Chronic rhinosinusitis (CRS) with nasal polyposis is a common problem resulting in nasal blockage, facial pain, and hy- posmia. Responses to therapy are frequently incomplete, and relapses are common. Although oral steroids are recommended when specialty care is required, little is known about their efficacy. In a study reported in the Annals of Internal Medicine, 60 adults with CRS and moderate-sized or larger nasal polyps who were referred by their primary physicians for specialty care received oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 µg twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 µg twice daily, for 18 weeks. Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis.
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