Google to retrieve existing systematic reviews
relevant to this systematic review, so that we could scan their reference lists for additional trials. In previous searches in 2006, we
contacted authors of published and unpublished trials and other
experts in the field but no additional trials were identified.
Data collection and analysis
Selection of studies
The two authors reviewed the titles and abstracts, where available,
of all studies identified by the searches and applied the inclusion/
exclusion criteria independently. We excluded articles that did not
meet the inclusion criteria. We obtained the full articles for those
studies that appeared to meet the inclusion criteria or where there
were insufficient data to make a decision. Any disagreement about
whether a study should be included was resolved by discussion
between the review authors.
Data synthesis
We did not identify sufficient trials to allow data analysis. Should
suitable trials be identified for updates of the review we will employ
the following methods:
Data analysis will be on an intention-to-treat basis. If data are
comparable and of sufficient quality, we will combine data to give
a summary measure of effect, otherwise we will not combine data.
We will examine statistical heterogeneity by subgroup analysis as
appropriate. We will seek statistical advice as necessary.
RESULTS
Description of studies
See: Characteristics of included studies; Characteristics of excluded
studies; Characteristics of ongoing studies.
Results of the search

Data extraction and management
The review authors independently extracted data from the studies using standardised data forms. We extracted data to allow an
intention-to-treat analysis. Where data were missing we wrote to
the authors of the study requesting further information.
We considered 30 studies to be possibly relevant based on the

abstract and obtained the full articles.
Included studies

Three trials satisfied the inclusion criteria (Alobid 2006; Hissaria

2006; Van Zele 2010). The methods, participants, interventions and outcomes of these studies are shown in the table of
Characteristics of included studies.
Excluded studies
Of the 30 studies retrieved in full text, we excluded 25.
Fourteen studies looked at the effects of oral steroids with or without topical steroids on nasal polyps but were excluded as they were
non-randomised and non-controlled trials (Bonfils 1998; Bonfils
2003; Bonfils 2006; Cassano 1996; Chi Chan 1996; Hessler 2007;
Jankowski 2003a; Jankowski 2003b; Nores 2003; Rasp 1997; Rasp
2000; Stevens 2001; Tuncer 2003; van Camp 1994).
Two of the papers were duplicate publications and were excluded
as they compared intramuscular steroids against surgery (Lildholdt
1988; Lildholdt 1989).
Damm 1999 compared two different durations of oral steroid
treatment but had to be excluded, despite contacting the authors,
as the outcome data were combined for the two groups and were
thus not extractable.
We excluded Alobid 2005 as it compared oral steroids against endoscopic sinus surgery, as well as Blomqvist 2001 for the same
reason. We excluded Blomqvist 2009 as it was a duplicate publication of Blomqvist 2001.
We excluded Ragab 2006 as it compared medical therapies not
including oral steroids against surgery. Kroflic 2006 compared
oral steroids versus topical furosemide and was thus excluded.
One randomised controlled trial compared oral steroids against
no intervention prior to endoscopic sinus surgery in both groups
but only intraoperative surgical outcome measures were reported
so the study had to be excluded (Sieskiewicz 2006).
We excluded Benitez 2006 as a possible duplication of Alobid
2006. Both studies were carried out in the same department and
during the same period of time: February 1999 to July 2003 in
Alobid 2006 with 78 participants and February 1999 to November
2003 in Benitez 2006 with 84 patients recruited. The participants
characteristics were also very similar. The main differences were
in the outcome measures and the subdivision of the treatment
group into patients with and without asthma in the second study
(Benitez 2006). We contacted the (same) corresponding author
for both trials but there was no comment on this point. After a
discussion between the review authors we decided not to include
Benitez 2006 so as to avoid possible bias (duplication of results).
We also identified two abstract publications of trials later to be published (Van Zele 2010) or still awaiting publication (Vaidyanathan
2009). We made attempts to obtain unpublished details and data
from the latter trial (Vaidyanathan 2009) but were unsuccessful.
The summaries of excluded studies are listed in the table of
Characteristics of excluded studies.
Risk of bias in included studies
Selection and performance bias

The included studies were randomised and controlled. On attempting to contact the corresponding authors of all three studies, only the corresponding author of Alobid 2006 replied that
randomisation was computer-generated on a 1:3 ratio. Van Zele
2010 used randomisation codes. Hissaria 2006 did not explain the
method of randomisation (patients were randomised by the
hospital pharmacy).
With the exception of Alobid 2006, where of the 78 patients recruited to the study only 18 (23%) were randomised to the control arm, the other studies showed more balanced study arms.
Alobid 2006, however, maintained a good proportion in the baseline characteristics of the groups population, while Hissaria 2006
had a larger number of males, history of aspirin sensitivity, smokers and subjects that had undergone previous polyp operations in
the control (placebo) group. Van Zele 2010 had a larger incidence
of asthma and aspirin intolerance also in the placebo group.
Concealment assignment was described in Hissaria 2006 and Van
Zele 2010. Subjects in both studies were blinded for the whole
duration of the study. No information on concealment was provided in Alobid 2006.
Attrition bias
Two participants in Alobid 2006 were lost to follow up in the control (placebo) group. One participant dropped out in the placebo
group in Hissaria 2006. Seven participants (15%) withdrew from
the placebo group before the first observation point in Van Zele
2010.
Detection bias
Alobid 2006 did not comment on blinding of assessors.
Hissaria 2006 used blind outcome assessors for the physician assessment of nasal symptoms, the assessment of polyp size on magnetic resonance imaging (MRI) scan and on nasoendoscopy. Study
personnel were blinded to the treatment/placebo groups as well
as pre- and post-treatment observation points in the polyp size
assessments with MRI/nasoendoscopy. At the end of the study
participants were unblinded by an independent physician and all
who had taken placebo accepted were offered and were offered
and accepted a course of oral steroids.
Van Zele 2010 study personnel were also blinded for the duration
of the study.
The scales used to measure nasal symptoms score varied significantly: a subset of six nasal symptoms of the Rhinosinusitis Outcome Measure questionnaire (RSOM-31) in Hissaria 2006; a nonvalidated scoring system (0 to 3) in Alobid 2006 and an unclear

