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Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations.

Abstract

BACKGROUND
Oral steroids are commonly used in the management of chronic rhinosinusitis (CRS) with and without nasal polyps (CRSwNP and CRSsNP, respectively). Past reports have included evaluation of the evidence for the use of oral steroids in CRS subtypes. However, a review with evidence-based recommendations for all CRS subtypes has never been performed. The purpose of this article is to provide a comprehensive, evidence-based approach for the utilization of oral steroids in the management of CRS.
METHODS
A systematic review of the literature was performed following recommendations of the Clinical Practice Guideline Manual, Conference on Guideline Standardization, and Appraisal of Guidelines and Research Evaluation. Inclusion criteria were: adult population ≥ 18 years old; CRS; oral steroids as the treatment group; and clearly defined primary clinical end-point.
RESULTS
This review identified and evaluated the literature on the use of oral steroids for CRSwNP, CRSsNP, allergic fungal sinusitis (AFS), and the use of oral steroids in the perioperative period in these patients. Recommendations based on evidence, benefit/harm assessment, and value judgments are made.
CONCLUSION
Oral steroids are strongly recommended for short-term management of CRSwNP. Oral steroids are also recommended for management of AFS. Oral steroid use in CRSsNP is optional due to insufficient strong evidence. Oral steroids are also strongly recommended in the perioperative period for CRSwNP and AFS. There is no recommendation for oral steroids use in the perioperative period in patients with CRSsNP. The risks of oral steroids are rare, but significant adverse effects must be considered.

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    • Authors

    Poetker DM, Jakubowski LA, Lal D, Hwang PH, Wright ED, Smith TL

    Institution

    Division of Otolaryngology, Department of Surgery, Zablocki VA Medical Center, Milwaukee, WI, USA.

    Source

    International forum of allergy & rhinology 3:2 2013 Feb pg 104-20

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22887970