Combined Oral and Intranasal Corticosteroid Therapy: An Advance in the Management of Nasal Polyposis?

Chronic rhinosinusitis with nasal polyps is a commonhealth problem, affecting 2 % to 5 % of the gen-eral population. Although the condition is not life-threatening, it is costly in terms of health care expendi-tures, decreased quality of life, and negative effects on lower airway disease (1–3). European guidelines recom-mend intranasal corticosteroids as first-line treatment for chronic rhinosinusitis with nasal polyps and reserve oral steroid therapy for patients with severe or uncon-trolled symptoms and endoscopic sinus surgery for pa-tients with inadequate improvement despite oral steroid therapy (1, 4). After surgery, many patients must con-tinue medical management to prevent relapse (5–7). Yet, these recommendations are largely based on con-sensus rather than on definitive evidence. Corticosteroids exert their anti-inflammatory effec