(possibly 0 to 3 points) scoring system in Van Zele 2010. Overall the assessment of nasal symptoms in the included studies was
poor.
One study (Hissaria 2006) was graded B for overall methodological
quality according to the stated criteria. The other two studies (
Alobid 2006; Van Zele 2010) were graded C.
Effects of interventions
Three trials comprising 166 participants were included in this review. We analysed the prespecified primary and secondary outcomes.
Primary outcome
Validated nasal symptoms scores
There was significant variation in the assessment of nasal symptoms. Hissaria 2006 used a subset of six nasal symptoms of the
Rhinosinusitis Outcome Measure (RSOM-31) questionnaire. The
nasal symptom scores were significantly reduced (reduction was
considered by an improvement of 20% or more) from before to
after two weeks of treatment in the treatment group (50 mg oral
prednisolone for 14 days) (64% reduction (P < 0.001)) versus the
control (placebo) group (11% reduction (P = non-significant)).
There was no long-term follow up in this study.
Alobid 2006 also showed a reduction in the scores of nasal symptoms (0 to 3 scoring system): nasal obstruction and loss of sense
of smell (P < 0.05) in the treatment group (reducing course of 30
mg oral prednisolone for two weeks) two weeks after commencing
treatment compared to the control (no treatment) group. After
the first assessment point at two weeks the nasal symptom scores
were still lower than at baseline at weeks 12, 24 and 48 in the
treatment group. However, the control group was not followed up
as due to ethical considerations this group was not kept without
known effective treatment for longer than six weeks.
Van Zele 2010 reported a decrease in nasal congestion at weeks
one, two and four after treatment in the treatment group (reducing course of 32 mg to 8 mg of methylprednisolone during 20
days) (week 1, P = 0.002; week 2, P = 0.007; week 4, P = 0.001)
compared to the placebo group. Post-nasal drip showed a score
reduction in the treatment group versus placebo (week 1, P = 0.31;
week 2, P = 0.007 and week 4, P = 0.001). Loss of sense of smell
also had a similar score reduction in the treatment group versus
placebo (week 1, P = 0.006; week 2, P = 0.001; week 4, P = 0.006).
Congestion and other nasal symptom scores worsened progressively after week four and returned to baseline values. There was no
significant effect of oral steroid treatment on rhinorrhoea compare
to placebo. After week four there were 10 patients (52%) in the
placebo group and two patients (14%) in the oral steroid group
that needed rescue treatment. There was no long-term assessment.
Secondary outcomes
Change in nasal endoscopic findings
Alobid 2006 showed a significant reduction in endoscopic assessment of polyp size (Lildholt classification, 0 to 3) at week two in
the treatment group versus control (P < 0.05) and the polyp size
was maintained in the treatment group at weeks 12, 24 and 48
(P < 0.05). Long-term effect was not comparable to the control
group.
In Hissaria 2006, at week two, there was a reduction in polyp size
of 48% (mean change; P < 0.005) compared to placebo.
Van Zele 2010 also showed a reduction of polyp size in the treatment group after week one (P = 0.002) that become maximal at
week two (P < 0.0001) compared to placebo. There was still a
significant reduction in polyp size after two months in the oral
steroid group (P < 0.05) compared to placebo but there was no
difference of effect after three months.
Change in radiological appearance
There was also a reduction in the magnetic resonance imaging

(MRI) score in the treatment group of 45% (P < 0.001) versus
placebo in Hissaria 2006 at week two.
Quality of life
Alobid 2006 used the validated Medical Outcome Study Short

Form-36 (SF-36; 0 to 100, 100 being the better quality of life
score) to assess general quality of life. Both the physical and mental
components of SF-36 showed a significant score increase for the
treatment group compared to the control group at week two (P
< 0.05). This increase was maintained in the treatment group at
weeks 12, 24 and 48 (P < 0.05).
In Hissaria 2006, RSOM-31 also measured quality of life. There
was also a reduction in total RSOM score in both groups but
the level of improvement was significantly more in the treatment
group (treatment, 53% improvement, P < 0.001 versus placebo
21% improvement, P < 0.005).
Adverse effects
There was no record of adverse events in Alobid 2006 and when we

contacted the main author he reported that there were no adverse
effects in the trial.
Hissaria 2006 reported adverse effects in both treatment and control groups. The main adverse effects were insomnia (in eight
participants in the treatment group and two in the placebo
group) and mood disturbance (five in the treatment group, two
in placebo); and in fewer numbers headache, dyspepsia, increased

appetite, fatigue, backache, gastrointestinal disturbance, acne and

feet oedema. There were no significant adverse effects.
Van Zele 2010 reported that 48.5% of the subjects in the study reported at least one adverse event. There were no significant differences in adverse events between the treatment and placebo groups.
DISCUSSION
Our objective in this 2010 update of the review was to assess the
effect of oral steroids in the treatment of nasal polyps. Despite
a large number of initial references retrieved, only three studies
met the inclusion criteria and were in general of moderate to poor
methodological quality (Hissaria 2006 grade B; Alobid 2006 and
Van Zele 2010 both grade C). Except for Alobid 2006, the format
used for presentation of data in the papers and lack of response
from the corresponding authors precluded a meta-analysis of the
results.
Hissaria 2006 and Alobid 2006 both compared treatment with
the oral steroid prednisolone at different doses (Hissaria 2006: 50
mg daily for two weeks; Alobid 2006: a reducing course starting
at 30 mg per day and reducing gradually during two weeks) versus
placebo. The study groups in Hissaria 2006 were more balanced
(20 patients each) than in Alobid 2006 (60 patients in the treatment group; 18 in the control group). Two patients were lost in
Alobid 2006 and one in Hissaria 2006, in both cases in the placebo
group. Both studies showed improvement in the outcome measures. Alobid 2006 continued to measure only the treatment group
for up to 48 weeks and the study reported that the improvements
on all outcomes measured were maintained during this time.
Van Zele 2010 compared three arms in their study: oral steroid
(reducing course of methylprednisolone) versus antibiotic (doxycycline) versus placebo. The groups were well-balanced with 14
patients each in the steroid and antibiotic groups and 19 in the
placebo group. However, there was a significant dropout of seven
patients (15%), all of them in the placebo group, after week four.
Up to this point in the study the treatment group showed a significant improvement of most nasal symptoms (nasal congestion,
postnasal drip and sense of smell) in the steroid group. Congestion
and other nasal symptom scores worsened progressively after week
four and returned to baseline values. Oral steroid had no effect on
reducing rhinorrhoea when compared to placebo. Interestingly,
doxycycline significantly reduced postnasal drip and rhinorrhoea,
the former even more than in the steroid group. Polyp size also
was reduced in the steroid group when compared to placebo, with
maximal reduction after two weeks. Doxycycline also showed a
reduction in polyp size. After the four-week assessment point, failure of treatment resulted in rescue treatment for all groups (14%
in the steroid group; 28% in antibiotic group and 52% in the
placebo group). Although the study continued to assess the longterm outcome measures for all groups, we considered the dropout
and rescue treatment rate inappropriate to include the long-term

effect data reported in this study in this review.
The individual study results in this review support the positive effect of a short course (and of different doses) of oral steroids in the
objective reduction of polyp size and the subjective improvement
of nasal symptoms and quality of life. As it was not possible to
conduct a meta-analysis we could not quantify the overall size of
this effect. There are no data to support the maintenance of this
effect in the long term (when compared to placebo) and without
this evidence this type of treatment could be relegated to an adjuvant treatment in the management of nasal polyposis.
In the studies included in this review there was no report of significant adverse effects of treatment with a short course of steroids.
Hissaria 2006 and Van Zele 2010 reported some minor adverse
effects in both treatment and placebo groups.
In general the evidence from randomised controlled trials or metaanalysis as to the adverse effects of steroids is both scarce and
variable.
A search through the Cochrane Reviews that compared the use of
steroids for the treatment of diverse conditions in adults identified
six reviews in which oral steroids were used. Three of these reviews
used a dose similar to that used for the treatment of nasal polyps
and there were some minor and short-lived adverse effects of oral
steroids (Buchbinder 2006; Walters 2005; Wei 2006), however
the adverse effect results were somewhat variable. In two of the
reviews the reported adverse effects were minor and short-lived
(Buchbinder 2006) or did not exist at all (Wei 2006). However,
in a third review on the use of oral steroids for chronic obstructive
pulmonary disease (COPD) (Walters 2005), the pooled adverse
effect from three of the studies in the review (111 participants)
showed an odds ratio of a major adverse effect of 7.76 (95% CI
2.34 to 25.70) or one major adverse effect for every nine people
treated. In one of the studies included in this review, the reported
osteocalcin level was significantly reduced in the oral steroid treatment group. The authors, in their conclusions, warned about the
increased risk of adverse effects at doses that are unacceptable in
the long term.
In the other three reviews (Burton 2009; Cheng 1999; Mash
2001), the dose and/or duration of treatment with oral steroid
used was significantly higher than that used for the treatment of
nasal polyps and although minor adverse effects were reported
there was no information on long-term effect.
The common message from all these reviews is that the pros and
cons of oral steroid therapy should be considered in individual
patients. The conclusions of one of these reviews (Mash 2001)
suggested that a systematic review of the side effects of steroids
would be necessary to address this issue fully.
With regards to the adverse effects of oral steroids specifically in the
treatment of nasal polyposis, two non-randomised studies looked

