The role of immediate postoperative systemic corticosteroids when utilizing a steroid-eluting spacer following sinus surgery.
OBJECTIVE
Steroid-eluting spacers can improve local drug delivery immediately following endoscopic sinus surgery and reduce the recurrence of inflammation warranting systemic corticosteroids. For chronic rhinosinusitis with nasal polyposis, the need for systemic corticosteroids immediately following endoscopic sinus surgery when using a steroid-eluting spacer has not been studied.


METHODS
A randomized, double-blind, placebo-controlled trial.


METHODS
Academic rhinology practice.


METHODS
Chronic rhinosinusitis patients with nasal polyposis who failed medical therapy and elected endoscopic sinus surgery were enrolled. Patients were randomized into either the treatment arm (postoperative prednisone 30 mg daily × 7 days; n = 18) or placebo arm (postoperative placebo pill daily × 7 days; n = 18). Outcomes were evaluated at 1 week, 3 weeks, and 2 months postoperatively. Primary outcome was endoscopic grading at postoperative month 2 using the Lund-Kennedy system. Secondary outcome included disease-specific quality of life using the Sinonasal Outcome Test (SNOT-22) survey. Patient enrollment occurred from January 2012 through February 2013 (NCT01564355).


RESULTS
Both arms received significant improvement in endoscopic grading and disease-specific quality of life from baseline compared to 2-month follow-up (P < .001). There were no significant differences in mean endoscopic scores between the postoperative prednisone and control groups at 1 week (P = .715), 3 weeks (P = .883), or 2 months (P = .343). There were no significant differences in SNOT-22 scores between groups at all follow-up points (all P > .119).


CONCLUSIONS
Minimizing systemic corticosteroid use in patients with chronic rhinosinusitis with nasal polyposis may avoid adverse events. Results from this study suggest that postoperative systemic corticosteroids immediately following endoscopic sinus surgery may not provide improved outcomes when utilizing a steroid-eluting spacer.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Jon F
JF
Dautremont
Brad
B
Mechor
Luke
L
Rudmik
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage*; D012016:Reference Values; D012220:Rhinitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography
D011241:Prednisone
chronic rhinosinusitis; corticosteroid; middle meatal spacer; sinus surgery; sinusitis; topical steroid