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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(02): e286-e295
DOI: 10.1055/s-0042-1743275
Original Research

Sinonasal Outcomes Using Oral Corticosteroids in Patients with Chronic Rhinosinusitis with Nasal Polyps and Positive Sinonasal Cultures

Jhon F. Martinez-Paredes    #
1   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
2   Department of Surgery, University of Texas – Rio Grande Valley, Edinburg, Texas, United States
,
Angela M. Donaldson   #
1   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Michael Marino 
3   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
,
Garret Choby 
4   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Osarenoma Olomu 
1   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, United States
,
Razan Alfakir 
5   Department of Speech, Language & Hearing Sciences, Auburn University, Alabama, United States
,
Janalee K. Stokken
4   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Erin O'Brien 
4   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Devyani Lal 
3   Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, United States
› Author Affiliations Funding None.
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Abstract

Introduction Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and positive sinonasal bacterial cultures may be recalcitrant to topical therapy alone due to the additional local inflammatory burden associated with bacterial infection/colonization.

Objective To evaluate sinonasal outcomes in CRSwNP patients with a positive perioperative bacterial culture, who were treated with postoperative intranasal corticosteroids (INCS) alone versus INCS in combination with a short-term course of oral corticosteroids (OCS).

Methods This is a retrospective chart review of CRSwNP patients. A total of 59 patients met inclusion criteria, including positive perioperative bacterial culture and treatment with INCS with or without concomitant use of OCS. Two cohorts were formed based on the chosen postoperative medical treatment; 32 patients underwent postoperative INCS alone, while 27 underwent INCS plus a ≤ 2-week course of OCS. The 22-item sinonasal outcome test (SNOT-22) scores and Lund-Kennedy scores (LKS) were assessed preoperatively, and at 2-week, 4-week, and 4 to 6 months after endoscopic sinus surgery (ESS).

Results There were no statistically significant differences in postoperative sinonasal symptoms or endoscopic scores between the cohorts treated with INCS plus OCS versus those prescribed INCS alone (p > 0.05). Our regression model failed to demonstrate a relationship between the use of OCS and better sinonasal outcomes at 2-week, 4-week, and 4 to 6 months after ESS (p > 0.05).

Conclusion Our study suggests that in a cohort of CRSwNP patients with recent bacterial infections, the postoperative use of combined OCS and INCS did not result in a statistical improvement of endoscopic and symptomatic outcomes over INCS irrigation alone. However, both treatment groups had a clinically significant improvement based on the Minimal Clinically Important Difference.

Keywords

chronic rhinosinusitis with nasal polyps - corticosteroids - culture - 22-item sinonasal outcome test - endoscopic sinus surgery

# First author co-authorship. Both authors have contributed equally and are listed in increasing order of seniority.




Publication History

Received: 14 May 2021

Accepted: 21 December 2021

Article published online:
19 December 2022

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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