in particular at the effect on osteopenia and bone density and their

results and conclusions may be helpful:
One retrospective study (Rajasekaran 2010) looked at 197 patients
diagnosed with chronic rhinosinusitis with or without polyposis.
The mean age of the patients was 51.1 years (range 15 to 79) and
81.7% had concomitant asthma. The patients had received at least
5 mg of oral steroids daily for at least three months. The authors
observed a higher rate of osteopenia/osteoporosis or low bone density (LBD) among men > 50 years of age and postmenopausal
women, which was 62.5% and 62.2% respectively. Comparing
this population with their respective younger populations there
was a statistically significant low bone mass (P < 0.0001) in the
older population groups, with an odds ratio of 10.6 (3.9 to 28.7)
and 34.6 (7.4 to 161.5) for men > 50 and postmenopausal women
respectively. There was no difference on gender. The authors advised careful evaluation and treatment in this older age group to
prevent additional bone-related complications.
One of the non-randomised excluded studies in this review
(Bonfils 2006) reported on adrenal suppression and osteoporosis in a prospective longitudinal study of 46 patients treated for
nasal polyposis with repeated short courses (more than 21 days
of treatment in total) of oral prednisolone 1 mg/kg body weight.
The mean age of the patients was 49.4 (+/- 1.6), 56.5% were male
and the mean duration of the treatment was 4.7 years (SD = 4.2)
with a mean number of oral steroid courses per year (seven to 10
days duration for each course) of 6.8 (SD = 4.7). Almost 80%
of these patients also received intranasal steroids simultaneously.
In 48.8% and 12.2% of patients there was osteopenia and osteoporosis (respectively) at the lumbar spine; 43.9% had osteopenia at the femoral neck (none had osteoporosis) and 40.5% and
54% had osteopenia and osteoporosis at the proximal femur. Also
20 of these patients (48.8%) had adrenal insufficiency on synacthen test but only one patient was symptomatic. The authors of
this study concluded that patients with severe nasal polyposis and
a high steroid consumption have a high prevalence of glucocorticoid-induced osteoporosis and secondary adrenal insufficiency.
They concluded that patients should be informed of the risks and
monitored during long-term steroid treatment.
In summary, the evidence relating to a short course of a moderate dose of oral steroids indicates that is safe, although very few
studies have looked at the effect on osteopenia and bone density
and secondary adrenal insufficiency. The studies that looked at
these parameters do report a high prevalence of osteoporosis and
secondary adrenal insufficiency. In conclusion there is a lack of
strong evidence for significant adverse effect/s of oral steroids for
the treatment nasal polyps. We concur with the consensus opin-
ion that the balance of risks and benefits of oral steroid therapy
should be carefully considered in each individual patient and that
this information should be conveyed to the patient as part of the
informed choice regarding their treatment.
A short course of oral steroids could be beneficial in the short term
to patients with nasal polyps (provided there are no contraindications).
AUTHORS CONCLUSIONS
Implications for practice
A limited number of trials of moderate to poor methodological
quality showed a short-term improvement with a short (two to
four-week) and variable dose course of oral steroids in the treatment of nasal polyps. The trials showed improvement in the objective reduction of polyp size and the subjective improvement of
nasal symptoms and quality of life. It was not possible to quantify
the overall size of this effect.
Without long-term supporting data, there is no evidence of a sustained effect of this treatment and without this evidence this type
of treatment could be relegated to an adjuvant treatment in the
management of nasal polyposis.
There were reports of some adverse events in the included trials
but no significant adverse effects of treatment with a short course
of steroids were reported.
Implications for research

There is still a need for trials of high methodological quality on
the use of oral steroids for the treatment of nasal polyps.
Longer follow up is necessary to establish the long-term effect of
this intervention.
The presence or absence of adverse effects of treatment with oral
steroids should always be reported in a standardised manner with
short and long-term measures.
ACKNOWLEDGEMENTS
The authors would like to thank the staff of the Cochrane ENT
Group for their help in producing this review, particularly Gemma
Sandberg for development of the search strategy and searching for
trials.

REFERENCES
References to studies included in this review

Alobid 2006 {published data only}
Alobid I, Benitez P, Pujols L, Maldonado M, BernalSprekelsen M, Morello A, et al.Severe nasal polyposis and its
impact on quality of life. The effect of a short course of oral
steroids followed by long-term intranasal steroid treatment.
Rhinology 2006;44(1):813.
Hissaria 2006 {published data only}
Hissaria P, Smith W, Wormald PJ, Taylor J, Vadas M, Gillis
D, et al.Short course of systemic corticosteroids in sinonasal
polyposis: a double-blind, randomized, placebo-controlled
trial with evaluation of outcome measures. Journal of Allergy
and Clinical Immunology 2006;118(1):12833.
Van Zele 2010 {published data only}
Van Zele T, Gevaert P, Holtappels G, Achim B, Wormald
P, Mayr S, et al.Treatment of nasal polyposis with oral
methylprednisolone: a double-blind, randomized, placebocontrolled trial with evaluation of clinical and biological
activity. American Academy of Allergy, Asthma and
Immunology (AAAAI) 64th Annual Meeting. Philadelphia,
PA, USA, March 14-18, 2008. Journal of Allergy and
Clinical Immunology. 2008; Vol. 121 (2 (Suppl 1)):S265,
Abstract No. 1028.
Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald

PJ, Mayr S, et al.Oral steroids and doxycycline: two
different approaches to treat nasal polyps. Journal of Allergy
and Clinical Immunology 2010;125(5):106976.
References to studies excluded from this review

Alobid 2005 {published data only}
Alobid I, Benitez P, Bernal-Sprekelsen M, Roca J, Alonso J,
Picado C, et al.Nasal polyposis and its impact on quality of
life: comparison between the effects of medical and surgical
treatments. Allergy 2005;60(4):4528.
Benitez 2006 {published data only}
Benitez P, Alobid I, de Haro J, Berenguer J, Bernal
Sprekelsen M, Pujols L, et al.A short course of oral
prednisone followed by intranasal budesonide is an effective
treatment of severe nasal polyps. Laryngoscope 2006;116(5):
7705.
Blomqvist 2001 {published data only}
Blomqvist EH, Lundblad L, Anggard A, Haraldsson PO,
Stjarne P. A randomised controlled study evaluating medical
treatment versus surgical treatment in addition to medical
treatment of nasal polyposis. Journal of Allergy and Clinical
Immunology 2001;107(2):2248.
Blomqvist 2009 {published data only}
Blomqvist EH, Lundblad L, Bergstedt H, Stjarne P. A
randomized prospective study comparing medical and
medical-surgical treatment of nasal polyposis by CT. Acta
Oto-Laryngologica 2009;129(5):5459.
Bonfils 1998 {published data only}

