Use Nasonex® in Pari Sinus?

Question

I had a surgery due to many nasal polyps (adenoids) and am now using Nasonex® (nasal steroid spray), nasal douche and Pari Sinus as recurrence prevention. Can I inhale Nasonex® with the Pari Sinus?

Many thanks and best regards,
I. J.

Answer

Dear Ms J.,

Nasonex® (mometasone furoate monohydrate) belongs to the topical cortisones that can be used as nasal sprays like Avamys® (Fluticasonfuroat), Flutide® Nasal (Fluticason propionat) or the older ones Budenasal, (Beclonasal…). The permanent therapy with the new nasal steroids can be considered very safe like the asthma therapy with low-dose topical steroids.
For the treatment of nasal polyps outside of CF there are excellent study results: they lead to a reduction of the nasal polyps and diminish the risk of recurrence after surgery. However, with nasal sprays it is hardly possible to reach the roots of the nasal polyps which often grow from the paranasal sinuses into the nasal passage. Nasal sprays only reach the nasal passage and the lower and middle nasal concha, they do not reach the paranasal sinuses. Therefore your question is comprehensible.

Even though it is likely that CF nasal polyps respond a bit less to topical cortisone than polyps e.g. based on an allergy, we do see many successes in the treatment and used these therapeutic agents generously and for the long term in CF. Nebulisation into the paranasal sinuses would be even better and this seems to be possible via vibrating aerosoles, e.g. via the Pari Sinus. However, the dosages in the nasal spray are so low that no therapeutic dosage would reach the sinuses with the Pari Sinus. Therefore, there is currently a study in non-CF patients with nasal polyps to bring Budesonide 0.5 mg (Budenobronch®, Pulmicort®) into the sinuses via Pari Sinus. We used this therapeutic method in single CF patients and in some cases the ENT physician could subsequently cancel a planned removal of the nasal polyps.
It would be desirable to also have such a study for CF patients but according to my knowledge this is currently not planned.

Best regards,
Dr. Jochen Mainz

12.08.2013