Harvard Medical School Adviser by the Faculty of Harvard Medical School

Q:

I have chronic sinusitis and nasal polyps. I recently switched doctors, and the new specialist suggested trying oral steroids, something that my previous doctor never mentioned. Could steroids help relieve pressure in my sinuses?

A.

It's true that a short course of five to seven days of oral steroids may be worth a try, particularly if your sinusitis isn't getting any better.

Sinusitis is inflammation of the mucous membranes that line the sinuses. Your sinuses are like little caves in the bones around your eyes and nose. They're lined with membranes that produce thin, watery mucus that drains into the nose through tiny openings. If those openings get blocked, fluid and mucus build up, creating a cozy place for naturally present bacteria to multiply.

The body responds to the increased numbers of bacteria with inflammation and swelling. This produces a painful feeling of pressure in the face. Like a cold, sinusitis causes nasal congestion because of excess mucus production and swollen nasal membranes. Indeed, sinusitis often feels like a cold that just won't go away. Some people get feverish and fatigued as their bodies mount an immune response.

Nasal polyps are fleshy growths inside the nasal passageways. Large nasal polyps can make breathing difficult and may diminish a person's sense of smell. But even if they're quite large, polyps may not be visible to the patient because they tend to develop high up in the nose.

Not all cases of chronic sinusitis result in polyps, but many do. Polyps are a common consequence of the continual nasal inflammation that occurs with chronic sinusitis, but they can also develop from allergies and other triggers

You've probably tried the usual techniques for dealing with your sinusitis, including inhaling steam, taking long, hot showers, drinking lots of water and sleeping with your head elevated. Doctors are discouraged from prescribing antibiotics for sinusitis too freely, primarily due to worries about increased bacterial resistance to antibiotics. But if sinusitis does not respond to decongestant and steam, or is unusually severe or persistent, then a course of antibiotics is often a good idea.

Once sinusitis becomes a chronic condition, the inflammation can take on a life of its own. At this point, steroids become an important treatment option. These are not the anabolic steroids that athletes use to build muscle. Rather, they are corticosteroids that have anti-inflammatory effects. (Corticosteroids are often called steroids for simplicity.)

Topical steroids can be applied directly to the nose with drops or sprays. In the United States, the nasal steroid that's used most often, fluticasone propionate (the brand name is Flonase), is available only as a spray.

However, polyps can block topical steroids from reaching the inflamed tissue. Taking an oral steroid like prednisone for a week or so reduces the size of the polyps a little bit, and may also have an overall effect on the inflamed tissue in the nose. Shrinking polyps and reducing inflammation seem to allow the topical steroid to reach its target and be more effective.

Taking a steroid orally exposes the whole body to the medication, not just the nose and sinuses, as occurs with the topical version. Side effects can be a problem. They may include elevated pressure in the eyes (glaucoma), increased blood pressure and mood swings.

Long-term use of oral steroids can lead to more serious side effects, such as weakened bones and increased susceptibility to infection. But most patients tolerate a short course well.

Chronic sinusitis patients who don't have polyps don't seem to respond so well to oral or topical steroids. Some doctors think that sinusitis with polyps and sinusitis without polyps are two distinct diseases. These doctors recommend steroid therapy only for patients with polyps.

If steroids don't help relieve your sinusitis, there are other options you can explore. These include the mucus-thinning agent guaifenesin (Mucinex). Minimally invasive surgery to remove polyps may help. Removing polyps can reduce the number and severity of sinus infections and sometimes restore normal sinus function.

Surgery isn't a cure-all, though. Polyps may grow back. Every situation is different, so it's important to discuss all the options with your ear, nose and throat specialist.

(Submit questions to harvard_adviser@hms.harvard.edu.)

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