Bonfils P. Medical treatment of paranasal sinus polyposis: a
prospective study in 181 patients [Le traitement medical de
la polypose nasosinusienne: etude prospective sur une serie
de 181 patients]. Annales dOto-Laryngologie et de Chirurgie
Cervico Faciale 1998;115(4):20214.
Bonfils P, Nores J-M, Halimi P, Avan P. Medical treatment
of stage I nasal polyposis over a 3-year follow-up period.
ORL 2004;66(1):2734.
Bonfils P, Halimi P, Malinvaud D. Adrenal suppression and
osteoporosis after treatment of nasal polyposis. Acta OtoLaryngologica 2006;126(11):1195200.
Cassano 1996 {published data only}
Cassano P, Marini F, Indraccolo AS, Curatoli FP.
Corticosteroid therapy in the prevention of recurrent postsurgical nasal polyposis. Acta Otorhinolaryngologica Italica
1996;16(4):3348.
Chi Chan 1996 {published data only}
Chi Chan A, Couto y Arcos F, Martin Biasotti F, Bross
Soriano D, Vazquez Valle MDC, Gonzalez Olvera S. Oral
steroids as preoperative medication in nasal polyposis
[Esteroides orales en la preparacion preoperatoria de
poliposis nasal]. Anales de Otorrinolaringologia Mexicana
1996;41(3):15560.
Damm 1999 {published data only}
Damm M, Jungehulsing M, Eckel HE, Schmidt M,
Theissen P. Effects of systemic steroid treatment in chronic
polypoid rhinosinusitis evaluated with magnetic resonance
imaging. Otolaryngology - Head and Neck Surgery 1999;120
(4):51723.
Hessler 2007 {published data only}
Hessler JL, Piccirillo JF, Fang D, Vlahiotis A, Banerji A,
Levitt RG, et al.Clinical outcomes of chronic rhinosinusitis
in response to medical therapy: results of a prospective
study. American Journal of Rhinology 2007;21(1):108.
Jankowski 2003a {published data only}
Jankowski R, Bodino C. Evolution of symptoms associated
to nasal polyposis following oral steroid treatment and
nasalisation of the ethmoid - radical ethmoidectomy is
functional surgery for NPS. Rhinology 2003;41(4):2119.
Jankowski 2003b {published data only}
Jankowski R, Bodino C. Olfaction in patients with
nasal polyposis: effects of systemic steroids and radical
ethmoidectomy with middle turbinate resection
(nasalisation). Rhinology 2003;41(4):22030.
Kroflic 2006 {published data only}
Kroflic B, Coer A, Baudoin T, Kalogjera L. Topical
furosemide versus oral steroid in preoperative management
of nasal polyposis. European Archives of Oto-RhinoLaryngology 2006;263(8):76771.

10
Lildholdt 1988 {published data only}

Lildholdt T, Fogstrup J, Gammelgaard N, Kortholm B,
Ulsoe C. Surgical versus medical treatment of nasal polyps.
Acta Otolaryngologica 1988;105(1-2):1403.
Lildholdt 1989 {published data only}
Lildholdt T. Surgical versus medical treatment of nasal
polyps. Rhinology. Supplement 1989;8:313.
Nores 2003 {published data only}
Nores J-M, Avan P, Bonfils P. Medical management of nasal
polyposis: a study in a series of 152 consecutive patients.
Rhinology 2003;41(2):97102.
Ragab 2006 {published data only}
Ragab SM, Lund VJ, Saleh HA, Scadding G. Nasal nitric
oxide in objective evaluation of chronic rhinosinusitis
therapy. Allergy 2006;61(6):71724.
of response to oral and intranasal corticosteroid in nasal

polyposis [completed]. ClinicalTrials.gov 2009 (accessed 31
October 2009). [: NCT00788749]
Vaidyanathan S, Williamson P, Barnes M, Clearie K,

Lipworth B. Influence of aspirin sensitivity and asthma
on steroid response in nasal polyposis. Thorax: British
Thoracic Society Winter Meeting, 3-5 December, 2008.
2008:Abstract S41.
Additional references
Buchbinder 2006
Buchbinder R, Green S, Youd JM, Johnston RV. Oral
steroids for adhesive capsulitis. Cochrane Database of
Systematic Reviews 2006, Issue 4. [DOI: 10.1002/
14651858.CD006189]
Rasp 1997 {published data only}

Rasp G, Bujia J. Treatment of nasal polyposis with systemic
and local corticoids. Acta Otorrinolaringologica Espanola
1997;48(1):3740.
Burton 2009
Burton JM, OConnor PW, Hohol M, Beyene J. Oral versus
intravenous steroids for treatment of relapses in multiple
sclerosis. Cochrane Database of Systematic Reviews 2009,
Issue 3. [DOI: 10.1002/14651858.CD006921.pub2]
Rasp 2000 {published data only}

Rasp G, Kramer MF, Ostertag P, Kastenbauer E. A new
system for the classification of ethmoid polyposis. Effect
of combined local and systemic steroid therapy. LaryngoRhino-Otologie 2000;79(5):26672.
Chalmers 1990
Chalmers I, Adams M, Dickersin K, Hetherington J,
Tarnow-Mordi W, Meinert C, et al.A cohort study of
summary reports of controlled trials. JAMA 1990;263:
14015.
Sieskiewicz 2006 {published data only}

Sieskiewicz A, Olszewska E, Rogowski M, Grycz E.
Preoperative corticosteroid oral therapy and intraoperative
bleeding during functional endoscopic sinus surgery
in patients with severe nasal polyposis: a preliminary
investigation. Annals of Otology, Rhinology and Laryngology
2006;115(7):4904.
Cheng 1999
Cheng K, Ashby D, Smyth RL. Oral steroids for cystic
fibrosis. Cochrane Database of Systematic Reviews 1999, Issue
4. [DOI: 10.1002/14651858.CD000407]
Stevens 2001 {published data only}

Stevens MH. Steroid-dependent anosmia. Laryngoscope
2001;111(2):2003.
Tuncer 2003 {published data only}
Tuncer U, Soylu L, Aydogan B, Karakus F, Akcali C. The
effectiveness of steroid treatment in nasal polyposis. Auris
Nasus Larynx 2003;30(3):2638.
van Camp 1994 {published data only}
van Camp C, Clement PA. Results of oral steroid treatment
in nasal polyposis. Rhinology 1994;32(1):59.
Van Zele 2008 {published data only}
Van Zele T, Gevaert P, Holtappels G, Achim B, Wormald
P, Mayr S, et al.American Academy of Allergy, Asthma and
Immunology (AAAAI) 64th Annual Meeting. Philadelphia,
PA, USA, March 14-18, 2008. Journal of Allergy and
Clinical Immunology. 2008; Vol. 121(2 (Suppl 1)):S265,
Abstract No. 1028.
References to ongoing studies

Vaidyanathan 2009 {published data only (unpublished sought but not
used)}
Vaidyanathan S, Lipworth B. A proof of concept study to
investigate the clinical, histological and molecular predictors
Drake-Lee 1984
Drake-Lee AB, Lowe D, Swanston A, Grace A. Clinical
profile and recurrence of nasal polyps. Journal of Laryngology
and Otology 1984;98:78393.
Drake-Lee 1997
Drake-Lee AB. Nasal polyps. In: Kerr AG, Mackay IS, Bull
TR editor(s). Scott-Browns Otolaryngology. 6th Edition.
Vol. 4: Rhinology, Oxford: Butterworth-Heinemann,
1997:4/10/116.
Drake-Lee 2004
Drake-Lee AB. Nasal polyps. Hospital Medicine 2004;65:
2647.
EPOS 2007
Fokkens WJ, Lund VJ, Mullol J, on behalf of the European
Position Paper on Rhinosinusitis and Nasal Polyps group.
European Position Paper on Nasal Polyps. Rhinology 2007;
45(Suppl 20):1139.
Handbook 2009
Higgins JPT, Green S, editors. Cochrane Handbook
for Systematic Reviews of Interventions 5.0.2 [updated
September 2009]. The Cochrane Collaboration, 2008.
Available from www.cochrane-handbook.org.
Larsen 1997
Larsen K, Tos M. A long-term follow-up study of nasal
polyp patients after simple polypectomies. European
Archives of Otorhinolaryngology 1997;254(Suppl 1):S858.

