title: The use of postoperative topical corticosteroids in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis.
abstract: BACKGROUND
  Topical intranasal corticosteroids (INCSs) are used to control disease symptoms in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). The evidence to recommend INCSs as part of the postoperative care is limited. This study was designed to assess the efficacy of INCSs in the postoperative care of patients undergoing functional endoscopic sinus surgery (FESS) during the 1st year postoperatively.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (1995 to May 2012), MEDLINE (January 1948 to May 2012), EMBASE (January 1980 to May 2012), and the reference lists of articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Randomized controlled trials (RCT) and cohort studies comparing INCSs with placebo or comparing different types of INCSs were included.
  
  
  RESULTS
  Eleven studies (n = 945 patients) were RCTs and one prospective cohort study (n = 32 patients). As measured by the standardized mean difference (SMD) INCSs had a beneficial effect on symptom scores (SMD, -1.35; 95% CI, -2.05 to -0.64; p = 0.0002; 3 trials; 137 patients) and polyp score (SMD, 0.53; 95% CI, -0.91 to -0.14; p = 0.007; 5 trials; 223 patients). Compared with placebo, the use of INCSs decreased the odds of polyp recurrence (odds ratio, 0.17; 95% CI, 0.06-0.51; p = 0.002; 2 trials; 74 patients). Two RCTs (n = 105) and one cohort study (n = 32) reported normal adrenocorticotropic hormone levels postintervention.
  
  
  CONCLUSIONS
  INCS use is a safe therapy in postoperative management of CRSwNP patients. INCS showed significant improvement in polyp score, patients' symptoms and significant decrease in polyp recurrence in the first year postoperatively.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marcela
authors.initials: M
authors.lastname: Fandiño
authors.forename: Kristian I
authors.initials: KI
authors.lastname: Macdonald
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Witterick
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000818:Animals; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004724:Endoscopy; D006801:Humans; D009298:Nasal Polyps / Q000188:drug therapy* / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D011182:Postoperative Care; D012008:Recurrence; D012220:Rhinitis / Q000188:drug therapy* / Q000601:surgery; D012852:Sinusitis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones