The nasal steroid spray Nasonex was approved by the FDA for the treatment of nasal polyps a year ago this month, largely on the strength of the newly reported study.
Nasal polyps are growths within the lining of the nose or sinuses most often seen in people with chronic allergies. The growths can reduce airflow in the nasal passages, create chronic congestion, runny nose and postnasal drip, as well as a diminished sense of smell, headaches, and snoring.
Better Than Surgery?
Just over 300 patients completed the four-month long study, paid for by Nasonex manufacturer Schering-Plough. Roughly half were treated with the steroid nasal spray and half were given placebo (fake) spray.
Once- and twice-daily use of the active steroid spray was significantly more effective for reducing the size and number of polyps than a placebo nasal spray.
Patients who got the steroid spray also had greater reductions in nasal congestion, and the steroid treatment was well tolerated.
The study is published in the December issue of the Journal of Allergy and Clinical Immunology.
Researcher Catherine Butkus Small, MD, tells WebMD that the nasal steroid spray has many advantages over surgery for the treatment of nasal polyps.
"The problem with surgery is that polyps do recur, which means that patients need more surgery," says the New York Medical College associate professor of medicine. "Multiple surgeries can cause scarring, which can lead to further problems in terms of congestion. It's kind of a domino effect."
She adds that surgery patients typically do not show dramatic improvements in their sense of smell, but the patients treated with the nasal steroid in her study did.
"Loss of smell and nasal congestion are the major complaints in the patients I see with nasal polyps," she says. "Both of these symptoms were significantly improved with both once-a-day and twice-a-day [Nasonex] treatment."
Already Widely Used
Allergy specialist and surgeon Richard A. Lebowitz, MD, says the new research probably will not have a big impact on clinical practice because physicians are already using steroid-based sprays for the treatment of nasal polyps.
Lebowitz is an otolaryngology professor and head and neck surgeon at New York University Medical Center.
"Few of us see polyps and immediately book the OR," he says. "You want to avoid surgery if possible."
Lebowitz typically treats patients with oral steroid pills for five to seven days, and then he puts them on a steroid nose spray.
"Oral steroids work better to shrink and even eliminate the polyps," he says. "But you can't keep people on them very long. The nasal sprays are safe to use long term, and I think it is pretty much agreed that they have a place in the first-line treatment of nasal polyps."