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.


OBJECTIVE
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.


CONCLUSIONS
The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.
Department of Otolaryngology and Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK. nigel12@doctors.org.uk
N K F
NK
Koo Ng
D
D
Young
G W
GW
McGarry
D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D014663:Nasal Decongestants / Q000008:administration & dosage*; D015508:Nasal Obstruction / Q000188:drug therapy* / Q000503:physiopathology; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010656:Phenylephrine / Q000008:administration & dosage*; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013256:Steroids / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D014663:Nasal Decongestants; D013256:Steroids; D010656:Phenylephrine; D008012:Lidocaine