Postoperative Oral Corticosteroid Use Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

Abstract

BackgroundPatients with chronic rhinosinusitis (CRS) refractory to medical management often require endoscopic sinus surgery (ESS). Oral corticosteroids (OCSs) are frequently prescribed postoperatively, but the evidence of their efficacy is limited.ObjectiveThe purpose of this study is to evaluate the efficacy of OCS use in patients with CRS following ESS.MethodsA systematic search was performed to identify studies examining the use of OCSs in patients undergoing ESS for CRS. The primary outcomes were sinonasal outcome test (SNOT) and Lund-Kennedy (LK) endoscopic scores. Secondary outcomes were visual analog scale (VAS) scores. Meta-analysis was conducted using a fixed effects model with a heterogeneity test via the I2 statistic.ResultsThe search yielded 1899 articles, and 22 were included in the qualitative analysis, 14 of which were randomized controlled trials with 793 total patients. OCS use differed based on type, dosage, and duration. Studies included in meta-analysis did not show a significant difference in SNOT (Standardized Mean Difference [SMD] -0.03, Confidence Interval [CI] -0.47-0.40, I2 0%), LK (SMD -0.20 CI -0.57-0.17 I2 58%), or VAS (SMD 0.19 CI -0.25-0.63 I2 54%) scores between steroid and non-steroid groups. Two studies that assessed OCSs in the allergic fungal rhinosinusitis (AFRS) subtype of CRS showed significant improvement in outcomes. Two additional studies examined OCS versus itraconazole in AFRS, with both groups showing improvement but neither one with greater significance.ConclusionThis study showed no significant difference in SNOT, LK, or VAS scores in patients with CRS who received OCSs following ESS. Given the limited number of studies in the analysis, further investigations are warranted before making recommendations.