Comparative Study between Topical Verapamil and Topical Corticosteroids in Treatment of Chronic Rhinosinusitis with Sinonasal Polyposis

Abstract Background: One of the most frequent chronic conditions in adults is chronic rhinosinusitis (CRS) either with nasal polyps (CRSwNP) or without nasal polys (CRSsNP). Verapamil is a calcium channel blocker (CCB) that could be used as an immunomodulator to relieve hypersensitivity disorders by inhibiting P-glycoprotein (p-gp) and reducing inflammation. Aim of Study: The aim of this research is to compare the efficacy of topical verapamil versus topical corticosteroids in the management of chronic rhinosinusitis with nasal polyps. Patients and Methods: A prospective study was conducted on 60 patients with (CRSwNP) presenting to ENT clinic in Al-Azhar University Hospitals between June 2021 and April 2022. These patients were divided into two groups: Group A, which received topical corticosteroid (Beclomethasone Dipro-pionate Monohydrate) 2 puffs in each nostril twice daily for 3 months and group B, which received topical verapamil 2 puffs in each nostril twice daily for the same duration. Results: Groups A and B had mean ages of 39.03±6.10 and 38.07±5.78 years respectively. Regarding gender, 76.7% were males and 23.3% females in group A while in group B, 80% were males and 20% females. The mean Total nasal symptom score in group A before and after management was 4.55±0.42 and 1.17±0.14 respectively while the mean Total nasal symptom score in group B before and after management was 4.01±0.22 and 1.29±0.09 respectively. It was noticed that there was statistically significant improvement in Total nasal symptom score after treatment. The mean total nasal polyp score in group A before and after management was 4.36±0.42 and 2.89±0.45 respectively while the mean polyp score in group B before and after management was 4.29±0.43 and 2.81±0.19 respectively. It was noticed that there had been a statistically significant decrease in total nasal polyp score. Conclusions: The study found that both treatments (topical corticosteroid and topical verapamil) significantly improved total nasal symptom score (TNSS) and total nasal polyp score (TNPS) with no difference between them.
There is improvement in patients of both groups (topical corticosteroid and topical Verapamil) in nasal obstruction, reduction in size of polyps, re-establishing nasal air way and nasal breathing with no marked side effects as these drugs used in atopical form and can be used as pre FESS preparation.