11
Larsen 2004
Larsen PL, Tos M. Origin of nasal polyps: an endoscopic
autopsy study. Laryngoscope 2004;114:7109.
Lund 1995
Lund VJ. Diagnosis and treatment of nasal polyps. BMJ
1995;311:14114.
Mash 2001
Mash BRJ, Bheekie A, Jones P. Inhaled versus oral steroids
for adults with chronic asthma. Cochrane Database
of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/
14651858.CD002160]
Mygind 1996
Mygind N, Lildholdt T. Nasal polyps treatment: medical
management. Allergy and Asthma Proceedings 1996;17:
27582.
Nash 2011
Nash JJ, Nash AG, Leach ME, Poetker DM. Medical
malpractice and corticosteroid use. Otolaryngology - Head
and Neck Surgery 2011;144(1):105.
Rajasekaran 2010
Rajasekaran K, Seth R, Abelson A, Batra PS. Prevalence
of metabolic bone disease among chronic rhinosinusitis
patients treated with oral glucocorticoids. American Journal
of Rhinology and Allergy 2010;24(3):2159.
Scadding 2002
Scadding GK. Comparison of medical and surgical
treatment of nasal polyposis. Current Allergy and Asthma
Reports 2002;2:4949.
Settipane 1977
Settipane GA, Chafee FH. Nasal polyps in asthma and
rhinitis. A review of 6,037 patients. Journal of Allergy and
Clinical Immunology 1977;59:1721.
Settipane 1996
Settipane GA. Epidemiology of nasal polyps. Allergy and
Asthma Proceedings 1996;17:2316.
Stammberger 1999
Stammberger H. Surgical treatment of nasal polyps: past,
present, and future. Allergy 1999;54(Suppl 53):711.
Walters 2005
Walters JAE, Walters EH, Wood-Baker R. Oral
corticosteroids for stable chronic obstructive pulmonary
disease. Cochrane Database of Systematic Reviews 2005, Issue
3. [DOI: 10.1002/14651858.CD005374]
Wei 2006
Wei BPC, Mubiru S, OLeary S. Steroids for idiopathic
sudden sensorineural hearing loss. Cochrane Database
of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/
14651858.CD003998.pub2]
Indicates the major publication for the study

12
CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]

Alobid 2006
Methods
Randomised: computer generation on a 1:3 ratio (explained by the main author when
contacted)
Allocation: not described
Blinding: not described
Participants
78 patients with nasal polyps diagnosed endoscopically and radiologically

Setting: hospital
Country: Spain
Mean age: 50 years (range 22 to 84 years)
% female: 35
Number randomised: 80 participants (20 to control group but 2 lost to follow up)
Aspirin sensitivity: 21% in treatment group; 6.4% in placebo group
Interventions
Group A: oral prednisone 30 mg daily for 4 days followed by a dose reducing by 5 mg every
2 days for 10 days
Group B: no steroid treatment for 2 weeks
Outcomes
The following outcomes were measured immediately before treatment and at 2 weeks:
nasal symptom score (unvalidated), polyp size score and quality of life assessment (Medical
Outcome Study Short Form-36 (SF-36) questionnaire)
Outcomes for the treatment group only (group A) were measured at 12, 24 and 48 weeks
Adverse events: not reported, but main author when contacted reported there were no
adverse effects in the trial
Notes
Two weeks after commencing oral steroid treatment, group A was commenced on treatment
with intranasal budesonide and followed up but group B was not followed up as it was
considered unethical not to offer known effective treatment to the control group for longer
than 6 weeks
Quality score: C
Risk of bias
Bias
Authors judgement
Support for judgement
Allocation concealment (selection bias)
Low risk
Randomisation using a computer-generated

list on a 1:3 ratio

13
Hissaria 2006
Methods
Randomised: participants were randomised by the hospital pharmacy, but the actual process
is not described
Blinding: participants and study personnel were blinded.
Participants
41 patients drawn mainly from allergy outpatient clinics who had nasal polyps diagnosed
endoscopically
Setting: hospital
Country: Australia
Mean age: 49 years for treatment group and 48 years for placebo group (range 18 to 65
years)
% female: 52
Number randomised: 41 participants (21 to control group but 1 lost to follow up)
Aspirin sensitivity: 10% in treatment group; 30% in placebo group
Interventions
Treatment group: oral prednisone 50 mg daily for 14 days

Placebo group: placebo for 14 days
Outcomes
The following outcomes were measured immediately before treatment and at 2 weeks:
physician assessment on a VAS (1 to 5 score) including grading of nasal symptoms (6 scales:
congestion, hyposmia, rhinorrhoea, sneezing, postnasal drip and itch); 6 nasal symptoms
score on part of Rhinosinusitis Outcome Measure (RSOM-31) questionnaire, polyp size
score on MRI and nasoendoscopy and quality of life assessment (total RSOM-31 score)
Adverse events: reported in both treatment and control groups. The main adverse effect
was insomnia (in 8 participants of the treatment group and 2 in the placebo group); mood
disturbance (5 in treatment, 2 in placebo); and in fewer numbers of headache, dyspepsia,
increased appetite, fatigue, backache, gastrointestinal disturbance, acne and feet oedema.
There were no significant adverse effects
Notes
The study was not designed to look at long-term outcome

Quality score: B
Risk of bias
Bias
Authors judgement
Unclear risk
B - Unclear
Van Zele 2010

Methods
Randomised: not described

Blinding: study personnel and participants were blinded for the duration of the study
Participants
47 patients recruited from 4 ear, nose and throat departments in Europe and 1 in Australia.
Patients had recurrent nasal polyps after surgery or massive bilateral nasal polyps
Setting: hospital
Country: Europe (Belgium, The Netherlands, Germany) and Australia

14
Van Zele 2010
(Continued)
Mean age: 49 years for steroid treatment group, 55 years for antibiotic treatment group
and 55 years for placebo group (range 18 to 65 years)
% female: 20
Number randomised: 47 participants (14 to each treatment group and 19 to placebo group
but 7 lost to follow up in placebo group)
Aspirin sensitivity: 14% in steroid treatment group; 7% in antibiotic group and 26% in
placebo group
Interventions
Steroid treatment group: oral methylprednisolone 32 mg daily for 5 days followed by a

reducing dose to 16 mg daily for 5 days and 8 mg daily for 10 days (total 20 days)
Antibiotic treatment group: oral doxycyline 200 mg on day 1, then 100 mg for 19 days
(total 20 days)
Placebo group: placebo for 20 days
Outcomes
The following outcomes were measured immediately before treatment and at 1, 2, 4, 8 and
12 weeks: total polyp score (0 to 4 for each nostril); peak nasal inspiratory flow (PNIF)
measurement and nasal symptoms (anterior rhinorrhoea, nasal obstruction, postnasal drip
and loss of sense of smell); eosinophil, IL-5 and eosinophilic cationic protein (ECP) counts
in blood and; ECP, IgE, IL-5, matrix metallo-proteinase (MMP-9) and myeloperoxidase
counts in nasal secretions
Adverse events: reported 48.5% of the subjects in the study reported at least 1 adverse
event. There were no significant differences of adverse events between the treatments and
placebo groups
Notes
After week 4 from the start of the study 52% of the participants assigned to the placebo
group underwent rescue treatment (either surgical or nasal steroids), 28% of the antibiotic
treatment group needed rescue treatment and likewise 14% of the steroid treatment group.
Therefore there was too large a number of dropouts in the study to assess long-term results
in any group
Quality score: C
Risk of bias
Bias
Authors judgement
Unclear risk
B - Unclear
MRI: magnetic resonance imaging

