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What Dosage Of Presnisone Should I Take And How Long For?
Question: 37, female.
Diagnosis - chronicrhinosinitis with polyps. Allergy tests - negative (though antihistamines help)
Medication - flixonase drops and ceritizine
Hello I have had crswnp for 12 years and had a CT scan a few months ago due to worsening symptoms. After the scan the symptoms improved a little (with increasing medication) and the consultant said that continuing with conservative management might be best but that surgery was up to me.
My symptoms are sneezing, running, blockage though this is usually controlled with medication. Despite medication I still feel pressure over my cheeks and increased resistance in the nasal passages though sometimes I think I can over focus on this too much.
I have attached the CT scan of the sinuses and wondered
1) how bad would you say this is compared to the general population
2) Would medication/a course of prednisone reduce the mucosa thickening in the maxillary sinus or is thai permanent?
3) What dosage of presnisone should I take and how long for?
4) I am undecided whether to have surgery I am not sure how much it will help
Thanks
Diagnosis - chronicrhinosinitis with polyps. Allergy tests - negative (though antihistamines help)
Medication - flixonase drops and ceritizine
Hello I have had crswnp for 12 years and had a CT scan a few months ago due to worsening symptoms. After the scan the symptoms improved a little (with increasing medication) and the consultant said that continuing with conservative management might be best but that surgery was up to me.
My symptoms are sneezing, running, blockage though this is usually controlled with medication. Despite medication I still feel pressure over my cheeks and increased resistance in the nasal passages though sometimes I think I can over focus on this too much.
I have attached the CT scan of the sinuses and wondered
1) how bad would you say this is compared to the general population
2) Would medication/a course of prednisone reduce the mucosa thickening in the maxillary sinus or is thai permanent?
3) What dosage of presnisone should I take and how long for?
4) I am undecided whether to have surgery I am not sure how much it will help
Thanks
Brief Answer:
Mild Chronic Sinusitis.
Detailed Answer:
Hi,
Thank you for your query.
1. Your limited scan images are suggestive of Mild Chronic Sinusitis. There is hardly any nasal polyposis. Compared to the chronic sinusitis population this is quite good. The maxillary sinuses do show polyps and mucosal lining thickening, smaller on the right side. Maxillary polyps require surgery only if they are more than half the height or volume of the maxillary sinus. The left Osteomeatal complex seems blocked while the right side appears clear.
2. Hypertonic saline nasal washes with added steroids (for example adding half a Budecort Respule to 200 ml of 2% nasal saline wash) will help reduce this condition further. After a few days, you can switch back to 0.9% nasal saline washes. Supportive medication such as inhaled nasal steroid sprays, mucolytics, anti-allergy medication (for non-specific allergies that will not show up on tests), steam inhalation, and short pulses of oral steroids will help. Immune modulators may be considered.
3. The nasal steroid saline washes will show better effects in the short term than steroid sprays and oral steroids.
4. If at all, I would recommend balloon sinuplasty for the left maxillary sinus. That too after a 6-8 week trial with the above treatment.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Mild Chronic Sinusitis.
Detailed Answer:
Hi,
Thank you for your query.
1. Your limited scan images are suggestive of Mild Chronic Sinusitis. There is hardly any nasal polyposis. Compared to the chronic sinusitis population this is quite good. The maxillary sinuses do show polyps and mucosal lining thickening, smaller on the right side. Maxillary polyps require surgery only if they are more than half the height or volume of the maxillary sinus. The left Osteomeatal complex seems blocked while the right side appears clear.
2. Hypertonic saline nasal washes with added steroids (for example adding half a Budecort Respule to 200 ml of 2% nasal saline wash) will help reduce this condition further. After a few days, you can switch back to 0.9% nasal saline washes. Supportive medication such as inhaled nasal steroid sprays, mucolytics, anti-allergy medication (for non-specific allergies that will not show up on tests), steam inhalation, and short pulses of oral steroids will help. Immune modulators may be considered.
3. The nasal steroid saline washes will show better effects in the short term than steroid sprays and oral steroids.
4. If at all, I would recommend balloon sinuplasty for the left maxillary sinus. That too after a 6-8 week trial with the above treatment.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your reply, that has helped.
Yes I can feel that my left nostril is always partially blocked it has been for years, I will ask my ENT doctor again about balloon sinoplasty. I did ask a while ago but he thought that FESS would be more appropriate. I will ask again at my next appointment as I am not keen on FESS due to the general anasthetic.
I wanted to ask further about medication as I live in the UK and mixing steroids with saline isn’t generally used, only the sprays. I have asked my gp and he is looking into it. Until then I will have to make my own solution. I wondered would it be ok to mix my fluticasone steroid spray (say 4 sprays = 200mg per nostril) with isotonic saline and pour it into my nostril? I find hypertonic too drying.
I could use the above steroid/saline mix in the mornings and then use the spray in the evenings… What is the best position to apply the drops to ensure they reach the maxillary sinuses or upside down?
