Intrasinus administration of topical budesonide to allergic patients with chronic rhinosinusitis following surgery

Objective. Whether instillation into the maxillary sinus of topical budesonide affected the immune response and improved allergic patients with chronic rhinosinusitis that had persistence of symptoms despite appropriate surgical intervention was assessed. Study Design: Double-blind placebo-controlled. Methods: Twenty-six patients with allergy to house dust mites who had previously had surgery and who had persistent symptoms of disabling rhinorrhea or pressure-pain resistant to oral antibiotics and intranasal corticosteroids were recruited. During the double-blind study, patients instilled 256 mug budesonide daily or placebo through an intubation device (maxillary antrum sinusotomy tube) into one of the maxillary sinuses for 3 weeks before clinical assessment and a second biopsy. Results: We found an improvement in the symptom scores in 11 of the 13 patients who received budesonide; we also found a decrease in CD-3 (P=.02) and eosinophils (P=.002), and a decrease in the density of cells expressing interleukin-4 (P=.0001) and interleukin-5 messenger RNA (P=.006) after treatment. Conclusion: Topical budesonide delivered through a maxillary antrum sinusotomy tube can control chronic rhinosinusitis that persists after surgery.