RSOM: Rhinosinusitis Outcome Measure questionnaire
VAS: visual analogue scale

15
Characteristics of excluded studies [ordered by study ID]
Study
Reason for exclusion
Alobid 2005
ALLOCATION
Randomised; randomisation method not given
PARTICIPANTS
Nasal polyps diagnosed endoscopically and radiologically
INTERVENTIONS
Oral steroids versus endoscopic sinus surgery
Benitez 2006
ALLOCATION
PARTICIPANTS
INTERVENTIONS
Oral steroids versus no treatment
The study was excluded as possible duplication of Alobid 2006. Both studies were carried out in the same
department and during the same period of time: February 1999 to July 2003 in Alobid 2006 with 78 participants
and February 1999 to November 2003 in Benitez 2006 with 84 patients recruited. The patient characteristics
were very similar. The main difference was in the outcome measures and the subgroups used in the second study
(Benitez 2006) where the treatment group was also subdivided into patients with and without asthma. We asked
the (same) corresponding author for both trials but they did not comment on this point
Blomqvist 2001
ALLOCATION
PARTICIPANTS
Nasal polyps diagnosed clinically and endoscopically
INTERVENTIONS
Oral steroids and topical steroids versus endoscopic sinus surgery and topical steroids
Blomqvist 2009
ALLOCATION
PARTICIPANTS
Nasal polyps diagnosed clinically and endoscopically
INTERVENTIONS
Oral steroids and topical steroids versus combined medical and surgical treatment
Bonfils 1998
ALLOCATION
Non-randomised, no control group
Bonfils 2003
ALLOCATION
Bonfils 2006
ALLOCATION
Cassano 1996
ALLOCATION
Non-randomised retrospective study

16
(Continued)
Chi Chan 1996
ALLOCATION
Damm 1999
ALLOCATION
PARTICIPANTS
20 patients (40 nasal cavities) with chronic polypoid rhinosinusitis - 80% of these patients (33 nasal cavities) had
nasal polyps diagnosed radiologically
INTERVENTIONS
Group1: total dose of 560 mg oral fluocortolone 12 days
Group 2: total dose of 715 mg oral fluocortolone for 20 days
Reducing dose regimen in both groups
OUTCOMES
Trial rejected because data were not extractable. Change in MRI appearances were not reported separately for
groups 1 and 2. Changes in symptom visual analogue scales were reported for Groups 1 and 2 in the chronic
polypoid rhino-sinusitis patients but not for subset of patients with nasal polyps
Hessler 2007
ALLOCATION
Jankowski 2003a
ALLOCATION
Jankowski 2003b
ALLOCATION
Kroflic 2006
ALLOCATION
PARTICIPANTS
INTERVENTIONS
Oral steroids versus topical furosemide
OUTCOMES
Trial rejected because only intraoperative surgical variables reported
Lildholdt 1988
ALLOCATION
Randomised using computer-generated random figures
PARTICIPANTS
Method of diagnosing nasal polyps not given
INTERVENTIONS
Intramuscular steroid versus surgery
Lildholdt 1989
ALLOCATION
Randomised using computer-generated random figures
PARTICIPANTS
Method of diagnosing nasal polyps not given
INTERVENTIONS
Surgical polypectomy followed by continuous topical steroid treatment versus a single dose of depot steroid

17
(Continued)
followed by continuous topical steroid treatment

Nores 2003
ALLOCATION
Ragab 2006
ALLOCATION
PARTICIPANTS
Chronic rhinosinusitis with or without nasal polyps diagnosed endoscopically and radiologically
INTERVENTIONS
Erythromycin, nasal douche and topical steroids versus surgery
Rasp 1997
ALLOCATION
Rasp 2000
ALLOCATION
Sieskiewicz 2006
ALLOCATION
PARTICIPANTS
Nasal polyps diagnosed clinically and radiologically
INTERVENTIONS
Oral steroids versus no intervention prior to endoscopic sinus surgery in both groups
Stevens 2001
ALLOCATION
Tuncer 2003
ALLOCATION
van Camp 1994
ALLOCATION
Van Zele 2008
Abstract of later publication: Van Zele 2010
MRI: magnetic resonance imaging

18
Characteristics of ongoing studies [ordered by study ID]

Vaidyanathan 2009
Trial name or title
A proof of concept study to investigate the clinical, histological and molecular predictors of response to oral
and intranasal corticosteroid in nasal polyposis
Methods
Randomised, double-blind, controlled trial
Participants
60 adults 18 to 75 years of age
Interventions
Treatment group: oral prednisolone 25 mg daily for 2 weeks followed by fluticasone nasal drops 800 g/day
for 2 months followed by fluticasone nasal spray 400 g/day for 4 months
Placebo group: oral placebo daily for 2 weeks followed by fluticasone nasal drops 800 g/day for 2 months
followed by fluticasone nasal spray 400 g/day for 4 months
Outcomes
Primary outcome measure: endoscopy polyp grading

Secondary outcome measures: mini RQLQ, TNS-4, PNIF, anosmia score, scratch n sniff cards, OUCC, 1
g synacthen test
Measurements at 0, 2, 10 and 28 weeks
Starting date
May 2004
Contact information
Mr S Vaidyanathan and Dr B Lipworth, University of Dundee, UK
Notes
PNIF: peak nasal inspiratory flow

RQLQ: Rhinitis Quality of Life Questionnaire

19
DATA AND ANALYSES

This review has no analyses.
APPENDICES
Appendix 1. Search strategies
CENTRAL
PubMed
EMBASE (Ovid)
CINAHL (EBSCO)
#1 NASAL POLYPS single

term (MeSH)
#2 POLYPS explode all trees
(MeSH)
#3 (polyp* OR papilloma*)
#4 NOSE explode all trees
(MeSH)
#5 (nose* OR nasal* OR nasi
OR intranasal* OR sinonasal*
OR paranasal*)
#6 (#2 OR #3)
#7 (#4 OR #5)
#8 (#6 AND #7)
#9 rhinopolyp*
#10 (#1 OR #8 OR #9)
#11 STEROIDS explode all
trees (MeSH)
#12 ADRENAL CORTEX
HORMONES explode all trees
(MeSH)
#13 GLUCOCORTICOIDS
explode all trees (MeSH)
#14 (steroid* OR glucocorticoid*
OR corticosteroid* OR glucosteroid* OR cyclocosteroid*)
#15 (beclomethasone OR beclometasone OR beclamet OR
beclocort OR becotide)
#16 (betamethasone OR betadexamethasone OR flubenisolone OR
celeston* OR cellestoderm OR
betnelan OR oradexon)
#17 (dexamethasone OR dexameth OR dexone OR dexam-
#1 NASAL POLYPS [Mesh]

