Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis.

BACKGROUND: Recently, topical steroid therapy delivery using high-volume sinonasal irrigations has been used more frequently, following endoscopic sinus surgery (ESS), to improve drug delivery into the paranasal sinuses. OBJECTIVE: The goal of this study was to perform a systematic review with meta-analysis of the efficacy of steroid nasal irrigation on postoperative management of CRS following ESS. METHODS: Five databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to March 2017 were independently reviewed by two researchers. Studies that scored CRS endoscopic findings and CRS-related quality of life postoperatively before and after steroid nasal irrigation, and that compared the effects of steroid nasal irrigation (treatment groups) with saline alone irrigation (control group) were included in the analysis. RESULTS: Twelve studies (n=360) met inclusion criteria. Steroid nasal irrigation significantly reduced the endoscopic score compared with pretreatment values and also improved quality of life. Adverse effects following steroid nasal irrigation such as increased intraocular pressure and hypothalamus-pituitary-adrenal axis disturbance were not significant. However, compared with saline alone irrigation, the additional effects of steroid irrigation were not significant in the view of the endoscopic score and disease-specific quality of life. CONCLUSION: Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regards to endoscopic score and CRS-related quality of life improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study. This article is protected by copyright. All rights reserved.