Postoperative Oral Corticosteroid Use Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic...

Area of Science:

• Otolaryngology
• Rhinology
• Evidence-based medicine

Background:

• Chronic rhinosinusitis (CRS) often necessitates endoscopic sinus surgery (ESS) when medical management fails.
• Oral corticosteroids (OCSs) are commonly used post-ESS for CRS, but their effectiveness lacks robust evidence.

Purpose of the Study:

• To systematically evaluate the efficacy of postoperative oral corticosteroids (OCSs) in patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Main Methods:

• A systematic literature search identified relevant studies on OCS use post-ESS for CRS.
• Meta-analysis was performed on sinonasal outcome test (SNOT), Lund-Kennedy (LK) endoscopic, and visual analog scale (VAS) scores.
• Included studies were analyzed for OCS type, dosage, and duration, with a focus on randomized controlled trials.

Main Results:

• Meta-analysis of 14 randomized controlled trials (793 patients) revealed no significant difference in SNOT, LK, or VAS scores between OCS and non-OCS groups.
• Two studies indicated significant outcome improvements with OCSs specifically in the allergic fungal rhinosinusitis (AFRS) subtype of CRS.
• Comparisons of OCSs versus itraconazole in AFRS showed improvement in both groups, without statistically significant differences between them.

Conclusions:

• Postoperative OCS use does not demonstrate a significant benefit for overall CRS patients undergoing ESS based on SNOT, LK, and VAS scores.
• A potential benefit of OCSs may exist for the allergic fungal rhinosinusitis (AFRS) subtype, meriting further investigation.
• Additional research is required to establish definitive recommendations regarding OCS use following ESS for CRS.