Oral and intranasal steroid treatments improve nasal patency and paradoxically increase nasal nitric oxide in patients with severe nasal polyposis

Introduction: Recently, we demonstrated that acoustic rhinometry (AR) measurements correlated with nasal cavity volumes in patients with nasal polyposis (NP). The aim of the present study was to evaluate whether AR and nasal nitric oxide (nNO) are useful methods in monitoring and follow-up of medical treatment of NP. Material and methods: Patients with severe nasal polyps were randomized into two groups after a 4-week steroid washout period (w0): a treatment group received oral prednisone for 2 weeks (w2) and intranasal budesonide for 12 weeks (w12) while the control group received no steroid treatment. Nasal volume (vol(0-6)), minimum cross-sectional area (mCSA), nNO, peak nasal inspiratory flow (PNIF), nasal obstruction, and smell loss were evaluated. Results: At w2, the treatment group showed a significant increase of vol 0-6 compared to w0 and the control group. The mCSA area also increased compared to w0 and the control group. At w12, the improvement in vol(0-6) and mCSA was maintained after intranasal steroids compared to w0. At w2, the treatment group showed a paradoxical increase of nNO compared to w0 and the control group. At w12, this increase was maintained by intranasal steroids. Conclusion: Both oral and intranasal steroid treatments improve nasal patency and paradoxically increase nNO, by opening the ostiomeatal complex. This suggests that AR and nNO are useful methods in the monitoring and follow-up of patients with NP.