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


CONCLUSIONS
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.
Division of Otolaryngology, Department of Surgery, Zablocki VA Medical Center, Milwaukee, WI, USA.
David M
DM
Poetker
Luke A
LA
Jakubowski
Devyani
D
Lal
Peter H
PH
Hwang
Erin D
ED
Wright
Timothy L
TL
Smith
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D002908:Chronic Disease; D019317:Evidence-Based Medicine; D006801:Humans; D009298:Nasal Polyps / Q000188:drug therapy*; D012220:Rhinitis / Q000188:drug therapy* / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones