Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis

Objective: To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis. Design: Randomized prospective controlled study. Patients were examined every 6 months during follow-up (range, 1-9 years). Patients: One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis. Intervention: All patients were surgically treated in the ENT Department, University of Siena Medical School. One month after surgery, group 1 patients (n=97) started treatment with intranasal furosemide, group 2 (n=40) received no therapeutic treatment, and group 3 (n=33) were treated with mometasone. Main Outcome Measures: Clinical and instrumental evaluation of postoperative outcomes. Results: Seventeen (17.5%) of 97 patients in group 1, 12 (30.0%) of 40 patients in group 2, and 8 (24.2%) of 33 patients in group 3 experienced nasal polyposis relapses. We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone, whereas patients who did not receive any treatment experienced more severe grades of chronic hyperplastic sinusitis with nasal polyposis (P<.005). Conclusion: Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis.