Effect of systemic steroids on humming nasal nitric oxide in chronic rhinosinusitis with nasal polyposis.
BACKGROUND
Increased nasal nitric oxide (NO) is a marker for paranasal sinus ostial patency. However, there are no data evaluating the effect of systemic steroids on humming nasal NO in chronic rhinosinusitis with nasal polyposis (CRSNP).


OBJECTIVE
To assess whether 2 weeks of oral steroids in CRSNP increases humming nasal NO, whether humming is a more sensitive indicator of this increase than other methods of measuring NO, and whether it correlates with improvements in clinical parameters for sinonasal disease.


METHODS
Adults with CRSNP (grade 2 and above) were treated with oral prednisolone, 25 mg/d for 2 weeks. Nasal NO was measured by aspiration, exhalation at 0.2 L·s⁻¹, and humming methods. Peak nasal inspiratory flow, Sinonasal Outcomes Test 20 score, symptoms, olfaction, and polyp grade were also measured before and after treatment.


RESULTS
Twelve patients (mean age, 49 years) completed the treatment. The differences in nasal NO before and after steroid treatment were significantly less pronounced as measured by geometric mean-fold ratio with aspiration (1.5; 95% confidence interval [CI], 1.1 to 1.9; P = .009) and exhalation (2.1; 95% CI, 1.2 to 3.9; P = .02) compared with the humming technique (4.9; 95% CI, 2.2 to 10.7; P = .001). The standardized response means for the methods of NO estimation were 0.97 for aspiration, 1.05 for exhalation, and 1.61 for humming.


CONCLUSIONS
This study demonstrates that humming nasal NO increases after 2 weeks of oral steroid therapy for CRSNP. Humming NO is more sensitive than aspiration and exhalation and is associated with improvements in symptoms, polyp size, and quality of life. Humming NO may fill the niche for a noninvasive marker of sinus ostial patency.
Asthma & Allergy Research Group, Centre for Cardiovascular and Lung Biology, University of Dundee, Dundee, Scotland.
Sriram
S
Vaidyanathan
Peter
P
Williamson
Kathleen
K
Anderson
Brian
B
Lipworth
D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy*; D009569:Nitric Oxide / Q000032:analysis / Q000378:metabolism*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide; D011239:Prednisolone