Management of rhinosinusitis during pregnancy: systematic review and expert panel recommendations

Abstract

Background: Management of rhinosinusitis during pregnancy requires special considerations. Objectives: 1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations. Methods: The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea. Results: Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations. Conclusions: The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.

Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review

“…Currently, there exists a paucity of literature regarding pregnancy‐induced rhinitis (PIR), especially management. A systematic review on rhinosinusitis management during pregnancy noted this gap and offered an expert panel review of opinions 69 . PIR can lead to nasal obstruction and other manifestations that can contribute to a patient's lack of sleep and obstructive sleep apnea, which, in turn, have several complications such as maternal hypertension, preeclampsia, and growth retardation of the baby 70–74 .…”

“…A systematic review on rhinosinusitis management during pregnancy noted this gap and offered an expert panel review of opinions. 69 PIR can lead to nasal obstruction and other manifestations that can contribute to a patient's lack of sleep and obstructive sleep apnea, which, in turn, have several complications such as maternal hypertension, preeclampsia, and growth retardation of the baby. [70][71][72][73][74] It is, therefore, important to explore the pathophysiology behind PIR and gather additional evidence-based data for management recommendations.…”

Otolaryngology and the Pregnant Patient

“…21 In-office procedures, such as polypectomy, balloon sinuplasty, and turbinate surgery, may be considered under local anesthesia, but elective endoscopic sinus surgery for CRS exacerbations, polyposis, or recurrent ARS should be deferred. 20…”

Management of allergic diseases in pregnancy

“…Specifically, CRS with nasal polyps is a Type 2 inflammatory disorder of the paranasal sinuses and linings of the nasal passages, which can aggravate during pregnancy. Therefore, accurate management is crucial to avoid asthma exacerbations 48 . Treatment during pregnancy is similar to the non‐pregnant population, and the use of add‐on therapy with biologicals (omalizumab and dupilumab) for CRS with nasal polyps (CRSwNP) during pregnancy is described below.…”

“…The most important steps to treat allergic rhinitis are trigger avoidance and treatment with the appropriate medications: nasal corticosteroids and antihistamines, combinations thereof, and oral antihistamines. Chronic rhinosinusitis (CRS) is a prevalent disease, and women are more often affected than men 47,48 . Specifically, CRS with nasal polyps is a Type 2 inflammatory disorder of the paranasal sinuses and linings of the nasal passages, which can aggravate during pregnancy.…”