Corticosteroid nasal irrigations after endoscopic sinus surgery in the management of chronic rhinosinusitis

Abstract

The philosophical approach to ESS in CRS is evolving. Topical therapies, when used appropriately, are highly effective for the most challenging eosinophilic patients. Although corticosteroid is a nonspecific therapy, it is effective when appropriately delivered.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Three article addressing the use of corticosteroid/saline sinus irrigations met inclusion criteria, all prospective cohort studies. In the largest study to date, Snidvongs et al 719 published a prospective cohort of 111 patients, 49 of whom had a diagnosis of CRSsNP (analyzed separately). Treatment was with once-daily nasal irrigations of 1 mg budesonide/betamethasone in 240 mL of normal saline in the immediate postoperative period.…”

“…In the included studies, dosage varied from 128 μg to 1 mg. One study used either budesonide or beclomethasone, also 1 mg but the percentage of patients using 1 or the other is not given. 719 The volume of saline ranged from 5 to 240 mL or was not stated. For 4 trials all or most of the patients had undergone sinus surgery immediately prior to the administration of the corticosteroid or had undergone surgery in the past.…”

The Effectiveness of Budesonide Nasal Irrigation After Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Asthma

“…The off-label use of budesonide irrigation is being rapidly accepted by physicians, and the safety and efficiency of the irrigation is also being confirmed [1,2,[4][5][6][7][8]. Sachanandani et al [6] applied irrigation to the nasal cavities of 0.5 mg/respule once a day for 30 days, and the subjects showed significant clinical improvement.…”

“…Recently, delivery of steroid in a large volume by nasal irrigation with high pressure mechanism has been recommended as a better option for treating chronic sinus mucosal inflammation than using a low volume with low pressure [4]. A post-sinus surgery corridor is essential especially for long-term treatment of recalcitrant CRS, to permit exposure of the drug to the mucosa, since the nasal irrigation solution can be successfully delivered via such a corridor [2]. The off-label use of budesonide nasal irrigation was introduced recently for postoperative management of patients with CRS.…”

“…The off-label use of budesonide nasal irrigation was introduced recently for postoperative management of patients with CRS. The safety and effectiveness of this procedure is becoming accepted by many physicians [2,[5][6][7][8]. The objective of this study was to figure out if budesonide nasal irrigation could reduce the repeated use of oral steroid in recalcitrant CRS patients with asthma.…”