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Nasal Steroids

The ideal nasal steroid should be: 

  1. Easily administered or directed into the nose, most often in the form of a spray
  2. Physiologic or not harmful to the nasal mucous membrane
  3. Compatible with the normal nasal functions of regulation of humidification and cleansing air en route to the lungs
  4. Not absorbed into the general circulation to avoid the adverse effects of systemic steroids
  5. Relatively slow acting to permit once or twice daily usage in most patients, and
  6. Effective in minimizing inflammation within the nose. 

Nasal steroid sprays have evolved from meeting few of the above requirements to now being both safe and effective in most patients. To meet these requirements, these sprays must be used daily and will often require weeks before their benefits are apparent to the patient. They should be sprayed towards the inner margin of the eye, which directs them towards the point of drainage of most of the sinuses. However, these drugs can cause nasal bleeding due to atrophy or erosion of the nasal mucous membrane, and require supervision by an ophthalmologist in those patients with glaucoma or cataracts. 

References

Gillespie MB, O'Malley BW Jr, Francis HW. An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host.Arch Otolaryngol Head Neck Surg. 1998;124:520-6.

Malani PN, Kauffman CA. Invasive and Allergic Fungal Sinusitis. Curr Infect Dis Rep. 2002;4:225-232

Manning SC, Mabry RL, Schaefer SD.Evidence of IgE-mediated hypersensitivity in allergic fungal sinusitis. Laryngoscope. 1993;103:717-21.

Ponikau JU, Sherris DA, , Kita H, Kern EB. Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2002;110:862-866. 

Ponikau JU, Sherris DA, Kephart GM, Kern EB, Gaffey TA, Tarara JE, Kita H..Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma? J Allergy Clin Immunol. 2003;112:877-82.

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