I also want to ask about macrolides/xylitol, as I read that it can help. Is there a specific spray or solution that can be easily purchased with this ingredient?
Thanks
Yes I can feel that my left nostril is always partially blocked it has been for years, I will ask my ENT doctor again about balloon sinoplasty. I did ask a while ago but he thought that FESS would be more appropriate. I will ask again at my next appointment as I am not keen on FESS due to the general anasthetic.
I wanted to ask further about medication as I live in the UK and mixing steroids with saline isn’t generally used, only the sprays. I have asked my gp and he is looking into it. Until then I will have to make my own solution. I wondered would it be ok to mix my fluticasone steroid spray (say 4 sprays = 200mg per nostril) with isotonic saline and pour it into my nostril? I find hypertonic too drying.
I could use the above steroid/saline mix in the mornings and then use the spray in the evenings… What is the best position to apply the drops to ensure they reach the maxillary sinuses or upside down?
I also want to ask about macrolides/xylitol, as I read that it can help. Is there a specific spray or solution that can be easily purchased with this ingredient?
Thanks
Brief Answer:
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Yes, Maxillary sinus Balloon Sinuplasty can be performed under local anesthesia and decongestion. It depends upon whether your ENT Doctor is conversant with Balloon Sinuplasty.
2. Budecort respules are avaiable for nebulisation. Budecort respules contain 0.5 mg of budesonide in 2 ml ampoules. That's 500 micrograms. Each fluticasone spray will be 27.5 to 50 micrograms per actuation, (depending on the brand), which theoretically means 20 to 10 sprays. Practically, how much of the mist dissolves or disperses will be difficult to accurately determine. You may alternate between hypertonic and isotonic saline as hypertonic will be more effective. You can self-titrate.
3. Head forward (sniffing position), for the spray. Also, hold your breath, and then use the nasal wash in each nostril. See this video: https://youtu.be/qFDYPZSbluQ?feature=shared
4. Low-dose macrolides have been used as immunomodulators. Beta 1,3/1,6 D-Glucan can also be used. Xlear Xylitol should be available OTC.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Yes, Maxillary sinus Balloon Sinuplasty can be performed under local anesthesia and decongestion. It depends upon whether your ENT Doctor is conversant with Balloon Sinuplasty.
2. Budecort respules are avaiable for nebulisation. Budecort respules contain 0.5 mg of budesonide in 2 ml ampoules. That's 500 micrograms. Each fluticasone spray will be 27.5 to 50 micrograms per actuation, (depending on the brand), which theoretically means 20 to 10 sprays. Practically, how much of the mist dissolves or disperses will be difficult to accurately determine. You may alternate between hypertonic and isotonic saline as hypertonic will be more effective. You can self-titrate.
3. Head forward (sniffing position), for the spray. Also, hold your breath, and then use the nasal wash in each nostril. See this video: https://youtu.be/qFDYPZSbluQ?feature=shared
4. Low-dose macrolides have been used as immunomodulators. Beta 1,3/1,6 D-Glucan can also be used. Xlear Xylitol should be available OTC.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks you have been very helpful, I will take on board the above.
I just wanted to clarify with the blockage in the osteomeatal complex and the sinus thickening do the nasal steroids have the ability to reduce the thickening that is already formed if I use consistently ? Or will the steroids only prevent further damage?
Just one more question .. I have read that up to 70% of people with CRSwNP develop asthma. I don’t currently have asthma but my dad developed asthma and polyps when he was in his 40’s. Would you say that I am likely to develop asthma too due to all my risk factors?
My blood eosinophils are 0.5 (if this makes a difference)
I hope I can avoid developing this but I was just wondering my level of risk.
I just wanted to clarify with the blockage in the osteomeatal complex and the sinus thickening do the nasal steroids have the ability to reduce the thickening that is already formed if I use consistently ? Or will the steroids only prevent further damage?
Just one more question .. I have read that up to 70% of people with CRSwNP develop asthma. I don’t currently have asthma but my dad developed asthma and polyps when he was in his 40’s. Would you say that I am likely to develop asthma too due to all my risk factors?
My blood eosinophils are 0.5 (if this makes a difference)
I hope I can avoid developing this but I was just wondering my level of risk.
Brief Answer:
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Yes, improvement and disease reversal are seen to the extent that surgical intervention can be avoided in many patients.
2. There will be a possibility, but this may not happen, given your lack of specific allergies and normal eosinophil count. Some nasal polyposis patients have Samter's Triad / Aspirin Exacerbated Respiratory Disease (AERD), however, they will have raised eosinophil counts.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Details as discussed below:
Detailed Answer:
Hi,
Thank you for following up.
1. Yes, improvement and disease reversal are seen to the extent that surgical intervention can be avoided in many patients.
2. There will be a possibility, but this may not happen, given your lack of specific allergies and normal eosinophil count. Some nasal polyposis patients have Samter's Triad / Aspirin Exacerbated Respiratory Disease (AERD), however, they will have raised eosinophil counts.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Kampana
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