{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T23:04:35Z","timestamp":1784329475704,"version":"3.55.0"},"reference-count":17,"publisher":"Societatea Romana de Morfologie","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rom J Morphol Embryol"],"published-print":{"date-parts":[[2026,7,10]]},"abstract":"<jats:p>Background and Objectives: This study evaluated mucosal remodeling across different corticosteroid regimens and identified barriers to treatment adherence in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Patients, Materials and Methods: We enrolled 56 consecutive patients divided into two arms: Group 1 (n=22) underwent sinus surgery after topical, systemic, or combined corticosteroid therapy, with mucosal biopsies evaluated via a four-parameter histopathological (HP) score (infiltrate, eosinophils, edema, fibrosis). Group 2 (n=34; 15 excluded due to systemic steroid use) received exclusive medical treatment and was assessed for compliance using the Medication Adherence Questionnaire (MAQ) at baseline and three months. Results: In Group 1, combined therapy (topical and systemic) demonstrated significantly lower HP scores compared with the topical-only group for inflammatory infiltrate (p=0.0280), tissue eosinophils (p=0.036), intramucosal edema (p=0.0400), and fibrosis (p=0.0393). In Group 2, a strong negative correlation was established between MAQ and Medication Adherence Report Scale-5 (MARS-5) (r=-0.9216, p 0.0001), confirming validity. Early treatment discontinuation and time constraints were the primary drivers of non-adherence. Conclusions: Combined topical and systemic corticosteroid therapy yields superior tissue remodeling outcomes by significantly reducing mucosal inflammation, eosinophilia, edema, and fibrosis compared to topical therapy alone. The MAQ is a valid clinical tool, highlighting early discontinuation and time constraints as key targets to optimize patient compliance and CRSwNP management.<\/jats:p>","DOI":"10.47162\/rjme.67.1.14","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T22:55:06Z","timestamp":1784328906000},"page":"139-146","source":"Crossref","is-referenced-by-count":0,"title":["Corticosteroid therapy in chronic rhinosinusitis with nasal polyps: from histopathological tissue remodeling to patient adherence and barriers"],"prefix":"10.47162","volume":"67","author":[{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology and Head and Neck Surgery, Sf. Maria Hospital, Bucharest, Romania","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex Iulian","family":"Milea","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai Alexandru","family":"Preda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Otorhinolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology and Head and Neck Surgery, Sf. Maria Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea Elena","family":"Milea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology and Head and Neck Surgery, Sf. Maria Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Aurelia","family":"Mogoant\u0103","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Otorhinolaryngology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionu\u0163","family":"T\u0103nase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Otorhinolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology and Head and Neck Surgery, Sf. Maria Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelin","family":"Bordea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Pathology, Colentina Clinical Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caius Codru\u0163","family":"Sarafoleanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Otorhinolaryngology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Otorhinolaryngology and Head and Neck Surgery, Sf. Maria Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26736","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"\"[1] Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O'Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu CC, Searyoh K, Rhee CS, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Sindvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CP. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology, 2020, 58(Suppl S29):1-464. https:\/\/doi.org\/10.4193\/Rhin20.600","DOI":"10.4193\/Rhin20.600"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"[2] Norelli F, Schiappoli M, Senna G, Pinter P, Olivieri B, Ottaviano G, De Corso E, Caminati M. Adherence to intranasal steroids in chronic rhinosinusitis with nasal polyposis prior to and during biologic therapy: a neglected matter. J Clin Med, 2024, 13(4):1066. https:\/\/doi.org\/10.3390\/jcm13041066","DOI":"10.3390\/jcm13041066"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"[3] Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F, Cohen N, Cervin A, Douglas R, Gevaert P, Georgalas C, Goossens H, Harvey R, Hellings P, Hopkins C, Jones N, Joos G, Kalogjera L, Kern B, Kowalski M, Price D, Riechelmann H, Schlosser R, Senior B, Thomas M, Toskala E, Voegels R, Wang de Y, Wormald PJ. EPOS 2012: European Position Paper on Rhinosinusitis and Nasal Polyps 2012. A summary for otorhinolaryngologists. Rhinology, 2012, 50(1):1-12. https:\/\/doi.org\/10.4193\/Rhino12.000","DOI":"10.4193\/Rhino12.000"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"[4] van der Veen J, Seys SF, Timmermans M, Levie