—Reviewed by Sue Pondrom
Explore this issue:July 2012
Nasal Steroids Effective in Chronic Rhinosinusitis with Polyposis
Do topical nasal steroids improve patient symptomatology in chronic rhinosinusitis with polyposis?
Background: Chronic rhinosinusitis (CRS) with nasal polyposis affects 0.5 percent to 4 percent of the world population and is present in approximately 20 percent of patients with chronic rhinosinusitis. A large number of randomized controlled trials have evaluated the efficacy of topical nasal steroids to improve symptomology. While prior studies have used a change in polyp size as a surrogate for a direct clinical benefit, there has been no demonstration of a correlation between endoscopic grading and patient symptom scores.
Study design: Systematic review with meta-analysis using standardized methodology.
Setting: Rhinology and Sinus Surgery, Division of Otolaryngology, Department of Surgery, University of Calgary, Alberta, Canada; Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston; Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
Synopsis: A total of 19 randomized controlled trials met inclusion and exclusion criteria for a systematic review. The trials were performed from 1993 to 2010, ranging in length from four to 270 weeks. All evaluated three steroid formulations: fluticasone, mometasone and budesonide.
The authors found that gender, age and history of prior polypectomy did not appear to influence steroid efficacy. They did, however, find publication bias in the studies. Topical nasal steroid therapy (all three in the studies) in patients with CRS and nasal polyposis were found to be efficacious. Noting that polyp size reduction is only an indirect measure of clinical success, the authors said one can argue that the most clinically relevant outcome is patient-reported symptoms.
Bottom line: Topical nasal steroids improve patient symptomatology in chronic rhinosinusitis with polyposis.
Reference: Rudmik L, Schlosser RJ, Smith TL, Soler ZM. Impact of topical nasal steroid therapy on symptoms of nasal polyposis: a meta-analysis. Laryngoscope. 122(7):1431-1437.
—Reviewed by Sue Pondrom
Study Looks at Costs of Laryngeal Diseases and Disorders
What are the annual direct costs associated with the evaluation and management of patients with laryngeal disorders, and what is the proportion of annual direct costs related to physician encounters, procedure claims and pharmacy claims?
Background: Approximately one-third of adults experience dysphonia at some point during their lifetime. Dysphonia impacts quality of life and work productivity. Prior studies have focused primarily on specific disease states and populations. One study, by Verdolini and Ramig, estimated costs but only for a teaching population, and it was not clear how cost estimates for voice therapy and surgery were determined.