The effect of intranasal fluticasone propionate irrigations on salivary cortisol, intraocular pressure, and posterior subcapsular cataracts in postsurgical chronic rhinosinusitis patients

Authors

  • Li-Xing Man MSc, MD, MPA,

    Corresponding author
    1. Department of Otolaryngology Head and Neck Surgery, University of Rochester, Rochester, NY
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  • Zachary Farhood BA,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX
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  • Amber Luong MD, PhD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX
    2. Texas Sinus Institute, The University of Texas Medical School at Houston, Houston, TX
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  • Samer Fakhri MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX
    2. Texas Sinus Institute, The University of Texas Medical School at Houston, Houston, TX
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  • Robert M. Feldman MD,

    1. Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, TX
    2. Robert Cizik Eye Clinic, The University of Texas Medical School at Houston, Houston, TX
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  • Philip R. Orlander MD,

    1. Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX
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  • Martin J. Citardi MD

    1. Department of Otorhinolaryngology–Head and Neck Surgery, The University of Texas Medical School at Houston, Houston, TX
    2. Texas Sinus Institute, The University of Texas Medical School at Houston, Houston, TX
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  • Funding sources for the study: Richie's Specialty Pharmacy (Conroe, TX).

  • Potential conflict of interest: S.F. is a consultant for Arthrocare ENT (Austin, TX) and Terumo Medical (Japan). A.L. receives research funding from Cadence Pharmaceuticals (San Diego, CA). M.J.C. is a consultant for Polyganics (Groningen, The Netherlands).

  • Presented orally at the 116th Annual Combined Otolaryngology Spring Meeting (COSM), April 10–13, 2013, Orlando, FL.

Abstract

Background

Intranasal corticosteroid irrigations, especially budesonide, are used increasingly in the management of chronic rhinosinusitis. In post–endoscopic sinus surgery patients, irrigations may offer improved delivery at higher doses to the paranasal sinuses than intranasal spray preparations. Fluticasone propionate may have higher potency and lower systemic bioavailability than budesonide, but there is little data on its effects as an intranasal irrigation on the hypothalamic-pituitary-adrenal axis or on ocular findings.

Methods

Adult patients who had previously undergone bilateral endoscopic sinus surgery and had not taken systemic corticosteroids in the last 6 months were prospectively enrolled. Subjects irrigated with 3 mg of fluticasone propionate in 240 mL saline solution twice daily. Salivary cortisol, intraocular pressure, and the presence of posterior subcapsular cataracts were measured before drug administration and after 6 weeks of continuous use.

Results

Twenty-three subjects completed the study. No subjects had salivary cortisol levels below the normal range before or after therapy, and there was no statistical difference in mean salivary cortisol levels pretreatment and posttreatment (0.294 vs 0.392 μg/dL; p = 0.27). There was no clinical or statistical difference in mean intraocular pressure before or after therapy (13.3 vs 13.3 mmHg; p = 0.86). No subjects developed a posterior subcapsular cataract.

Conclusion

Fluticasone propionate irrigations did not suppress salivary cortisol levels or result in ocular changes. Irrigation with fluticasone propionate 3 mg in 240 mL saline twice daily may be a safe alternative to other intranasal or systemic corticosteroid treatments for chronic rhinosinusitis patients.

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