Corticosteroid therapy in chronic rhinosinusitis with nasal polyps: from histopathological tissue remodeling to patient adherence and barriers.

BACKGROUND AND

OBJECTIVES

This study evaluated mucosal remodeling across different corticosteroid regimens and identified barriers to treatment adherence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

PATIENTS, MATERIALS AND

METHODS

We enrolled 56 consecutive patients divided into two arms: Group 1 (n=22) underwent sinus surgery after topical, systemic, or combined corticosteroid therapy, with mucosal biopsies evaluated via a four-parameter histopathological (HP) score (infiltrate, eosinophils, edema, fibrosis). Group 2 (n=34; 15 excluded due to systemic steroid use) received exclusive medical treatment and was assessed for compliance using the Medication Adherence Questionnaire (MAQ) at baseline and three months.

RESULTS

In Group 1, combined therapy (topical and systemic) demonstrated significantly lower HP scores compared with the topical-only group for inflammatory infiltrate (p=0.0280), tissue eosinophils (p=0.036), intramucosal edema (p=0.0400), and fibrosis (p=0.0393). In Group 2, a strong negative correlation was established between MAQ and Medication Adherence Report Scale-5 (MARS-5) (r=-0.9216, p<0.0001), confirming validity. Early treatment discontinuation and time constraints were the primary drivers of non-adherence.

CONCLUSIONS

Combined topical and systemic corticosteroid therapy yields superior tissue remodeling outcomes by significantly reducing mucosal inflammation, eosinophilia, edema, and fibrosis compared to topical therapy alone. The MAQ is a valid clinical tool, highlighting early discontinuation and time constraints as key targets to optimize patient compliance and CRSwNP management.