Effect of topical furosemide on sinonasal polyposis relapse after endoscopic sinus surgery

Authors

  • Souvagini Acharya Department of Otorhinolaryngology and Head Neck Surgery, VSSIMSAR, Burla, Odisha, India
  • Alka Kapil Department of Otorhinolaryngology and Head Neck Surgery, VSSIMSAR, Burla, Odisha, India
  • Kamalini Bepari Department of Otorhinolaryngology and Head Neck Surgery, VSSIMSAR, Burla, Odisha, India
  • Sandrendu Rajan Department of Otorhinolaryngology and Head Neck Surgery, VSSIMSAR, Burla, Odisha, India
  • Prachi Mohapatra Department of Internal Medicine, IMS, BHU, Varanasi, Uttar Pradesh
  • Ashima Mishra Department of Internal Medicine, VSSIMSAR, Burla, Odisha, India
  • Aishwarya Aparajita Department of Otorhinolaryngology and Head Neck Surgery, VSSIMSAR, Burla, Odisha, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20205628

Keywords:

Topical furosemide, Sinonasal polyposis, Relapse, Endoscopic sinus surgery, VAS, Meltzer endoscopic grading

Abstract

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) relapse is commonly seen during follow up period after endoscopic sinus surgery. Some studies claim the credibility of topical furosemide in preventing the polyposis recurrence after surgery. This randomised control trial was done to check the effectiveness of topical furosemide on sinonasal polyposis relapse after the endoscopic sinus surgery.

Methods: In the current study, 44 patients, attending ENT department, VSSIMSAR, for follow up after endoscopic sinus surgery, were evaluated clinically and endoscopically to demonstrate the prevalence and severity of polyposis relapse using Visual analogue scale (VAS) and meltzer endoscopic grading, before initiating the intervention. Patients were then randomised in two groups- one receiving topical furosemide nebulization and other intranasal normal saline spray, respectively. All patients were evaluated again at 1st, 2nd, 4th and 6th month follow-ups by VAS and MEG, setting statistical significance at p<0.05.

Results: The MEG was grade 0 in 77% (17) patients of furosemide group and 32% (7) of normal saline group (p=0.0147). Statistically significant improvement was also observed in VAS for nasal symptoms in former group (p=0.028) than latter. The rate of relapse was less (23.81%) in furosemide group as compared to normal saline group (65%) but result not statistically significant at p<0.05.

Conclusions: Topical furosemide can be used as a valid therapeutic approach for reducing the severity of sinonasal polyposis relapse after endoscopic sinus surgery with no known side effects of furosemide when administered topically.

 

References

Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg. 1995;113(1):104-9.

Bhattacharyya N. Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States. Ann Otol Rhinol Laryngol. 2011;120:423-7.

Bassiouni A, Wormald P-J. Role of frontal sinus surgery in nasal polyp recurrence. Laryngoscope.2013;123(1):36-41.

Bernstein JM, Yankaskas JR. Increased ion transportin cultured nasal polyp epithelial cells. Arch OtolaryngolHead Neck Surg. 1994;120:993-96.

DeConde AS, Mace JC, Levy JM, Rudmik L, Alt JA, Smith TL. Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis. The Laryngoscope. 2017;127:550-55.

Meltzer EO, Hamilos DL, Hadley JA. Rhinosinusitis Initiative. Rhinosinusitis: developing guidance for clinical trials. J Allergy Clin Immunol. 2006;118(5):S17-61.

Gift AG. Visual analogue scale: measurement of subjective phenomena. Nurs Res.1989;38(5):286-88.

Smith TL, Kern R, Palmer JN. Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up. Int Forum Allergy Rhinol. 2013;3(1):4-9.

Fokkens WJ, Lund WJ, Mullol J, Bachert C, Alobid I, Baroody F, et al. European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl. 2012;23:1-298.

Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, et al. Chronic rhinosinusitis in Europe- an underestimated disease. A GALEN study. Allergy. 2011;66:1216-23.

Hopkins C, Browne JP, Slack R, Lund V, Topham J, Reeves B, et al. The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Clin Otolaryngol. 2006;31:390-8.

Smith TL, Litvack JR, Hwang PH. Determinants of Outcomes of Sinus Surgery: A MultiInstitutional Prospective Cohort Study. Otolaryngol Head Neck Surg. 2010;142(1):55-63.

Passàli D, Mezzedimi C, Passàli GC, Bellussi L. Efficacy of inhalation form of furosemide to prevent postsurgical relapses of rhinosinusal polyposis. ORLJ Otorhinolaryngol Relat Spec. 2000;62(6):307-10.

Passali D, Bernstein JM, Passali FM, Damiani V, Passali GC, Bellussi L. Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis. Arch Otolaryngol HeadNeck Surg 129:656-59.

Iwamoto LM, Fujiwara N, Nakamura KT, Wada RK. NaK2Cl cotransporter inhibition impairs human lung cellular proliferation. Am J Physiol Lung Cell Mol Physiol. 287(3):L510-14.

Niven AS, Argyros G. Alternate treatments in asthma. Chest 123(4):1254-65.

Downloads

Published

2020-12-24

Issue

Vol. 7 No. 1 (2021): January 2021

Section

Original Research Articles