OR rhinopolyp* [tiab]
#2 POLYPS [Mesh] OR
POLYP* [tiab] OR PAPILLOMA* [tiab]
#3
NOSE
[Mesh] OR NOSE* [tiab] OR
NASAL* [tiab] OR NASI [tiab]
OR INTRANASAL* [tiab] OR
SINONASAL* [tiab] OR
PARANASAL* [tiab]
#4 #1 OR (#2 AND #3)
#5 STEROIDS [Mesh] OR
ADRENAL CORTEX HORMONES [Mesh] OR GLUCOCORTICOIDS [Mesh]
#6 STEROID*[tiab] OR GLUCOCORTICOID*[tiab] OR
CORTICOSTEROID*[tiab]
OR GLUCOSTEROID*[tiab]
OR CYCLOSTEROID*[tiab]
#7 BECLOMETASONE[tiab]
OR
BECLAMET[tiab]
OR
BECLOCORT[tiab]
OR
BECOTIDE[tiab]
OR
BETADEXAMETHASONE[tiab]
OR
FLUBENISOLONE[tiab]
OR
CELESTON$1[tiab]
OR CELLESTODERM[tiab]
OR
BETNELAN[tiab]
OR
DEXAMETH[tiab]
OR DEXONE[tiab] OR
DEXAMETASONE[tiab]
OR
DECADRON[tiab]
1 nose polyp/
2 polyp/ or polyposis/
3 (polyp* or papillom*).tw.
4 2 or 3
5 exp *nose/
6 (NOSE* or NASAL* or
NASI or INTRANASAL* or
SINONASAL*
or
PARANASAL*).tw.
7 5 or 6
8 4 and 7
9 rhinopolyp*.tw.
10 1 or 8 or 9
11 exp Corticosteroid/
12 (STEROID* or GLUCOCORTICOID*
or CORTICOSTEROID* or
GLUCOSTEROID* or CYCLOSTEROID*).tw.
13
(BECLOMETASONE
or BECLAMET or BECLOCORT or BECOTIDE or BETADEXAMETHASONE or
FLUBENISOLONE or CELESTON* or CELLESTODERM
or BETNELAN or DEXAMETH or DEXONE or DEXAMETASONE
or DECADRON or DEXASONE
or
HEXADECADRON or HEXADROL or ETHYLFLU ORPREDNISOLONE or MILLIC ORTEN or ORADEXON
or CORTISOL or CORTI-
S1 (MH Nasal Polyps)

S2 (MH Polyps+)
S3 TX polyp* OR papilloma*
S4 S2 or S3
S5 (MH Nose+)
S6 TX NOSE* or NASAL* or
SINONASAL*
or
PARANASAL*
S7 S5 or S6
S8 S4 and S7
S9 TX rhinopolyp*
S10 S1 or S8 or S9
S11 (MH Steroids+)
S12 (MH Glucocorticoids)
S13 (MH Adrenal Cortex
Hormones+)
S14 TX STEROID* or GLUCOCORTICOID* or CORTICOSTEROID* or GLUCOSTEROID* or CYCLOSTEROID*
S15 TX BECLOMETASONE
or
HEXADECADRON or HEX-

20
(Continued)
etasone OR decadron OR dexasone OR hexadecadron OR

hexadrol OR methylfluorprednisolone OR millicorten)
#18 (flunisolide OR fluticasone
OR hydrocortisone OR cortisol OR cortifair OR cortril OR
hyrocortone OR cortef OR epicortisol OR efcortesol)
#19 (methylprednisolone OR
medrol OR metripred OR urbason)
#20 (mometasone OR prednisolone OR precortisyl OR
deltacortril OR deltastab OR
prednesol OR deltasone OR
prednisone OR cortan OR liquid NEXT pred OR meticorten)
#21 (paramethasone OR triamcinolone OR aristocort OR
volon OR atolone OR kenacort
OR orasone OR panasol OR
prednicen)
#22 (#11 OR #12 OR #13 OR
#14 OR #15 OR #16 OR #17
or #18 or #19 or #20 or #21)
#23 (#10 AND #22)
OR DEXASONE[tiab] OR
HEXADECADRON[tiab]
OR
HEXADROL[tiab]
OR ETHYLFLU[tiab] ORPREDNISOLONE[tiab] OR
MILLIC[tiab] ORTEN[tiab]
OR[tiab] ORADEXON[tiab]
OR
CORTISOL[tiab]
OR
CORTIFAIR[tiab]
OR CORTRIL[tiab] OR
HYROCORTONE[tiab]
OR
CORTEF[tiab]
OR
EPICORTISOL[tiab]
OR
EFCORTESOL[tiab]
OR MEDROL[tiab] OR
METRIPRED[tiab]
OR
URBASON[tiab]
OR
MOMETASONE[tiab] OR
PRECORTISYL[tiab]
OR
DELTACORTRIL[tiab]
OR
DELTASTAB[tiab]
OR
PREDNESOL[tiab]
OR
DELTASONE[tiab]
OR CORTAN[tiab] OR
LIQUID PRED[tiab] OR
METICORTEN[tiab]
OR
ORASONE[tiab] OR PANASOL[tiab] OR PREDNICEN
[tiab]
#8 PARAMETHASONE[tiab]
OR ARISTOCORT[tiab] OR
VOLON[tiab]
OR ATOLONE[tiab] OR KENACORT[tiab] OR BECLOMETHASONE[tiab] OR
4419-39-0[tiab] OR BETAMETHASONE[tiab] OR
378-44-9 [tiab] OR BUDESONIDE[tiab] OR 51333-22-3
[tiab] OR CORTISONE[tiab]
OR 53-06-5[tiab] OR DEXAMETHASONE[tiab] OR 50-02-2 [tiab]
OR FLUNISOLIDE[tiab] OR
3385-03-3[tiab] OR FLUTICASONE[tiab] OR 9056653-3[tiab] OR FLUTICASONE PROPIONATE [tiab]
FAIR or CORTRIL or HYROCORTONE or CORTEF

or EPICORTISOL or EFCORTESOL or MEDROL
or METRIPRED or URBASON or MOMETASONE or
PRECORTISYL or DELTACORTRIL or DELTASTAB
or PREDNESOL or DELTASONE or CORTAN or (LIQUID adj PRED) or METICORTEN or ORASONE or
PANASOL or PREDNICEN).
tw.
14 (PARAMETHASONE or
ARISTOCORT or VOLON or
ATOLONE or KENACORT
or BECLOMETHASONE or
4419-39-0 or BETAMETHASONE or 378-44-9 or BUDESONIDE
or 51333-22-3 or CORTISONE or 53-06-5 or DEXAMETHASONE or 50-02-2
or FLUNISOLIDE or 338503-3 or FLUTICASONE or
90566-53-3 or (FLUTICASONE adj PROPIONATE) or
80474-14-2 or HYDROCORTISONE or CORTISOL or
50-23-7 or METHYLPREDNISOLONE or 83-43-2 or
MOMETASONE or 10510222-5 or PREDNISOLONE
or 50-24-8 or PREDNISONE
or 53-03-2 or TRIAMCINOLONE or 124-94-7).tw.
15 11 or 12 or 13 or 14
16 10 and 15

