Comparison of three modalities of corticosteroids administration in chronic rhinosinusitis

Body: Background: Olfactory dysfunction is deemed to be a significant contributor to poor quality of life in chronic rhinosinusitis (CRS). Objective: Firstly, to assess the effectiveness of three modalities of corticosteroids administration in patients with CRS. Secondly, to compare modalities between themselves. Subjects and methods: A cohort of 30 patients with CRS (aged from 18 to72 years) were recruited and randomized in three groups depending on the route of corticosteroids administration. Corticosteroids were administrated during 16 days by oral (Medrol®, 32mg/8d - 16mg/4d - 8mg/4d), nasal spray (Rhinocort®, 2 x 2 x 64Fg/nostril) or nebulized (Pulmicort®, 2 x 1mg/4mL) (Sonic nebulizer, AOHBOX NL11SN, DTF Medical) route. Olfactory function was assessed using orthonasal (Sniffing stick test with the threshold-discrimination-identification score)(TDI) and retronasal psychophysical olfactory (odors identification) (RETRO) tests at inclusion and after the treatment. Results: TDI and RETRO were similar between three groups at baseline. TDI improved by 5.5, 5.8 and -1.1 for sonic nebulization, oral and nasal spray groups respectively. This improvement was significantly different between modalities (p = 0.010) and only clinically relevant for oral and nebulized administration. It was similar between oral and nebulized administration but significantly higher than nasal spray administration. RETRO improved by 1.1, 4.2 and 0.7 for sonic nebulization, oral and nasal spray groups respectively (p = 0.231) Conclusion: Effectiveness of nebulized and oral administration is demonstrated on orthonasal olfactory. The benefit is better than with nasal spray.