Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

Abstract

PurposeTo analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome.Materials and MethodsWe performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade.ResultsThere was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611).ConclusionLow dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

Response to Glucocorticosteroids Predicts Olfactory Outcome After ESS in Chronic Rhinosinusitis

“…Whether and how much CRS patients may benefit from steroids also seems dependent on CRS endotype with characteristics such as eosinophilia and the presence of nasal polyps. In general, it could be shown that several types of CRS; for example, CRS with a high degree of eosinophilia seem to have less benefit from ESS in general, although they seem to have higher benefit from preoperative glucocorticosteroid administration compared to other CRS types . Also a meta‐analysis failed to reveal significant differences in postoperative symptom score between steroid and nonsteroid groups of CRSwNP patients …”

Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine

“…Multiple methods have been described to improve visualization and decrease bleeding including use of total intravenous anesthesia [6,7], local infiltration with epinephrine [11], topical decongestants [12], head of bed elevation [5], warm water irrigation [13], greater palatine canal injection with epinephrine [14], and preoperative oral steroid therapy [4]. Recent data demonstrating the safety of concentrated topical epinephrine indicates that it is safe, minimizes blood loss and potentially obviates the need for oral steroid use [8].…”

“…While corticosteroids have long been a mainstay of therapy, concern over their significant possible side effects has catalyzed the proliferation of topical [2] and implantable formulations [3]. Despite this, the use of preoperative systemic steroids has persisted with the assumption that reducing inflammation will result in less operative bleeding and improved surgical times [4]. …”

“…The current literature supporting the use of preoperative oral steroids is conflicting suggesting that this practice should be reexamined [4]. Furthermore, there has been concurrent progress in adjunctive intraoperative techniques to reduce bleeding including head positioning [5], the use of total intravenous anesthesia [6,7], and the use of powerful topical vasoconstrictive agents.…”

Short-term pre-operative systemic administration with low-dose of steroid does not make a false-negative diagnosis of definite eosinophilic chronic rhinosinusitis after endoscopic sinus surgery

“…According to JESREC diagnostic criteria, definite ECRS is diagnosed after ESS, based on the histological findings of more than 70 eosinophils in high power magnification fields of the resected nasal polyps. But, it was reported that systemic administration with steroid decreased the number of eosinophils in the nasal polyps in patients with CRS with nasal polyps (9). Therefore, there is a risk that preoperative systemic administration with steroid makes a false negative diagnosis of definite ECRS in patients with probable ECRS after ESS.…”