Background: Nasal polyposis is an inflammatory disease of unknown etiology. This study aimed to evaluate the effect of a short course of oral prednisone followed by intranasal budesonide on nasal symptoms, polyp size, nasal flow, and computed tomography scan.

Methods: Eighty‐four patients with severe nasal polyps were included. After a steroid washout period, patients were randomized into two groups: group A (n = 63) received oral prednisone for 2 weeks and group B (n = 21) did not receive any steroid treatment. Patients from group A received intranasal budesonide for 12 weeks.

Results: Atopy was positive in 36.8% of patients. Blood eosinophilia was higher in asthmatic (7.2 ± 0.7%, P < .05) than in nonasthmatic (3.0 ± 0.4%) patients. Asthmatic patients showed higher scores on nasal obstruction and loss of smell than nonasthmatics. Oral steroids caused a significant improvement in all nasal symptoms and improved polyp size (2.1 ± 0.1, P < .05) and nasal flow (560 ± 35 cm³/s, P < .05) compared with nontreated patients (2.8 ± 0.1 and 270 ± 34 cm³/s, respectively). Intranasal budesonide maintained the improvement on nasal symptoms, polyp size, and nasal flow. Steroid treatment reduced the computed tomography scan score (15.4 ± 1, P < .05) compared with before treatment (18.2 ± 0.8).

Conclusion: A short course of oral steroids improved all nasal symptoms, polyp size, and nasal flow, whereas intranasal steroid maintain this effect.