Effect of Postoperative Montelukast on Chronic Rhinosinusitis with Polyposis Recurrence Following Functional Endoscopic Sinus Surgery

Introduction: The recurrence rate after surgery of chronic rhinosinusitis with nasal polyposis is high. Nasal and systemic steroids are effective in the decrease (reduction) of recurrence following surgery. Due to the complications of the corticosteroids, alternative treatments are studied, including leukotriene antagonists. In this study, the combination of the leukotriene receptor antagonist drug (montelukast) and intranasal steroid is compared with an intranasal steroid alone, in prevention of postoperative recurrence in patients with nasal polyposis. Materials and Methods: This double-blind randomized clinical trial (RCT) was performed enrolling 30 chronic rhinosinusitis patients with polypoid undergoing the functional endoscopic sinus surgery. Patients were randomly divided into two groups. The patients in both groups were given fluticasone nasal spray and in the case and control group was used montelukast (10mg) and placebo tablet respectively for 6 weeks following the operation. 12 weeks after surgery, patients were evaluated regarding symptoms and sinonasal involvement was determined using endoscopy. Results: Four patients were excluded due to non-cooperation in using drugs. There was no significant difference between the case and control groups regarding the prior history and preoperative symptoms and sinus involvement. After surgery, symptoms and sinus involvement improved significantly in both groups. Postoperative montelukast together with nasal fluticasone spray did not significantly differ from nasal fluticasone spray and placebo in decreasing the symptoms and polyps. Conclusion: The addition of montelukast to nasal steroid spray does not affect the postoperative relapse of symptoms and endoscopic findings of patients with chronic polypoid rhinosinusitis compared to the nasal steroid spray alone for the treatment.