ADROL or ETHYLFLU ORPREDNISOLONE or MILLIC ORTEN or ORADEXON

or CORTISOL or CORTIFAIR or CORTRIL or HYROCORTONE or CORTEF
PANASOL or PREDNICENTX BECLOMETASONE
or
or PREDNESOL or DELTASONE or
S16 TX PARAMETHASONE
or ARISTOCORT or VOLON
or ATOLONE or KENA-
21
(Continued)
OR 80474-14-2[tiab] OR HYDROCORTISONE[tiab] OR
CORTISOL[tiab] OR 50-237[tiab] OR METHYLPREDNISOLONE[tiab]
OR
83-43-2 [tiab] OR MOMETASONE[tiab] OR 105102-22-5
[tiab]
OR
PREDNISOLONE[tiab] OR 50-248
[tiab]
OR PREDNISONE[tiab] OR
53-03-2[tiab] OR TRIAMCINOLONE[tiab] OR 124-94-7
[tiab]
#9 #5 OR #6 OR #7 OR #8
#10 #4 AND #9
CORT or BECLOMETHASONE or 4419-39-0 or BETAMETHASONE or 378-449 or BUDESONIDE or 5133322-3 or CORTISONE or 5306-5 or DEXAMETHASONE
or 50-02-2 or FLUNISOLIDE
or 3385-03-3 or FLUTICASONE
or 90566-53-3 or (FLUTICASONE adj PROPIONATE) or
or 53-03-2 or TRIAMCINOLONE or 124-94-7
S17 S11 or S12 or S13 or S14
or S15 or S16
S18 S10 and S17
Web of Science/ BIOSIS Pre- ISRCTN (mRCT)

views (Web of Knowledge)
CAB Abstracts (Ovid)
Cochrane
Ear,
Nose
and Throat Disorders Group
Trials Register
#1 TS=(nose OR nasal* OR (nose OR nasal) AND (polyp%

paranasal* OR sinonasal* OR OR papillom%)
intranasal*) AND (polyp* OR
papillom*)) OR rhinopolyp*)
#2 TS=(STEROID* or GLUCOCORTICOID* or CORTICOSTEROID* or GLUCOSTEROID* or CYCLOSTEROID*)
#3 TS=(BECLOMETASONE
or
HEXADECADRON or HEX-
1 (polyp* or papillom*).tw.
2 (NOSE* or NASAL* or
SINONASAL*
or
PARANASAL*).tw.
3 1 AND 2
4 rhinopolyp*.tw.
5 3 OR 4
6 exp Corticosteroid/
7 (STEROID* or GLUCOCORTICOID*
or CORTICOSTEROID* or
GLUCOSTEROID* or CYCLOSTEROID*).tw.
8
(BECLOMETASONE
or BETNELAN or DEXAM-
(
(nose OR nasal* OR paranasal*
OR sinonasal* OR intranasal*)
AND (polyp* OR papillom*)
) AND (STEROID* or GLUCOCORTICOID* or CORTICOSTEROID* or GLUCOSTEROID* or CYCLOSTEROID*)

22
(Continued)
ADROL or ETHYLFLU ORPREDNISOLONE or MILLIC ORTEN or ORADEXON

PANASOL or PREDNICEN)
#4 TS=(PARAMETHASONE
or ARISTOCORT or VOLON
or ATOLONE or KENACORT or BECLOMETHASONE or 4419-39-0 or BETAMETHASONE or 378-449 or BUDESONIDE or 5133322-3 or CORTISONE or 5306-5 or DEXAMETHASONE
or 50-02-2 or FLUNISOLIDE
or 3385-03-3 or FLUTICASONE
or 90566-53-3 or (FLUTICASONE adj PROPIONATE) or
or 53-03-2 or TRIAMCINOLONE or 124-94-7)
#5 #4 OR #3 OR #2
#6 #5 AND #1
ETH or DEXONE or DEXAMETASONE

or
PANASOL or PREDNICEN).
tw.
9 (PARAMETHASONE or
ARISTOCORT or VOLON or
ATOLONE or KENACORT
or BECLOMETHASONE or
4419-39-0 or BETAMETHASONE or 378-44-9 or BUDESONIDE
or 51333-22-3 or CORTISONE or 53-06-5 or DEXAMETHASONE or 50-02-2
or FLUNISOLIDE or 338503-3 or FLUTICASONE or
90566-53-3 or (FLUTICASONE adj PROPIONATE) or
or 53-03-2 or TRIAMCINOLONE or 124-94-7).tw.
10 7 OR 8 OR 9
11 5 AND 10

23
WHATS NEW
Last assessed as up-to-date: 11 October 2010.
Date
Event
Description
17 February 2011
New search has been performed
We ran full new searches in October 2010.
17 February 2011
New citation required and conclusions have changed
We included two new studies (Hissaria 2006; Van Zele

2010) and excluded a further nine. The review conclusions have been strengthened. High-quality studies with
long-term follow up are still necessary
HISTORY
Protocol first published: Issue 2, 2005
Review first published: Issue 1, 2007
Date
Event
Description
26 October 2008
Amended
Converted to new review format.
CONTRIBUTIONS OF AUTHORS
Pablo Martinez-Devesa: co-ordination of the review, screening search results, screening retrieved papers against inclusion criteria and
editing of review, writing to authors of papers for additional information and writing of review.
Shalini Patiar: co-ordination of review, screening search results, organising retrieval of papers, screening retrieved papers against inclusion
criteria, writing to authors of papers for additional information, writing to experts in field and writing of review.
DECLARATIONS OF INTEREST
None known.

24
SOURCES OF SUPPORT
Internal sources
None, Not specified.
External sources
None, Not specified.
DIFFERENCES BETWEEN PROTOCOL AND REVIEW

We added the secondary outcome measure Improvement in validated quality of life measures.
INDEX TERMS
Medical Subject Headings (MeSH)
Administration, Oral; Nasal Obstruction [etiology]; Nasal Polyps [complications; drug therapy]; Olfaction Disorders [etiology];
Prednisone [ administration & dosage]; Randomized Controlled Trials as Topic; Steroids [ administration & dosage]
MeSH check words

Humans

25

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Oral steroids for nasal polyps (Review)

Oral steroids for nasal polyps (Review)

Oral steroids for nasal polyps (Review)

Oral steroids for nasal polyps

PLAIN LANGUAGE SUMMARY

patients over the age of 20 years. In asthmatic patients aged over

Oral steroids for nasal polyps (Review)

The aetiology of nasal polyps is unknown. Most theories consider

Oral steroids for nasal polyps (Review)

consent prior to steroid therapy. However, only three of 83 cases

Children < 16 years

Criteria for considering studies for this review

Reduction in validated nasal symptom scores.

Change in nasal endoscopic findings

Two or more of the criteria below.

Search methods for identification of studies

Oral steroids for nasal polyps (Review)

Assessment of risk of bias in included studies

Searching other resources

Data collection and analysis

Results of the search

We considered 30 studies to be possibly relevant based on the

Oral steroids for nasal polyps (Review)

Three trials satisfied the inclusion criteria (Alobid 2006; Hissaria

Risk of bias in included studies

Selection and performance bias

Oral steroids for nasal polyps (Review)

Validated nasal symptoms scores

Change in nasal endoscopic findings

Change in radiological appearance

There was also a reduction in the magnetic resonance imaging

Alobid 2006 used the validated Medical Outcome Study Short

There was no record of adverse events in Alobid 2006 and when we

Oral steroids for nasal polyps (Review)

appetite, fatigue, backache, gastrointestinal disturbance, acne and

and rescue treatment rate inappropriate to include the long-term

Oral steroids for nasal polyps (Review)

in particular at the effect on osteopenia and bone density and their

Implications for research

Oral steroids for nasal polyps (Review)

References to studies included in this review

Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald

References to studies excluded from this review

Bonfils 1998 {published data only}

Oral steroids for nasal polyps (Review)

Lildholdt 1988 {published data only}

of response to oral and intranasal corticosteroid in nasal

Vaidyanathan S, Williamson P, Barnes M, Clearie K,

Rasp 1997 {published data only}

Rasp 2000 {published data only}

Sieskiewicz 2006 {published data only}

Stevens 2001 {published data only}

References to ongoing studies

Oral steroids for nasal polyps (Review)

Indicates the major publication for the study

Oral steroids for nasal polyps (Review)

Characteristics of included studies [ordered by study ID]

78 patients with nasal polyps diagnosed endoscopically and radiologically

Support for judgement

Allocation concealment (selection bias)

Randomisation using a computer-generated

Oral steroids for nasal polyps (Review)