P, Jorissen M, Fokkens WJ, Hellings PW. Real-life study showing uncontrolled rhinosinusitis after sinus surgery in a tertiary referral centre. Allergy, 2017, 72(2):282-290. https:\/\/doi.org\/10.1111\/all.12983","DOI":"10.1111\/all.12983"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"[5] Phillips KM, Singerman KW, Sedaghat AR. Individual symptom visual analogue scale severity scores for determining EPOS guideline-based chronic rhinosinusitis disease control. Rhinology, 2022, 60(3):229-235. https:\/\/doi.org\/10.4193\/Rhin21.446","DOI":"10.4193\/Rhin21.446"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"[6] Doulaptsi M, Prokopakis E, Seys S, Pugin B, Steelant B, Hellings P. Visual Analogue Scale for sino-nasal symptoms severity correlates with Sino-Nasal Outcome Test 22: paving the way for a simple outcome tool of CRS burden. Clin Transl Allergy, 2018, 8:32. https:\/\/doi.org\/10.1186\/s13601-018-0219-6","DOI":"10.1186\/s13601-018-0219-6"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"[7] Plath M, Sand M, Cavaliere C, Plinkert PK, Baumann I, Zaoui K. Normative data for interpreting the SNOT-22. Acta Otorhinolaryngol Ital, 2023, 43(6):390-399. https:\/\/doi.org\/10.14639\/0392-100X-N2279","DOI":"10.14639\/0392-100X-N2279"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"[8] Brunet A, Milara J, Fr\u00edas S, Cortijo J, Armengot M. Molecular and clinical predictors of quality of life in chronic rhinosinusitis with nasal polyps. J Clin Med, 2023, 12(4):1391. https:\/\/doi.org\/10.3390\/jcm12041391","DOI":"10.3390\/jcm12041391"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"[9] Chan AHY, Horne R, Hankins M, Chisari C. The Medication Adherence Report Scale: a measurement tool for eliciting patients' reports of nonadherence. Br J Clin Pharmacol, 2020, 86(7):1281-1288. https:\/\/doi.org\/10.1111\/bcp.14193","DOI":"10.1111\/bcp.14193"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"[10] Mihani JG, Burazeri E, Dyrmishi X, Dra\u00e7ini R, Todd R, Horne R, K\u00eblli\u00e7i S. Validity and reliability of Medication Adherence Report Scale (MARS-5) in a Southeastern European population. J Pharm Policy Pract, 2025, 18(1):2525359. https:\/\/doi.org\/10.1080\/20523211.2025.2525359","DOI":"10.1080\/20523211.2025.2525359"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"[11] Kim IA, Nosulya EV, Ragimova DR. Osobennosti priverzhennosti lecheniyu bol'nykh khronicheskim rinosinusitom s polipami nosa [Features of adherence to treatment of patients with chronic rhinosinusitis with nasal polyps]. Vestn Otorinolaringol, 2022, 87(1):81-86. https:\/\/doi.org\/10.17116\/otorino20228701181","DOI":"10.17116\/otorino20228701181"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"[12] Miotti SM, Br\u00fchlmann C, Yalamanoglu A, Steiner UC, Meerwein CM, Soyka MB. Topical corticosteroids adherence in chronic rhinosinusitis with nasal polyps patients on Dupilumab. Rhinology, 2025, 63(4):510-512. https:\/\/doi.org\/10.4193\/Rhin25.102","DOI":"10.4193\/Rhin25.102"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"[13] Lourijsen ES, Fokkens WJ, Reitsma S. Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps. Rhinology, 2020, 58(3):213-217. https:\/\/doi.org\/10.4193\/Rhin19.468","DOI":"10.4193\/Rhin19.468"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"[14] Suh JD, Ramakrishnan V, Chiu AG. The role of topical therapies in the treatment of chronic rhinosinusitis. Braz J Otorhinolaryngol, 2011, 77(6):680-681. https:\/\/doi.org\/10.1590\/s1808-86942011000600001","DOI":"10.1590\/S1808-86942011000600001"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"[15] He CJ, Baker O, LaMonte O, Verpukhovskiy P, Chen Y, Wang H, Yan CH, DeConde AS. Determinants of medication adherence to Budesonide nasal irrigation in patients with chronic rhinosinusitis and allergic rhinitis. Int Forum Allergy Rhinol, 2025, 15(10):1164-1166. https:\/\/doi.org\/10.1002\/alr.70010","DOI":"10.1002\/alr.70010"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"[16] Tajudeen BA, Ganti A, Kuhar HN, Mahdavinia M, Heilingoetter A, Gattuso P, Ghai R, Batra PS. The presence of eosinophil aggregates correlates with increased postoperative Prednisone requirement. Laryngoscope, 2019, 129(4):794-799. https:\/\/doi.org\/10.1002\/lary.27693","DOI":"10.1002\/lary.27693"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"[17] Maniu AA, Perde-Schrepler MI, Tatomir CB, T\u0103nase MI, Dindelegan MG, Budu VA, R\u0103deanu GD, Cosgarea M, Mogoant\u0103 CA. Latest advances in chronic rhinosinusitis with nasal polyps endotyping and biomarkers, and their significance for daily practice. Rom J Morphol Embryol, 2020, 61(2):309-320. https:\/\/doi.org\/10.47162\/RJME.61.2.01\"","DOI":"10.47162\/RJME.61.2.01"}],"container-title":["Romanian Journal of Morphology and Embryology"],"original-title":[],"link":[{"URL":"https:\/\/rjme.ro\/RJME\/resources\/files\/670126139146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T23:01:37Z","timestamp":1784329297000},"score":1,"resource":{"primary":{"URL":"https:\/\/rjme.ro\/archive\/67\/1\/14\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,7,12]]},"published-print":{"date-parts":[[2026,7,12]]}},"URL":"https:\/\/doi.org\/10.47162\/rjme.67.1.14","relation":{},"ISSN":["1220-0522","2066-8279"],"issn-type":[{"value":"1220-0522","type":"print"},{"value":"2066-8279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}