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Original Investigation
November 2016

Effect of Topical Furosemide on Rhinosinusal Polyposis Relapse After Endoscopic Sinus SurgeryA Randomized Clinical Trial

Author Affiliations
  • 1Otolaryngology–Head and Neck Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
  • 2Department of Clinical Pharmacy, Faculty of Pharmacy, Islamic Azad University, Pharmaceutical Sciences Branch, Tehran, Iran
  • 3Department of Pharmaceutics, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • 4Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
  • 5Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1045-1049. doi:10.1001/jamaoto.2016.1249
Key Points

Question  What is the effect of topical furosemide on recurrence rate of rhinosinusal polyposis after endoscopic sinus surgery?

Findings  In this randomized clinical trial of 84 adults, the grade of polyps was 0 in 79% of the patients in the furosemide group compared with 38% in the placebo group.

Meaning  In this trial, topical furosemide was a safe drug with no important adverse effects that substantially reduced the severity of polyposis after endoscopic sinus surgery.

Abstract

Importance  Evidence from previous studies suggests that furosemide may be effective in reducing the recurrence of polyps after sinus surgery. However, the evidence is limited and insufficient, and further investigations are required.

Objective  To assess the effect of topical furosemide on recurrence rate of rhinosinusal polyposis after endoscopic sinus surgery.

Design, Setting, and Participants  Triple-blind randomized clinical trial of patients aged 18 to 60 years with chronic rhinosinusitis associated with polyposis who did not respond to medical treatment and were candidates for endoscopic sinus surgery at Besat Hospital, Hamadan University of Medical Sciences, from April 2014 to June 2015.

Interventions  Patients were randomly assigned to receive postoperative nasal spray, 2 puffs twice a day for 2 months, either 300 µg of furosemide per day or placebo.

Main Outcomes and Measures  Six months after surgery, the patients were examined for nasal and paranasal sinus polyposis using Meltzer endoscopic grading, computed tomographic (CT) scan of paranasal sinuses (PNS) scoring, Sino-Nasal Outcome Test (SNOT-22) scoring, and visual analog scale (VAS).

Results  Of 110 patients enrolled, 84 patients remained for analysis (53 men and 31 women; mean age in the furosemide group, 37.02 years, range, 18-58 years; mean age in the placebo group, 36.30 years, range, 18-60 years). Six months after the intervention, the grade of polyposis decreased in both groups, but this reduction was substantial in the furosemide group vs the placebo group. The severity of polyposis was significantly lower in the furosemide group vs the placebo group based on SNOT-22 scoring (difference, 8.05; 95% CI, 3.24-12.85) and VAS (difference, 0.81; 95% CI, 0.22-1.39) but not significantly different based on CT scan of PNS scoring (difference, 2.52; 95% CI, −0.35 to 5.39). The incidence of adverse effects (nasal irritation, headache, and constipation) were not significantly different between the 2 groups.

Conclusions and Relevance  These findings indicate that topical furosemide is a safe drug, with no important adverse effects, that can substantially reduce the severity of polyposis after endoscopic sinus surgery.

Trial Registration  Iranian Registry of Clinical Trials registration number: IRCT201403143186N5

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