Study on Oral Corticosteroids and Chronic Rhinosinusitis (CRS)

Oral corticosteroids are commonly used anti-inflammatory medications for chronic rhinosinusitis (CRS). In a recent study, researchers have found no use of oral corticosteroids after endoscopic sinus surgery (ESS) for chronic rhinosinusitis without polyps and, they also reported that it may be associated with worse psychologic outcomes. The study findings were published in the JAMA Otolaryngol Head Neck on March 04, 2021.

Although there is evidence supporting the use of oral corticosteroids for treating CRS with polyps, there remains a considerable knowledge gap concerning indications for oral corticosteroids in CRS without nasal polyps. Therefore, researchers of the Stanford University School of Medicine, California, conducted a study to assess the efficacy of oral corticosteroids following ESS in CRS without polyps.

It was a prospective double-blinded, placebo-controlled, randomized noninferiority trial of 72 patients with CRS without polyps undergoing ESS in a single academic tertiary rhinology practice. Researchers randomized patients into two treatment groups: a 12-day postoperative taper of oral prednisone (n=33) vs matched placebo tablets (n=39). The major outcomes assessed were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Researchers also assessed the treatment-related adverse effects.

Key Findings of the Study

• When comparing longitudinal differences between treatment groups, the researchers found no clinically meaningful difference observed in SNOT-22 total (F[4,254] = 1.71, η² = 0.01) or Lund-Kennedy scores (F[4,247] = 1.23, η² = 0.02).
• Similarly, in SNOT-22 subdomain analyses, they found no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains.
• Additionally, they noted that the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4,254] = 3.18, η² = 0.05).
• Reported adverse effects were similar between the two treatment groups.

The authors concluded, "In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery."

They further added, "These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered."

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