Lack of additive benefit of oral steroids on short‐term postoperative outcomes in nasal polyposis

Abstract

Objectives: There is a lack of evidence concerning the efficacy of oral corticosteroids (OCS) as a postoperative treatment for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The objective of our study was to determine the shortterm additive benefit of postoperative OCS in CRSwNP patients. Methods: We prospectively randomized CRSwNP patients who were treated by endoscopic sinus surgery. All patients were resistant to maximum medical treatment according to European position paper on rhinosinusitis and nasal polyps 2012 guidelines. Treatment group received postoperative OCS in descending doses plus nasal douching over a period of 4 weeks, whereas the control group received only nasal douching. The efficacy of OCS was determined by a total 5 item symptoms score (T5SS), polyp size score, Barcelona Smell Test 24 and Medical Outcome Study Short Form-36 questionnaire for quality of life (QoL). Results: Of the 70 enrolled patients, 35 were in the treatment group and 35 in the control group. After 4 weeks of follow-up, patients from both groups improved in T5SS, QoL, endoscopic findings (except for crusts that increased in both) and sense of smell, without significant differences between OCS and control groups. Conclusion: Postoperative OCS as an add-on treatment for CRSwNP patients does not improve sinonasal and QoL outcomes; thus, they should not be routinely recommended.

Effect of postoperative systemic prednisolone on short-term and long-term outcomes in chronic rhinosinusitis with nasal polyps: A multi-centered randomized clinical trial

“…However, this effect had diminished at a follow-up time of 10-12 weeks. Previous randomized controlled studies that directly examined the postoperative effect on systemic steroids were conducted by Shen et al, 2019 ( 13 ), Dautremont et al, 2014 ( 12 ), Arancibia et al, 2020 ( 11 ) and Chang et al, 2021 ( 14 ).…”

“…Arancibia et al ( 11 ), included n=70 CRSwNP patients into their trial. A total of n=35 patients were randomized to topical steroids via nasal douching plus an oral steroid taper, n=35 patients were randomized to the control group and received only nasal douching.…”

Yardstick for the medical management of chronic rhinosinusitis

“…66,69 There were 2 recent studies that evaluated the utility of postoperative OCS. Arancibia et al 70 performed surgery on a group of patients with CRSwNP and then randomized them to a tapering course of prednisone or placebo for 4 weeks accompanied by nasal saline douching. Both groups had substantial improvements in symptoms, endoscopic scores, smell, and QOL 4 weeks after surgery irrespective of OCS intake.…”

Perspectives in Therapy of Chronic Rhinosinusitis

“…Various doses of OCS, from 15 mg to 1 mg/kg daily, are used perioperatively and clinical trials are needed to determine the optimal dose [ 76 ]. Postoperative OCS as an add-on treatment for CRS should not be routinely recommended [ 77 , 78 ]. It was observed that a short course of OCS is more effective than INCS in eCRSsNP [ 79 ].…”