Treatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids

hronic rhinosinusitis (CRS) is one of the most com-mon chronic disorders in the developed world, affect-ing 32 million persons (16.3% of the population) in theUnited States alone (1). Annual health care costs for CRSare estimated at $6 billion, which is probably an underes-timate because of the indirect costs from lost productivityand the effect on general and lower airway health outcomes(1–3). Chronic rhinosinusitis with nasal polyposis, a dis-tinct pathologic subtype of CRS with an estimated preva-lence of 3% to 5%, has a greater burden of symptoms anda higher relapse rate after treatment (4, 5). This conditionis managed by various practitioners, including primary carephysicians, otolaryngologists, respiratory physicians, andallergologists.Despite the high prevalence and significant morbidityassociated with CRS with nasal polyposis, evidence toguide practitioners on initiation and maintenance of ther-apy is limited. Current international guidelines (5) recom-mend that primary care physicians diagnose CRS with na-sal polyposis on the basis of such symptoms as nasalblockage, discharge, facial pain or pressure, and reductionin the sense of smell for more than 12 weeks. Topicalsteroids are recommended for CRS, with or without nasalpolyposis, along with nasal saline douching and antiallergymedications as needed (5). Referral to an otolaryngologistis recommended if no response is observed after 3