Endoscopically guided frontal sinus beclomethasone instillation for refractory frontal sinus/recess mucosal edema and polyposis

Despite its metabolic complications, systemic corticosteroid therapy remains a mainstay in the treatment of refractory polyposis after endoscopic frontal sinusotomy. Furthermore, topical nasal corticosteroids often fail, presumably due to the relatively small dosage actually absorbed by the polyps. In order to minimise steroid complications while increasing the locally absorbed dose, beclomethasone (approximately 1 cc, 84 mcg/100 mu l) was instilled under endoscopic guidance directly into the frontal sinus in 31 instances in 16 patients with postoperative frontal recess/sinus polyposis and mucosal edema. The frontal recess/sinus polyposis/edema resolved completely in 9 frontal sinuses, improved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complications were noted. AM cortisol levels remained in the normal range. Endoscopically guided frontal sinus beclomethasone instillation should be considered for the treatment of refractory post-operative-frontal sinus/recess polyposis/edema. Further basic and clinical research into the pathophysiology of the nasal mucosa is also warranted.