Clinical efficacy of an extended local treatment in nasal polyps with different endotypes: A prospective randomized controlled study.

PURPOSE: To compare the efficacy of 3 corticosteroid delivery methods and assess whether extending treatment duration enhances patient outcomes. METHODS: This prospective randomized controlled trial enrolled 138 patients with chronic rhinosinusitis with nasal polyps (CRSwNP) from FA Hospital between September 2019 and February 2025. Patients were randomly allocated to 3 groups receiving a two-week regimen: Nasal Spray (budesonide nasal spray 256 μg/day), Nasal Drop (budesonide nasal spray 256 μg/day & budesonide nasal drop 1 mg/day) and Oral Steroids (budesonide nasal spray 256 μg/day & oral prednisone 30 mg/day). Visual-analogue scale (VAS), the 22-item Sinonasal Outcome Test (SNOT-22), and nasal polyps endoscopic scores (NP scores) were assessed pre- and post-treatment. The two-week data were compared to one-week time points from separate cohorts in our prior work. RESULTS: Compared to baseline (Day 0), the nasal drop group showed significantly greater VAS reduction than the nasal spray group after 2 weeks (P = 0.02), particularly in nasal obstruction (P = 0.04) and purulent rhinorrhea (P < 0.01), and was comparable to the oral group (P = 0.96). Regarding SNOT-22, the nasal drop group demonstrated superior improvement in extranasal (P = 0.02) and sleep disorder symptoms (P = 0.03) compared to the nasal spray group from baseline to 2 weeks, with no significant difference versus the oral group (P = 0.48). Additionally, the 2 weeks use of oral corticosteroids was associated with notable polyp size reduction (P = 0.02), especially in type-2 CRSwNP (P = 0.01). Extending treatment duration from 1 to 2 weeks yielded significant subjective improvements in the nasal drop group (P = 0.04), and significant endoscopic improvement only in the nasal spray group (P < 0.01). CONCLUSIONS: Adding intranasal drops to nasal spray enhances short-term symptom relief, whereas oral steroids reduce polyp size more effectively, particularly in type 2 CRS.