Rhinosinusitis often follows radiotherapy in the treatment of carcinoma of the nasopharynx. The interval and severity may vary with the dose of radiation and stage of the carcinoma. In this randomised, controlled study, patients who developed rhinosinusitis after radiotherapy treatment for carcinoma of the nasopharynx were given either fluticasone proprionate with nasal irrigation or the latter alone. The two groups were matched for age, cancer stage, radiation dose and time interval between radiotherapy and development of rhinosinusitis.
It was noted that significant improvement occurred in terms of overall symptoms, nasal obstruction and headaches (VAS scores), fewer endoscopic findings of rhinosinusitis (ANOVA scores) and quality of life (SNOT-20 scores). There was no significant difference in pre and post therapy sinus CT (Lund-Mackay scores) findings, sense of smell and rhinorrhoea.
The authors attribute the improvement to the action of steroids in blocking the inflammatory pathway by inhibiting cyclo-oxygenase 2 and attenuating prostaglandins. Ciliary clearance is subsequently improved. This may not be achieved with irrigation alone. As for lack of improvement in CT findings, the authors postulate that these are not always related to the symptoms, as deduced from several earlier studies. Use of intranasal steroids in any nasal or sinus inflammation is generally considered to be a routine practice, but this is probably the first study of this application specifically in post radiotherapy patients, treated for carcinoma of the nasopharynx and is statistically well supported.
