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.