Budesonide Nasal Douching: An Effective Method in Postoperative AFRS Management MC01-MC03
Dr. Rajeev Kumar Verma,
Krashi Upaz Mandi Road, Ward No 1, Shrimadhopur, Siker-332715, Rajasthan, India.
Introduction: The aim of management of Allergic Fungal Rhinosinusitis (AFRS) is to control the disease process and the local immune response of the nasal mucosa. This is achieved by a two pronged approach – surgical clearance of all sinuses by Functional Endoscopic Sinus Surgery (FESS) followed by suppression of local immune response using steroids. Recently delivery of topical steroid by way of douching has been introduced. The effect of budesonide in management of postoperative AFRS patients is yet to be studied.
Aim: To evaluate the role of budesonide nasal douching in postoperative management of AFRS.
Materials and Methods: A total of 60 postoperative AFRS patients were randomly divided into two groups. Both groups received routine post Functional Endoscopic Sinus Surgery (FESS) medication as per the institute protocol. One group of patients received budesonide douching in addition to the routine care. Both groups were evaluated endoscopically at one, two and six weeks post op. Pre and postoperative quality of life change, patient complains, need for revision surgery and endoscopic Kupferberg scoring were used to compare the two postoperative groups.
Results: The average preoperative Sino-Nasal Outcome Test 22 (SNOT-22) score was 50.2. It was reduced to an average of 29.6 in patients who used the standard postoperative regimen and to 19.8 postoperatively in patients who had budesonide added to their douching solutions. The average Kupferberg score was 1.2 for patients who did receive budesonide as compared to 1.9 for patients who did not receive budesonide douching.
Conclusion: Budesonide douching can offer a safe and effective tool in managing local inflammatory response in AFRS. It leads to a significantly better quality of life and has an effective response on nasal mucosa – leading to lesser mucosal oedema and lesser incidence of polypoidal changes postoperatively.