title: Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis.
abstract: BACKGROUND
  Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment.
  
  
  OBJECTIVE
  To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS.
  
  
  METHODS
  Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed.
  
  
  RESULTS
  Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p=0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations.
  
  
  CONCLUSIONS
  High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores.
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil. Electronic address: edumacoto@uol.com.br.
authors.forename: Eduardo Macoto
authors.initials: EM
authors.lastname: Kosugi
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: Guilherme Figner
authors.initials: GF
authors.lastname: Moussalem
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: Juliana Caminha
authors.initials: JC
authors.lastname: Simões
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: Rafael de Paula e Silva Felici de
authors.initials: Rde P
authors.lastname: Souza
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: Vitor Guo
authors.initials: VG
authors.lastname: Chen
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Saraceni Neto
authors.affiliation: Sector of Rhinology, Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
authors.forename: José Arruda
authors.initials: JA
authors.lastname: Mendes Neto
mesh_terms: D000328:Adult; D019819:Budesonide / Q000008:administration & dosage*; D002908:Chronic Disease; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055556:Nasal Lavage; D011446:Prospective Studies; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D019819:Budesonide
keywords: Corticosteroides; Corticosteroids; Endoscopia; Endoscopy; Irrigação terapêutica; Nasal polyps; Pólipos nasais; Sinusite; Sinusitis; Therapeutic irrigations