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  • Drs. Dubin and Reh

Steroid (Budesonide) Irrigations- Dr. Reh

Chronic sinusitis is a common disease that effects roughly 12.5% of the US population. Chronic sinusitis symptoms include nasal congestion and obstruction, loss of smell and taste, drainage, fatigue and facial pressure/pain. Many patients with chronic sinusitis also have asthma.

A common misconception about chronic sinusitis is that it is caused solely by an anatomic obstruction or an infection that can be “cured” by an antibiotic or surgery. Chronic sinusitis or chronic rhinosinusitis (CRS) is actually an inflammatory disease similar to asthma or rheumatoid arthritis. It is a complex disease that stimulates an abundance of research to attempt to understand its causes and develop new treatments. The important thing to understand about CRS is there are likely many potential causes both environmental and inherent to the patient. More importantly, there currently is no curative therapy that will eradicate the disease from a patient. The good news is that like so many other chronic diseases, there are effective therapies that can help moderate the disease and, in many cases, give patients normal lives with minimal symptoms. These treatments can include surgery and daily medications.

There is perhaps no more safe and effective therapy for CRS than budesonide irrigations. Oral and topical steroids are very successful in controlling symptoms in CRS patients. Long term oral steroids have severe side effects such as bone loss, alterations in blood sugars, hip fractures and psychosis. Topical steroids are much safer but less effective that oral steroids. Often times they don’t distribute into a patient’s nasal and sinus cavities. In patients who have had thorough surgery to remove polyps or inflamed sinus tissue, sinus irrigations or rinses can effectively penetrate their sinus cavities. High flow saline irrigations such as those used in rinse bottles (link Neilmed?) may more effectively penetrate the sinuses than sprays like those used in over the counter or prescription topical steroids. Budesonide is a topical steroid used in nebulizers that historically was given to asthma patients for inhaled treatment. Budesonide vials can be added to a high flow sinus saline irrigation and used to rinse the sinus cavities with topical steroids. The exciting news is that this therapy is extremely effective in controlling sinus inflammation especially in patients who’ve had sinus surgery1. The dose is no different than in over the counter topical steroids, so it is safe2 but more effective a treating inflammation.

CRS patients who have had surgery and are compliant with their budesonide irrigations (use it daily) have an excellent chance of minimizing or eliminating their symptoms. In our experience, this therapy has dramatically reduced the need for revision surgery in compliant CRS patients.

Refs:

1. Snidvongs K, Pratt E, Chin D, Sacks R, Earls P, Harvey RJ. Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis. Int Forum Allergy Rhinol. 2012 Sep-Oct;2(5):415-21.

2. Welch KC, Thaler ER, Doghramji LL, Palmer JN, Chiu AG.The effects of serum and urinary cortisol levels of topical intranasal irrigations with budesonide added to saline in patients with recurrent polyposis after endoscopic sinus surgery. Am J Rhinol Allergy. 2010 Jan-Feb;24(1):26-8.

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