Backgrounds: Asthma co-mobidity is known to be associated with a poor prognosis for chronic rhinosinusitis with nasal polyps (CRSwNP). Systemic and topical glucocorticosteroid has been proved to be effective for recurrent nasal polyps after surgery.
Methods: We evaluated the steroid responsiveness and bacterial culture in 42 patients with CRSwNP associated with asthma during postoperative follow-up.
Results: Seventeen patients controlled by topical glucocorticosteroid therapy did not require systemic glucocorticosteroids (non-users). The remaining 25 patients showed recurrence of nasal polyps in spite of basal medication of topical corticosteroids and required oral corticosteroids. Eight patients were considered to be steroid non-responders. On the other hand, 17 patients responded to a short-term intake of oral corticosteroids (steroid responders). There was a statistically significant difference in the detection rate of pathogens from the sinus during acute exacerbations between steroid responders and non-users of steroids. There was a significant difference in symptomatic scores only between steroid non-responders and non-users of steroids, whereas the other parameters showed no significant differences.
Conclusion: Bacterial infection plays a critical role in recurrent polyps and refractory symptoms as well as in the poor response to glucocorticosteroids during postoperative followup.
Source: Ikeda et al. J Otol Rhinol.