Effect of budesonide nasal irrigationon Hypothalamic-Pituitary-Adrenal Axis in patientswith chronic rhinosinusitis post endoscopic sinus surgery: A prospective study
Jesada Kanjanaumporn,1,2 Sorranut Thaweboon,1 Songklot Aeumjaturapat,1,2 Kornkiat Snidvongs,1,2
Supinda Chusakul,1,2 Kachorn Seresirikachorn,1,2 Lalita Prathanee1,2
Affiliations:
1 Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
2 Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Abstract
Background: Corticosteroids added to high volume saline nasal irrigation have been introduced as a more effective method of delivering corticosteroids to the sinuses than nasal sprays. However, information regarding the effect of this intervention on the hypothalamic-pituitary-adrenal (HPA) axis is still limited.
Objective: To evaluate the safety of long-term corticosteroid (6 months) nasal irrigation in patients with chronic rhinosinusitis (CRS) post endoscopic sinus surgery.
Methods: Seventeen patients with CRS were included. After undergoing endoscopic sinus surgery, the patients were prescribed budesonide nasal irrigations (250 ml via squeeze bottle) twice daily (1 mg/day) for six months. The serum morning cortisol levels of these patients were then evaluated at 3 and 6 months post-operatively.
Results: Median serum morning cortisol levels were 10.5 mcg% at pre-operative baseline; 10.3 mcg% at 3 months; and 11.2 mcg% at 6 months on post-operative follow-up. There were no significant changes in the serum morning cortisol levels (P value = 0.71 and 0.63 respectively). Three of 17 patients (17.65%) had mildly abnormal serum morning cortisol levels (4, 4.3 and 4.9 mcg%) at 3 months. However, these levels were within a normal range at 6 months.
Conclusion: Serum morning cortisol levels were not significantly changed after usage of budesonide nasal irrigation for 6 months.
Key words: budesonide nasal irrigation, corticosteroid, serum morning cortisol, chronic rhinosinusitis, endoscopic sinus surgery