Nasal steroid use and osteitis development in chronic rhinosinusitis with nasal polyps

Abstract
Objectives
Osteitis and tissue remodeling are inflammatory processes associated with the severity of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal steroids are the mainly recommended therapeutics in the treatment of the disease, and besides their beneficial effects, they may worsen osteitis via osteopenia. This study aimed to search for the coalescence of osteitis in CRSwNP and nasal steroid use (NSU).

Methods
A cross-sectional study was designed. Patients who underwent paranasal sinus computed tomography (PNSCT) imaging were queried, and the sino‐nasal outcome test-22 (SNOT-22) was completed. Regular NSU was defined as a continued treatment for 2 months in the last 6 months. The cumulative period of NSU during the last 6 months was determined and classified as no use or, for 1 to 3 months, or more than 3 months. Lund-MacKay scores (LMS) and Global Osteitis Scores (GOS) were calculated for 10 sinuses via PNSCT.

Results
Sixty-two patients were included in the study. The mean GOS score was 5.7 ± 1.7 points higher in patients with regular NSU (p = 0.002, 95% CI: 9.2–2.2, t-test). LMS and SNOT-22 scores also were significantly higher for patients with regular NSU (p = 0.036 and < 0.001 consecutively). The mean GOS score showed a significant increase according to the cumulative period of NSU (p < 0.001, one-way ANOVA test). Similarly, LMS and SNOT-22 scores were also significantly associated with the duration of total NSU. GOS score showed a significant positive high correlation with LMS and SNOT-22 scores (p < 0.001, r = 0.608 and r = 0.753 consecutively).

Conclusions
This association found between the severity of GOS and NSU is probably due to the severity of the disease. However, it may question the value of the NSU effect in the development of osteitis. The presence of NSU should be investigated in future histopathological studies.

Level of evidence
IV